Bill Text: NY A02018 | 2025-2026 | General Assembly | Introduced
Bill Title: Repeals managed long term care provisions for Medicaid recipients; establishes provisions for fully integrated plans for long term care including PACE and MAP plans.
Spectrum: Partisan Bill (Democrat 45-1)
Status: (Introduced) 2025-01-14 - referred to health [A02018 Detail]
Download: New_York-2025-A02018-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2018 2025-2026 Regular Sessions IN ASSEMBLY January 14, 2025 ___________ Introduced by M. of A. PAULIN, SHRESTHA, CLARK, ROSENTHAL, LEVENBERG, GALLAGHER, R. CARROLL, SHIMSKY, SIMON, DINOWITZ, SANTABARBARA, STECK, EACHUS, LUPARDO, EPSTEIN, BICHOTTE HERMELYN, KELLES, MAMDANI, WEPRIN, GIBBS, REYES, GONZALEZ-ROJAS, TAPIA, FORREST, SEAWRIGHT, COLTON, BRAUNSTEIN, MEEKS, BRONSON, CONRAD, BURDICK, KIM, HUNTER, SIMONE, DE LOS SANTOS, MITAYNES, TAYLOR, ALVAREZ, BENEDETTO, DAVILA, SAYEGH, ZINERMAN, HYNDMAN, RAGA, ANDERSON, McDONOUGH -- read once and referred to the Committee on Health AN ACT to amend the public health law, the social services law, the elder law and the mental hygiene law, in relation to long term care options; and to repeal certain provisions of the public health law relating to managed long term care The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Legislative intent. The state, as part of an ambitious 2 effort to move all Medicaid recipients to some form of managed care, 3 moved those in need of home and community-based long term care services 4 for over a one hundred twenty day period into managed long term care 5 plans on a mandatory basis over ten years ago. The original intent of 6 the MLTC program was that the managed long term care plans would develop 7 into fully capitated plans over time. This has not happened. 8 Therefore, it is the intent of the legislature to repeal the partially 9 capitated managed long term care program and instead, provide appropri- 10 ate home and community-based long term care benefits under a fee-for- 11 service arrangement. Fully capitated programs such as the PACE program 12 shall continue to be an option. This transition shall not be implemented 13 until the commissioner of health is satisfied that all necessary and 14 appropriate transition planning has occurred, and federal approvals have 15 been obtained. 16 § 2. Section 4403-f of the public health law is REPEALED and a new 17 section 4403-f is added to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05134-01-5A. 2018 2 1 § 4403-f. Long term care options. 1. The following words or phrases, 2 as used in this section, shall have the following meanings: 3 (a) "Program of all-inclusive care of the elderly" or "PACE" means a 4 fully capitated federally recognized model of comprehensive care for 5 persons fifty-five years of age or older that are eligible for medicaid 6 and may also be eligible for Medicare, qualifying for nursing home 7 levels of care who wish to remain in their community (see, Sections 1894 8 and 1934 to Title XVIII of the Social Security Act; 42 CFR 460), which 9 are licensed to operate under article twenty-nine-ee of this chapter. 10 (b) "Medicaid advantage plus program" or "MAP" means a fully capitated 11 state developed model of comprehensive care for persons eighteen years 12 of age or older that are eligible for Medicaid and also eligible for 13 medicare, qualifying for nursing home levels of care. 14 (c) "Care coordination entity" means an entity that has obtained 15 approval from the commissioner based on guidelines established by the 16 department to promote continuity of care and coordination of services 17 for all enrollees. The entity may be organized as a health home 18 specially certified by the commissioner to serve home and community- 19 based services eligible recipients, but this shall not preclude other 20 organizational structures as determined by the commissioner. 21 2. The commissioner shall submit the appropriate waivers, including 22 but not limited to those authorized pursuant to sections eleven hundred 23 fifteen and nineteen hundred fifteen of the federal social security act 24 or successor provisions, and any other waivers necessary to require on 25 or after April first, two thousand twenty-eight, medical assistance 26 recipients who are eighteen years of age or older and who require long 27 term care services, as specified by the commissioner, for a continuous 28 period of more than one hundred twenty days, to receive such services 29 through an available fully integrated plan including a PACE or MAP plan, 30 or through a fee-for-service based model with services coordinated by a 31 care coordination entity. The commissioner shall establish guidelines on 32 the establishment and operation of care coordination entities. Such 33 guidelines shall address the payment methods that ensure provider 34 accountability for cost effective quality outcomes. Copies of such waiv- 35 er applications and amendments thereto shall be provided to the chairs 36 of the senate finance committee, the assembly ways and means committee 37 and the senate and assembly health committees before their submission to 38 the federal government. 39 3. Persons that are determined eligible to receive long term care 40 services through PACE or MAP, or through a fee-for-service based model 41 with services coordinated by a care coordination entity established 42 pursuant to subdivision two of this section shall have at least thirty 43 days to select a PACE or MAP provider, or care coordination entity and 44 shall be provided with information to make an informed choice. Where a 45 participant has not selected such a provider or care coordination enti- 46 ty, the commissioner shall assign such participant to a care coordi- 47 nation entity taking into account consistency with any prior community- 48 based direct care workers having recently served the recipient, quality 49 performance criteria, capacity and geographic accessibility. 