Bill Text: NY A07687 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to a review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services.

Spectrum: Slight Partisan Bill (Democrat 4-2)

Status: (Introduced - Dead) 2016-01-06 - referred to health [A07687 Detail]

Download: New_York-2015-A07687-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         7687
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                     May 22, 2015
                                      ___________
       Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
         Committee on Health
       AN ACT to amend the social services law, in relation to  the  review  of
         reimbursement  methodologies under contracts or agreements with insur-
         ers under the medical assistance program for home and  community-based
         long term care services
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Subdivision 18 of section 364-j of the social services law,
    2  as amended by chapter 649 of the laws of 1996, paragraph (b) as  amended
    3  by  chapter  433  of the laws of 1997, paragraph (c) as added by section
    4  40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d)
    5  as added by section 55 of part B of chapter 57 of the laws of  2015,  is
    6  amended to read as follows:
    7    18.  (a) The department of health may, where not inconsistent with the
    8  rate setting authority of other state agencies and subject  to  approval
    9  of  the  director  of  the division of the budget, develop reimbursement
   10  methodologies and fee schedules for determining the amount of payment to
   11  be made to managed care providers under the managed care  program.  Such
   12  reimbursement methodologies and fee schedules may include provisions for
   13  payment of managed care fees and capitation arrangements.
   14    (b)  The  department  of  health  in  consultation  with organizations
   15  representing managed care providers shall select an independent  actuary
   16  to  review  any such reimbursement rates. Such independent actuary shall
   17  review and make recommendations concerning appropriate actuarial assump-
   18  tions relevant to the establishment of rates including but  not  limited
   19  to  the adequacy of the rates in relation to the population to be served
   20  adjusted for case mix, the scope of services the plans must provide, the
   21  utilization of services and the network of providers necessary  to  meet
   22  state  standards.  The independent actuary shall issue a report no later
   23  than December thirty-first, nineteen hundred ninety-eight  and  annually
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD11080-01-5
       A. 7687                             2
    1  thereafter. Such report shall be provided to the governor, the temporary
    2  president  and the minority leader of the senate and the speaker and the
    3  minority leader of the assembly. The department of health  shall  assess
    4  managed  care providers under the managed care program on a per enrollee
    5  basis to cover the cost of such report.
    6    (c) In setting such reimbursement methodologies, the department  shall
    7  consider  costs  borne by the managed care program to ensure actuarially
    8  sound and adequate rates of payment to ensure quality of care.
    9    [(c)] (D) The department of health shall require the independent actu-
   10  ary selected pursuant to paragraph (b) of this subdivision to provide  a
   11  complete actuarial memorandum, along with all actuarial assumptions made
   12  and  all other data, materials and methodologies used in the development
   13  of rates, to managed care providers thirty days prior to  submission  of
   14  such  rates  to  the  centers  for  medicare  and  medicaid services for
   15  approval. Managed care providers may request additional  review  of  the
   16  actuarial soundness of the rate setting process and/or methodology.
   17    [(d)]  (E)(I)  THE DEPARTMENT OF HEALTH SHALL SELECT AND CONTRACT WITH
   18  AN INDEPENDENT ACTUARY TO STUDY AND REVIEW ADEQUATE REIMBURSEMENT  METH-
   19  ODOLOGIES  UNDER CONTRACTS OR AGREEMENTS WITH INSURERS UNDER THE MEDICAL
   20  ASSISTANCE PROGRAM FOR HOME AND COMMUNITY-BASED LONG TERM CARE  SERVICES
   21  PROVIDED UNDER THIS ARTICLE, BY FISCAL INTERMEDIARIES OPERATING PURSUANT
   22  TO  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE OR RATES OF PAYMENT
   23  FOR SUCH SERVICES UNDER THE MEDICAL ASSISTANCE PROGRAM  TO  ENSURE  SUCH
   24  CONTRACTS OR RATES SHALL SUPPORT COMPENSATION FOR PERSONS PROVIDING SUCH
   25  HOME  CARE  AIDE  SERVICES  AND  CONSUMER  DIRECTED  PERSONAL ASSISTANCE
   26  SERVICES TO ENSURE THE RETENTION OF A  QUALIFIED  WORKFORCE  CAPABLE  OF
   27  PROVIDING  HIGH QUALITY CARE TO RECIPIENTS OF SUCH SERVICES IN BOTH WAGE
   28  PARITY AND NON-WAGE PARITY REGIONS. SUCH COMPENSATION SHALL AT A MINIMUM
   29  INCLUDE WAGE PARITY COMPENSATION AS REQUIRED  UNDER  SECTION  THIRTY-SIX
   30  HUNDRED  FOURTEEN-C  OF  THE  PUBLIC HEALTH LAW OR SUCH WAGE AS REQUIRED
   31  UNDER ARTICLE NINETEEN OR  NINETEEN-A  OF  THE  LABOR  LAW  AS  REQUIRED
   32  TOGETHER  WITH  THE FOLLOWING COSTS: RECRUITMENT, TRAINING AND RETENTION
   33  OF DIRECT CARE PERSONNEL INCLUDING WAGE; SALARY; MANDATORY CONTRIBUTIONS
   34  PURSUANT TO TITLE 26, SUBTITLE C, CHAPTER 21 OF THE UNITED  STATES  CODE
   35  (FICA);  COSTS  ATTRIBUTED  TO  WORKERS COMPENSATION; COUNTY LIVING WAGE
   36  LAWS AS APPROPRIATE; AND A SUPPLEMENTAL BENEFIT RATE.
   37    (II) THE DEPARTMENT OF HEALTH SHALL REPORT ON THE RESULTS OF THE INDE-
   38  PENDENT ACTUARY FINDINGS UNDER  THIS  PARAGRAPH  TO  THE  GOVERNOR,  THE
   39  TEMPORARY  PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE
   40  CHAIRS OF THE SENATE HEALTH COMMITTEE AND ASSEMBLY HEALTH  COMMITTEE  ON
   41  OR BEFORE JANUARY FIRST, TWO THOUSAND SIXTEEN.
   42    (F)  The  department of health shall annually provide to the temporary
   43  president of the senate and the speaker of the assembly the annual Medi-
   44  caid managed care operating reports submitted  to  the  department  from
   45  managed  care  plans  that  contract  with  the state to manage services
   46  provided under the Medicaid program.
   47    S 2. This act shall take effect immediately; provided that the  amend-
   48  ments made to section 364-j of the social services law by section one of
   49  this act shall not affect the repeal of such section and shall be deemed
   50  repealed therewith.