50 § 3. Subdivision 2 of section 365-a of the social services law is 51 amended by adding two new paragraphs (nn) and (oo) to read as follows: 52 (nn) The department shall promulgate regulations for all Medicaid 53 enrollees receiving services through a fee-for-service model pursuant to 54 section forty-four hundred three-f of the public health law that include 55 the establishment and operation of care coordination entities to promote 56 continuity of care and coordination of services to ensure that eachA. 2018 3 1 enrollee has an ongoing source of care appropriate to their needs as 2 required by 42 CFR § 438.208. The regulations shall include conflict- 3 free case management protections to ensure that assessment and coordi- 4 nation of services are separate from the delivery of those services. In 5 selecting providers of case management services, the department shall 6 prioritize providers with proven experience serving populations receiv- 7 ing home and personal care services. 8 (oo) The department shall conduct an evaluation of the viability of 9 utilizing care coordination entities operating pursuant to this section 10 for assessments or reassessments required for determining an individ- 11 ual's needs for services that are controlled by the independent assessor 12 established pursuant to subdivision ten of section three hundred sixty- 13 five-a of this title. 14 § 4. Stakeholder engagement. 1. The commissioner of health shall 15 convene an advisory group composed of stakeholder representatives which 16 shall seek input from representatives of home and community-based long 17 term care services providers, including representative associations, 18 recipients, the department of health, local social services districts, 19 and the direct care workforce, among others, to: 20 (a) further evaluate and promote the transition of persons in receipt 21 of home and community-based long term care services into fee-for-service 22 arrangements, where appropriate, and to develop guidelines for such 23 care; and 24 (b) determine a process to transition providers, including but not 25 limited to licensed home care services agencies, certified home health 26 agencies, and fiscal intermediaries, to a fee-for-service reimbursement 27 system. 28 2. In implementing the transition to a fee-for-service model the 29 commissioner of health, in consultation with the advisory group, shall, 30 to the extent practicable, consider and select programs and policies 31 that seek to maximize continuity of care and minimize disruption to the 32 provider labor workforce, and shall continue to support providers, 33 licensed home care services agencies, and fiscal intermediaries that are 34 based on a commitment to quality and value; provided that nothing in 35 this subdivision shall supersede or invalidate any contracts or awards 36 provided to fiscal intermediaries pursuant to subdivision 4-a of section 37 365-f of the social services law, provided that the provisions of subdi- 38 vision 4-b of section 365-f of the social services law shall still 39 apply, or contracts or awards provided to licensed home care services 40 agencies pursuant to section 3605-c of the public health law. 41 3. The commissioner of health shall report biannually on the implemen- 42 tation of this section. The reports shall include, but not be limited 43 to: (a) satisfaction of enrollees with care coordination/case management 44 and timeliness of care; (b) service utilization data including changes 45 in the level, hours, frequency, and types of services and providers; (c) 46 enrollment data; (d) quality data; and (e) continuity of care for 47 participants as they move out of managed long term care and into the 48 fee-for-service model. The commissioner shall publish the report on the 49 department's website and provide notice to the temporary president of 50 the senate, the speaker of the assembly, the chair of the senate stand- 51 ing committee on health and the chair of the assembly health committee. 52 4. The commissioner of health shall seek input from representatives of 53 home and community-based long term care services providers, recipients, 54 and the Medicaid managed care advisory review panel, among others, to 55 assist in the development of guidelines for the establishment and opera- 56 tion of care coordination entities pursuant to section 4403-f of theA. 2018 4 1 public health law. The guidelines shall be finalized and posted on the 2 department of health's website no later than November first, two thou- 3 sand twenty-seven. 4 § 5. Paragraph (o) of subdivision 2 of section 365-a of the social 5 services law, as added by chapter 659 of the laws of 1997, is amended to 6 read as follows: 7 (o) care and services furnished by a [managed long term care plan or8approved managed long term care demonstration pursuant to the provisions9of] PACE or MAP plan as such terms are defined by section forty-four 10 hundred three-f of the public health law to eligible individuals [resid-11ing in the geographic area] served by such entity, when such services 12 are furnished in accordance with an agreement with the department of 13 health and meet the applicable requirements of federal law and regu- 14 lation. 15 § 6. Subparagraph (iii) of paragraph (e) of subdivision 2 of section 16 365-a of the social services law, as amended by section 36-a of part B 17 of chapter 57 of the laws of 2015, is amended to read as follows: 18 (iii) the commissioner shall provide assistance to persons receiving 19 services under this paragraph who are transitioning to receiving care 20 from a [managed long term care plan certified pursuant to] PACE or MAP 21 plan as such terms are defined by section forty-four hundred three-f of 22 the public health law, consistent with subdivision thirty-one of section 23 three hundred sixty-four-j of this title; 24 § 7. Subdivision 10 of section 365-a of the social services law, as 25 amended by section 1 of part QQ of chapter 57 of the laws of 2022, is 26 amended to read as follows: 27 10. The department of health shall establish or procure the services 28 of an independent assessor or assessors no later than October 1, 2022, 29 in a manner and schedule as determined by the commissioner of health, to 30 take over from local departments of social services[,] and Medicaid 31 Managed Care providers, [and Medicaid managed long term care plans] 32 including a MAP plan, or a PACE plan if the PACE plan elects to utilize 33 the independent assessor as such terms are defined by section forty-four 34 hundred three-f of the public health law, the performance of assessments 35 and reassessments required for determining individuals' needs for 36 personal care services, including as provided through the consumer 37 directed personal assistance program, and other services or programs 38 available pursuant to the state's medical assistance program as deter- 39 mined by such commissioner for the purpose of improving efficiency, 40 quality, and reliability in assessment [and to determine individuals'41eligibility for Medicaid managed long term care plans]. Notwithstanding 42 the provisions of section one hundred sixty-three of the state finance 43 law, or sections one hundred forty-two and one hundred forty-three of 44 the economic development law, or any contrary provision of law, 45 contracts may be entered or the commissioner may amend and extend the 46 terms of a contract awarded prior to the effective date and entered into 47 to conduct enrollment broker and conflict-free evaluation services for 48 the Medicaid program, if such contract or contract amendment is for the 49 purpose of procuring such assessment services from an independent asses- 50 sor. Contracts entered into, amended, or extended pursuant to this 51 subdivision shall not remain in force beyond September 30, 2025. 52 § 8. Paragraph (d) of subdivision 1 and paragraph (h) of subdivision 3 53 of section 218 of the elder law, as amended by section 1 of chapter 259 54 of the laws of 2018, are amended to read as follows: 55 (d) "Long-term care facilities" shall mean residential health care 56 facilities as defined in subdivision three of section twenty-eightA. 2018 5 1 hundred one of the public health law; adult care facilities as defined 2 in subdivision twenty-one of section two of the social services law, 3 including those adult homes and enriched housing programs licensed as 4 assisted living residences, pursuant to article forty-six-B of the 5 public health law; or any facilities which hold themselves out or adver- 6 tise themselves as providing assisted living services and which are 7 required to be licensed or certified under the social services law or 8 the public health law. Within the amounts appropriated therefor, "long- 9 term care facilities" shall also mean [managed long-term care plans and10approved managed long-term care or operating demonstrations] a PACE or 11 MAP plan as such terms are defined in section forty-four hundred three-f 12 of the public health law and the term "resident", "residents", "patient" 13 and "patients" shall also include enrollees of such plans. 14 (h) Within the amounts appropriated therefor, the state long-term care 15 [ombudsman] ombudsperson program shall include services specifically 16 designed to serve persons enrolled in [managed long-term care plans or17approved managed long-term care or operating demonstrations authorized18under] a PACE or MAP plan as such terms are defined by section forty- 19 four hundred three-f of the public health law, and shall also review and 20 respond to complaints relating to marketing practices by such plans and 21 demonstrations. 22 § 9. Subdivisions (a), (c), (d), (f), the opening paragraph of subdi- 23 vision (g) and subdivision (h) of section 13.40 of the mental hygiene 24 law, subdivisions (a), (d), (f) and the opening paragraph of subdivision 25 (g) as added by section 72-b of part A of chapter 56 of the laws of 26 2013, subdivision (c) as amended by section 17 of part Z of chapter 57 27 of the laws of 2018, and subdivision (h) as added by section 1 of part D 28 of chapter 58 of the laws of 2014, are amended to read as follows: 29 (a) The commissioner and the commissioner of health shall jointly 30 establish a people first waiver program for purposes of developing a 31 care coordination model that integrates various long-term habilitation 32 supports and/or health care. The people first waiver program shall 33 include the use of developmental disability individual support and care 34 coordination organizations, herein referred to as DISCOs, pursuant to 35 section forty-four hundred three-g of the public health law, health 36 maintenance organizations, herein referred to as HMOs, providing 37 services under subdivision eight of section forty-four hundred three of 38 the public health law, and [managed] long term care [plans, herein39referred to as MLTCs] options, providing or coordinating services under 40 [subdivisions twelve, thirteen and fourteen of] section forty-four 41 hundred three-f of the public health law. Services shall be provided as 42 described in section forty-four hundred three-g of the public health 43 law, subdivision eight of section forty-four hundred three of the public 44 health law, and [subdivisions twelve, thirteen and fourteen of] section 45 forty-four hundred three-f of the public health law. 46 (c) No person with a developmental disability who is receiving or 47 applying for medical assistance and who is receiving, or eligible to 48 receive, services operated, funded, certified, authorized or approved by 49 the office, shall be required to enroll in a DISCO, HMO or [MLTC] long 50 term care option in order to receive such services until program 51 features and reimbursement rates are approved by the commissioner and 52 the commissioner of health, and until such commissioners determine that 53 a sufficient number of plans that are authorized to coordinate care for 54 individuals pursuant to this section or that are authorized to operate 55 and to exclusively enroll persons with developmental disabilities pursu- 56 ant to subdivision twenty-seven of section three hundred sixty-four-j ofA. 2018 6 1 the social services law are operating in such person's county of resi- 2 dence to meet the needs of persons with developmental disabilities, and 3 that such entities meet the standards of this section. No person shall 4 be required to enroll in a DISCO, HMO or [MLTC] long term care option in 5 order to receive services operated, funded, certified, authorized or 6 approved by the office until there are at least two entities operating 7 under this section in such person's county of residence, unless federal 8 approval is secured to require enrollment when there are less than two 9 such entities operating in such county. Notwithstanding the foregoing or 10 any other law to the contrary, any health care provider: (i) enrolled in 11 the Medicaid program and (ii) rendering hospital services, as such term 12 is defined in section twenty-eight hundred one of the public health law, 13 to an individual with a developmental disability who is enrolled in a 14 DISCO, HMO or [MLTC] long term care option, or a prepaid health services 15 plan operating pursuant to section forty-four hundred three-a of the 16 public health law, including, but not limited to, an individual who is 17 enrolled in a plan authorized by section three hundred sixty-four-j [or] 18 of the social services law, shall accept as full reimbursement the nego- 19 tiated rate or, in the event that there is no negotiated rate, the rate 20 of payment that the applicable government agency would otherwise pay for 21 such rendered hospital services. 22 (d) DISCOs, HMOs and [MLTCs] long term care options operating under 23 this section shall ensure, to the greatest extent practicable, that 24 their assessment, services, and the grievance and appeals processes are 25 culturally and linguistically competent. 26 (f) There shall be a joint advisory council chaired by the commission- 27 er and the commissioner of health that shall be charged with advising 28 both commissioners in regard to the oversight of DISCOs, HMOs providing 29 services under subdivision eight of section forty-four hundred three of 30 the public health law, and [MLTCs] long term care options providing 31 services under [subdivisions twelve, thirteen and fourteen of] section 32 forty-four hundred three-f of the public health law. The joint advisory 33 council may be comprised of the members of existing advisory councils or 34 similar entities serving the office, provided that it shall be comprised 35 of twelve members, including individuals with developmental disabili- 36 ties, family members of, advocates for, and providers of services to 37 people with developmental disabilities. Three members of the joint advi- 38 sory council shall also be members of the special advisory review panel 39 on medicaid managed care established under section three hundred sixty- 40 four-jj of the social services law. The joint advisory council shall 41 review all managed care options provided to individuals with develop- 42 mental disabilities, including: the adequacy of habilitation services; 43 the record of compliance with person-centered planning, person-centered 44 services and community integration; the adequacy of rates paid to 45 providers in accordance with the provisions of [paragraph one of subdi-46vision four of] section forty-four hundred three of the public health 47 law, paragraph [a-two] (a-2) of subdivision eight of section forty-four 48 hundred three of the public health law or [paragraph a-two of subdivi-49sion twelve of] section forty-four hundred three-f of the public health 50 law; and quality of life, health, safety and community integration of 51 individuals with developmental disabilities enrolled in managed care. 52 The commissioner and commissioner of the office for people with develop- 53 mental disabilities or their designees shall attend all meetings of the 54 joint advisory council. The joint advisory council shall report its 55 findings, recommendations, and any proposed amendments to pertinent 56 sections of the law to the commissioner and the commissioner of health,A. 2018 7 1 the senate majority leader and speaker of the assembly. The joint advi- 2 sory council shall have access to any and all information that may be 3 lawfully disclosed to it and that is necessary to perform its functions 4 under this section. 5 Notwithstanding any inconsistent provision of sections one hundred 6 twelve and one hundred sixty-three of the state finance law, or section 7 one hundred forty-two of the economic development law, or any other law 8 to the contrary, the commissioner and the commissioner of health are 9 authorized to enter into a contract or contracts under section forty- 10 four hundred three-g of the public health law, subdivision eight of 11 section forty-four hundred three of the public health law, and [subdivi-12sion twelve of] section forty-four hundred three-f of the public health 13 law, provided, however, that: 14 (h) Consistent with and subject to the terms of federal approval, the 15 commissioner shall establish the managed care for persons with develop- 16 mental disabilities advocacy program, hereinafter referred to as the 17 advocacy program. The activities of the advocacy program shall be coor- 18 dinated with the independent Medicaid managed care ombuds services 19 provided to persons with disabilities enrolling in Medicaid managed 20 care. The advocacy program shall advise individuals of applicable rights 21 and responsibilities, provide information and assistance to address the 22 needs of individuals with disabilities, and pursue legal, administrative 23 and other appropriate remedies or approaches to ensure the protection of 24 and advocacy for the rights of the enrollees. The advocacy program shall 25 provide support to eligible individuals with developmental disabilities 26 enrolling in developmental disability individual support and care coor- 27 dination organizations pursuant to section forty-four hundred three-g of 28 the public health law, health maintenance organizations providing 29 services pursuant to subdivision eight of section forty-four hundred 30 three of the public health law, [managed long term care plans] long term 31 care options providing services under [subdivisions twelve, thirteen and32fourteen of] section forty-four hundred three-f of the public health 33 law, and fully integrated dual advantage plans providing services under 34 subdivision twenty-seven of section three hundred sixty-four-j of the 35 social services law. The commissioner shall select an independent organ- 36 ization or organizations to provide advocacy services under this subdi- 37 vision. 38 § 10. Paragraph (c) of subdivision 6 of section 2801-e of the public 39 health law, as amended by chapter 257 of the laws of 2005, is amended to 40 read as follows: 41 (c) The commissioner may, as necessary, waive existing methodologies 42 for determining public need under this article, article thirty-six of 43 this chapter and article seven of the social services law[, as well as44enrollment limitations under section forty-four hundred three-f of this45chapter,] to accommodate permanent conversions of beds to other programs 46 or services on the basis that any such increases in capacity are linked 47 to commensurate reductions in the number of residential health care 48 facility beds. 49 § 11. The opening paragraph of paragraph (ccc) of subdivision 1 of 50 section 2807-v of the public health law, as amended by section 12 of 51 part C of chapter 57 of the laws of 2023, is amended to read as follows: 52 Funds shall be deposited by the commissioner, within amounts appropri- 53 ated, and the state comptroller is hereby authorized and directed to 54 receive for the deposit to the credit of the state special revenue funds 55 - other, HCRA transfer fund, medical assistance account, or any succes- 56 sor fund or account, for purposes of funding the state share ofA. 2018 8 1 increases in the rates for certified home health agencies, long term 2 home health care programs, AIDS home care programs, hospice programs and 3 [managed] long term care [plans and approved managed long term care4operating demonstrations as defined in] options in section forty-four 5 hundred three-f of this chapter for recruitment and retention of health 6 care workers pursuant to subdivisions nine and ten of section thirty-six 7 hundred fourteen of this chapter from the tobacco control and insurance 8 initiatives pool established for the following periods in the following 9 amounts: 10 § 12. Section 2807-x of the public health law is REPEALED. 11 § 13. Subdivision 8 of section 3605 of the public health law, as 12 amended by section 49 of part D of chapter 56 of the laws of 2012, is 13 amended to read as follows: 14 8. Agencies licensed pursuant to this section but not certified pursu- 15 ant to section [three thousand six hundred eight] thirty-six hundred 16 eight of this article, shall not be qualified to participate as a home 17 health agency under the provisions of title XVIII or XIX of the federal 18 Social Security Act provided, however, an agency which has a contract 19 with a state agency or its locally designated office or, as specified by 20 the commissioner, with a managed care organization participating in the 21 managed care program established pursuant to section three hundred 22 sixty-four-j of the social services law or with a [managed long term23care plan established pursuant to] PACE or MAP plan as such terms are 24 defined by section forty-four hundred three-f of this chapter, may 25 receive reimbursement under title XIX of the federal Social Security 26 Act. 27 § 14. The opening paragraph of subdivision 9 of section 3614 of the 28 public health law, as amended by section 56 of part A of chapter 56 of 29 the laws of 2013, is amended to read as follows: 30 Notwithstanding any law to the contrary, the commissioner shall, 31 subject to the availability of federal financial participation, adjust 32 medical assistance rates of payment for certified home health agencies 33 for such services provided to children under eighteen years of age and 34 for services provided to a special needs population of medically complex 35 and fragile children, adolescents and young disabled adults by a CHHA 36 operating under a pilot program approved by the department, long term 37 home health care programs, AIDS home care programs established pursuant 38 to this article, hospice programs established under article forty of 39 this chapter and for [managed] long term care [plans and approved40managed long term care operating demonstrations as defined in] options 41 under section forty-four hundred three-f of this chapter. Such adjust- 42 ments shall be for purposes of improving recruitment, training and 43 retention of home health aides or other personnel with direct patient 44 care responsibility in the following aggregate amounts for the following 45 periods: 46 § 15. Paragraph (a) of subdivision 10 of section 3614 of the public 47 health law, as amended by section 57 of part A of chapter 56 of the laws 48 of 2013, is amended to read as follows: 49 (a) Such adjustments to rates of payments shall be allocated propor- 50 tionally based on each certified home health agency, long term home 51 health care program, AIDS home care and hospice program's home health 52 aide or other direct care services total annual hours of service 53 provided to medicaid patients, as reported in each such agency's most 54 recently available cost report as submitted to the department or for the 55 purpose of the [managed] long term care [program] option a suitable 56 proxy developed by the department in consultation with the interestedA. 2018 9 1 parties. Payments made pursuant to this section shall not be subject to 2 subsequent adjustment or reconciliation; provided that such adjustments 3 to rates of payments to certified home health agencies shall only be for 4 that portion of services provided to children under eighteen years of 5 age and for services provided to a special needs population of medically 6 complex and fragile children, adolescents and young disabled adults by a 7 CHHA operating under a pilot program approved by the department. 8 § 16. Paragraph (b) of subdivision 2 of section 4409 of the public 9 health law, as added by section 5 of part NN of chapter 57 of the laws 10 of 2023, is amended to read as follows: 11 (b) The department is authorized to address to any health maintenance 12 organization, and [managed long term care plan with a certificate of13authority pursuant to] a PACE or MAP plan as such terms are defined by 14 section forty-four hundred three-f of this article, or officers thereof, 15 any inquiry in relation to its contracts with providers and other enti- 16 ties providing covered services to the health maintenance 17 organization's, or [managed long term care plan's] PACE or MAP plans' 18 enrollees, including but not limited to the rates of payment and payment 19 terms and conditions therein. Every entity or person so addressed shall 20 reply in writing to such inquiry promptly and truthfully, and such reply 21 shall be, if required by the department, signed by such individual, or 22 by such officer or officers of a corporation, as the department shall 23 designate, and affirmed by them as true under penalty of perjury. Fail- 24 ure to comply with the requirements of this section shall be subject to 25 civil penalties under section twelve of this chapter. Each day after the 26 deadline established by the department for reply until such time that 27 the provider submits a good faith response shall be considered a sepa- 28 rate and subsequent violation. In accordance with the process outlined 29 in this paragraph, employers shall provide any documents or materials in 30 the employer's possession, custody, or control that are requested by the 31 department as needed to support or verify the employer's reply. 32 § 17. Subparagraph (i) of paragraph (e) of subdivision 3 of section 33 364-j of the social services law, as amended by section 38 of part A of 34 chapter 56 of the laws of 2013, is amended to read as follows: 35 (i) an individual dually eligible for medical assistance and benefits 36 under the federal Medicare program; provided, however, nothing herein 37 shall: (a) require an individual enrolled in a [managed] long term care 38 [plan] option, pursuant to section forty-four hundred three-f of the 39 public health law, to disenroll from such program; or (b) make enroll- 40 ment in a Medicare managed care plan a condition of the individual's 41 participation in the managed care program pursuant to this section, or 42 affect the individual's entitlement to payment of applicable Medicare 43 managed care or [fee for service] fee-for-service coinsurance and deduc- 44 tibles by the individual's managed care provider. 45 § 18. Paragraphs (b) and (c) of subdivision 27 of section 364-j of 46 the social services law, as added by section 72 of part A of chapter 56 47 of the laws of 2013, are amended to read as follows: 48 (b) The FIDA program shall provide targeted populations of 49 [medicare/medicaid] Medicare/Medicaid dually eligible persons with 50 comprehensive health services that include the full range of [medicare] 51 Medicare and [medicaid] Medicaid covered services, including but not 52 limited to primary and acute care, prescription drugs, behavioral health 53 services, care coordination services, and long-term supports and 54 services, as well as other services, through managed care providers, as 55 defined in subdivision one of this section[, including managed long termA. 2018 10 1care plans, certified pursuant to section forty-four hundred three-f of2the public health law]. 3 (c) Under the FIDA program established pursuant to this subdivision, 4 up to three managed [long term] care plans may be authorized to exclu- 5 sively enroll individuals with developmental disabilities, as such term 6 is defined in section 1.03 of the mental hygiene law. The commissioner 7 of health may waive any of the department's regulations as such commis- 8 sioner, in consultation with the commissioner of the office for people 9 with developmental disabilities, deems necessary to allow such managed 10 [long term] care plans to provide or arrange for service for individuals 11 with developmental disabilities that are adequate and appropriate to 12 meet the needs of such individuals and that will ensure their health and 13 safety. The commissioner of the office for people with developmental 14 disabilities may waive any of the office for people with developmental 15 disabilities' regulations as such commissioner, in consultation with the 16 commissioner of health, deems necessary to allow such managed [long17term] care plans to provide or arrange for services for individuals with 18 developmental disabilities that are adequate and appropriate to meet the 19 needs of such individuals and that will ensure their health and safety. 20 § 19. Subdivision 31 of section 364-j of the social services law, as 21 added by section 36-b of part B of chapter 57 of the laws of 2015, is 22 amended to read as follows: 23 31. [(a)] The commissioner shall require managed care providers under 24 this section, [managed long-term care plans] a PACE or MAP plan as such 25 terms are defined under section forty-four hundred three-f of the public 26 health law and other appropriate long-term service programs to adopt 27 expedited procedures for approving personal care services for a medical 28 assistance recipient who requires immediate personal care or consumer 29 directed personal assistance services pursuant to paragraph (e) of 30 subdivision two of section three hundred sixty-five-a of this title or 31 section three hundred sixty-five-f of this title, respectively, or other 32 long-term care, and provide such care or services as appropriate, pend- 33 ing approval by such provider or program. 34 § 20. Paragraphs (a) and (c) of subdivision 32 of section 364-j of the 35 social services law, as amended by section 1 of part KKK of chapter 56 36 of the laws of 2020, are amended to read as follows: 37 (a) The commissioner, or for the purposes of subparagraph (iv) of 38 paragraph (c) of this subdivision, the Medicaid inspector general in 39 consultation with the commissioner, may, in [his or her] their 40 discretion, apply penalties to managed care organizations subject to 41 this section and article forty-four of the public health law, including 42 [managed long term care plans] a PACE or MAP plan as such terms are 43 defined by section forty-four hundred three-f of the public health law, 44 for untimely or inaccurate submission of encounter data; provided howev- 45 er, no penalty shall be assessed if the managed care organization or a 46 PACE or MAP plan submits, in good faith, timely and accurate data and a 47 material amount of such data is not successfully received by the depart- 48 ment as a result of department system failures or technical issues that 49 are beyond the control of the managed care organization. 50 (c) (i) Penalties assessed pursuant to this subdivision against a 51 managed care organization other than a [managed long term care plan52certified pursuant to] PACE or MAP plan as such terms are defined by 53 section forty-four hundred three-f of the public health law shall be as 54 follows:A. 2018 11 1 (A) for encounter data submitted or resubmitted past the deadlines set 2 forth in the model contract, the Medicaid capitated premiums shall be 3 reduced by one-third percent; [and] 4 (B) for incomplete or inaccurate encounter data, evaluated at a cate- 5 gory of service level, that fails to conform to department developed 6 benchmarks for completeness and accuracy, the Medicaid capitated premi- 7 ums shall be reduced by one and one-third percent; and 8 (C) for submitted data that results in a rejection rate in excess of 9 ten percent of department developed volume benchmarks, the Medicaid 10 capitated premiums shall be reduced by one-third percent. 11 (ii) Penalties assessed pursuant to this [subdivisions] subdivision 12 against a [managed] long term care [plan] option certified pursuant to 13 section forty-four hundred three-f of the public health law shall be as 14 follows: 15 (A) for encounter data submitted or resubmitted past the deadlines set 16 forth in the model contract, the Medicaid capitated premiums shall be 17 reduced by one-quarter percent; 18 (B) for incomplete or inaccurate encounter data, evaluated at a cate- 19 gory of service level, that fails to conform to department developed 20 benchmarks for completeness and accuracy, the Medicaid capitated premi- 21 ums shall be reduced by one percent; and 22 (C) for submitted data that results in a rejection rate in excess of 23 ten percent of department developed volume benchmarks, the Medicaid 24 capitated premiums shall be reduced by one-quarter percent. 25 (iii) For incomplete or inaccurate encounter data, identified in the 26 course of an audit, investigation or review by the Medicaid inspector 27 general, the Medicaid capitated premiums shall be reduced by an addi- 28 tional one percent. 29 § 21. Paragraph (x) of subdivision (b) of section 364-jj of the social 30 services law, as amended by section 39 of part C of chapter 60 of the 31 laws of 2014, is amended to read as follows: 32 (x) in accordance with the recommendations of the joint advisory coun- 33 cil established pursuant to section 13.40 of the mental hygiene law, 34 advise the commissioners of health and developmental disabilities with 35 respect to the oversight of DISCOs and of health maintenance organiza- 36 tions and [managed] long term care [plans] options providing services 37 authorized, funded, approved or certified by the office for people with 38 developmental disabilities, and review all managed care options provided 39 to persons with developmental disabilities, including: the adequacy of 40 support for habilitation services; the record of compliance with 41 requirements for person-centered planning, person-centered services and 42 community integration; the adequacy of rates paid to providers in 43 accordance with the provisions of [paragraph 1 of] subdivision four of 44 section forty-four hundred three of the public health law, paragraph 45 (a-2) of subdivision eight of section forty-four hundred three of the 46 public health law or [paragraph (a-2) of subdivision twelve of] section 47 forty-four hundred three-f of the public health law; and the quality of 48 life, health, safety and community integration of persons with develop- 49 mental disabilities enrolled in managed care; and 50 § 22. Subdivision 6 of section 365-f of the social services law, as 51 added by section 50 of part D of chapter 56 of the laws of 2012, is 52 amended to read as follows: 53 6. Notwithstanding any inconsistent provision of this section or any 54 other contrary provision of law, managed care programs established 55 pursuant to section three hundred sixty-four-j of this title and 56 [managed] long term care [plans] options and other care coordinationA. 2018 12 1 models established pursuant to section [four thousand four] forty-four 2 hundred three-f of the public health law shall offer consumer directed 3 personal assistance programs to enrollees. 4 § 23. Paragraph (a) of subdivision 4 of section 365-h of the social 5 services law, as amended by section 2 of part LL of chapter 56 of the 6 laws of 2020, is amended to read as follows: 7 (a) The commissioner of health is authorized to assume responsibility 8 from a local social services official for the provision and reimburse- 9 ment of transportation costs under this section. If the commissioner 10 elects to assume such responsibility, the commissioner shall notify the 11 local social services official in writing as to the election, the date 12 upon which the election shall be effective and such information as to 13 transition of responsibilities as the commissioner deems prudent. The 14 commissioner is authorized to contract with a transportation manager or 15 managers to manage transportation services in any local social services 16 district, other than transportation services provided or arranged for 17 enrollees of [managed long term care plans issued certificates of18authority under] a PACE or MAP plan as defined by section forty-four 19 hundred three-f of the public health law. Any transportation manager or 20 managers selected by the commissioner to manage transportation services 21 shall have proven experience in coordinating transportation services in 22 a geographic and demographic area similar to the area in New York state 23 within which the contractor would manage the provision of services under 24 this section. Such a contract or contracts may include responsibility 25 for: review, approval and processing of transportation orders; manage- 26 ment of the appropriate level of transportation based on documented 27 patient medical need; and development of new technologies leading to 28 efficient transportation services. If the commissioner elects to assume 29 such responsibility from a local social services district, the commis- 30 sioner shall examine and, if appropriate, adopt quality assurance meas- 31 ures that may include, but are not limited to, global positioning track- 32 ing system reporting requirements and service verification mechanisms. 33 Any and all reimbursement rates developed by transportation managers 34 under this subdivision shall be subject to the review and approval of 35 the commissioner. 36 § 24. Subparagraph (vi) of paragraph (b) of subdivision 4 of section 37 365-h of the social services law, as added by section 2 of part LL of 38 chapter 56 of the laws of 2020, is amended to read as follows: 39 (vi) Responsibility for transportation services provided or arranged 40 for enrollees of [managed] long term care [plans issued certificates of41authority] options under section forty-four hundred three-f of the 42 public health law, not including a program designated as a Program of 43 All-Inclusive Care for the Elderly (PACE) as authorized by Federal 44 Public law 1053-33, subtitle I of title IV of the Balanced Budget Act of 45 1997, and, at the commissioner's discretion, other plans that integrate 46 benefits for dually eligible Medicare and Medicaid beneficiaries based 47 on a demonstration by the plan that inclusion of transportation within 48 the benefit package will result in cost efficiencies and quality 49 improvement, shall be transferred to a transportation management broker 50 that has a contract with the commissioner in accordance with this para- 51 graph. Providers of adult day health care may elect to, but shall not be 52 required to, use the services of the transportation management broker. 53 § 25. Subdivision 14 of section 366 of the social services law, as 54 amended by section 1 of part NN of chapter 57 of the laws of 2021, is 55 amended to read as follows:A. 2018 13 1 14. The commissioner of health may make any available amendments to 2 the state plan for medical assistance submitted pursuant to section 3 three hundred sixty-three-a of this title, or, if an amendment is not 4 possible, develop and submit an application for any waiver or approval 5 under the federal social security act that may be necessary to disregard 6 or exempt an amount of income, for the purpose of assisting with housing 7 costs, for individuals receiving coverage of nursing facility services 8 under this title, other than short-term rehabilitation services, and for 9 individuals in receipt of medical assistance while in an adult home, as 10 defined in subdivision twenty-five of section two of this chapter, who: 11 are (i) discharged to the community; and (ii) if eligible, enrolled or 12 required to enroll and have initiated the process of enrolling in a 13 [plan certified] long term care option pursuant to section forty-four 14 hundred three-f of the public health law; and (iii) do not meet the 15 criteria to be considered an "institutionalized spouse" for purposes of 16 section three hundred sixty-six-c of this title. 17 § 26. This act shall take effect immediately; provided, however, that: 18 (i) sections two, five, six, seven, eight, nine, ten, eleven, twelve, 19 thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, 20 twenty, twenty-one, twenty-two, twenty-three, twenty-four and twenty- 21 five of this act shall take effect April 1, 2028; 22 (ii) the amendments to paragraph (o) of subdivision 2 of section 365-a 23 of the social services law made by section five of this act shall not 24 affect the expiration and/or repeal of such paragraph and shall be 25 deemed to expire therewith; 26 (iii) the amendments to paragraph (h) of subdivision 3 of section 218 27 of the elder law made by section eight of this act shall be subject to 28 the repeal of such paragraph and shall expire and be deemed repealed 29 therewith; 30 (iv) the amendments to subparagraph (i) of paragraph (e) of subdivi- 31 sion 3, paragraphs (b) and (c) of subdivision 27, subdivision 31 and 32 paragraphs (a) and (c) of subdivision 32 of section 364-j of the social 33 services law made by sections seventeen, eighteen, nineteen and twenty 34 of this act shall be subject to the repeal of such section and shall 35 expire and be deemed repealed therewith; 36 (v) the amendments to paragraph (x) of subdivision (b) of section 37 364-jj of the social services law made by section twenty-one of this act 38 shall be subject to the expiration of such section and shall expire and 39 be deemed repealed therewith; and 40 (vi) the amendments to section 365-h of the social services law made 41 by sections twenty-three and twenty-four of this act shall be subject to 42 the expiration of such section and shall expire and be deemed repealed 43 therewith. 44 Effective immediately, the commissioner of health shall promulgate any 45 rules and regulations and take steps, including requiring the submission 46 of reports or surveys, submission and receipt of state plans, and neces- 47 sary federal waivers, as may be necessary for the timely implementation 48 of this act on such effective date.
