Bill Text: NY S00707 | 2025-2026 | General Assembly | Introduced

---

Bill Title: Requires certain data to be included in reports on the administration of managed long term care plans; changes reporting period to annually.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced) 2025-01-08 - REFERRED TO HEALTH [S00707 Detail]

Download: New_York-2025-S00707-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                           707

                               2025-2026 Regular Sessions

                    IN SENATE

                                       (Prefiled)

                                     January 8, 2025
                                       ___________

        Introduced  by Sens. MAY, CLEARE, JACKSON, KRUEGER, RAMOS, SKOUFIS, WEBB
          -- read twice and ordered printed, and when printed to be committed to
          the Committee on Health

        AN ACT to amend the public health law, in  relation  to  data  reporting
          required on the administration of managed long term care plans

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subparagraph (ix) of paragraph  (b)  of  subdivision  7  of
     2  section  4403-f  of  the  public health law, as added by section 56-a of
     3  part D of chapter 56 of the laws of 2012 and as relettered by section  4
     4  of  part  B  of  chapter  57  of the laws of 2018, is amended to read as
     5  follows:
     6    (ix) (1) The commissioner shall report [biannually]  annually  on  the
     7  implementation  of  this subdivision. The reports shall include, but not
     8  be limited to:
     9    (A) satisfaction of enrollees with care coordination/case  management;
    10  timeliness of care;
    11    (B)  service  utilization  data including changes in the level, hours,
    12  frequency, and types of services and providers;
    13    (C) enrollment data, including auto-assignment rates by plan;
    14    (D) quality data; and
    15    (E) continuity of care for participants as they move to  managed  long
    16  term care, with respect to community based and nursing home populations,
    17  including  pediatric  nursing  home  populations,  and medically fragile
    18  children being served by home care agencies  affiliated  with  pediatric
    19  nursing  homes  and  diagnostic  and treatment centers primarily serving
    20  medically fragile children.
    21    (2) The following data shall be included  in  the  report  under  this
    22  subdivision and shall be posted on the department's website in an inter-
    23  active  format. To the extent the data set forth in this subparagraph is

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01012-01-5
        S. 707                              2

     1  not now reported by plans to the department, plans shall be required  to
     2  report this data through a reporting mechanism that the department shall
     3  develop by October first, two thousand twenty-five:
     4    (A)  Statewide  and  regional  service utilization data for each plan,
     5  with the number and percentage of "member months"  authorized  for  each
     6  range  of  hours per month as reported in cost reports filed under para-
     7  graph (a) of this subdivision, and using "member months" as  defined  in
     8  the  cost reports, including all required exhibits.   Data shall include
     9  the number of member months for whom each type of  service  was  author-
    10  ized,  and  the  percentage of each plan's total member months for which
    11  members were authorized for each of the ranges of  hours  per  month  of
    12  each service.  These numbers and percentages shall be reported separate-
    13  ly  for each of the following services: personal care, consumer directed
    14  personal care, private duty nursing and home health services, and  shall
    15  be  reported  separately  for each region of the state in which the plan
    16  operates and on a statewide basis;
    17    (B) Data on "per member per month" expenditures by managed  long  term
    18  care  plan,    as  reported in cost reports filed under paragraph (a) of
    19  this subdivision, including but not limited  to,  administrative  costs,
    20  case  management,  personal  care, consumer directed personal assistance
    21  programs, home health care, private duty nursing, adult day health care,
    22  social adult day, dental care, vision care, audiology, podiatry, medical
    23  supplies, durable medical equipment, personal emergency response system,
    24  home-delivered meals,  the various therapy and rehab  services  -  phys-
    25  ical,  occupational  and  speech therapy, and nursing facility services.
    26  The reports shall include, for each plan on  a  statewide  and  regional
    27  basis, a calculation of the total percentage of all service expenditures
    28  expended  for  home  and community-based long term care services and the
    29  percentage for institutional long term  care  services,  and  the  total
    30  number  of  member  months in which members received home and community-
    31  based long term care services and the number of member months  in  which
    32  members  received  solely institutional services.   The reports shall be
    33  in an interactive format that enables a comparison between  plans  on  a
    34  statewide basis and for each region;
    35    (C)  Data  on  personal care and consumer directed personal assistance
    36  program contracting,  including  but  not  limited  to,  hours  of  care
    37  provided and expenses allocated by contracted entity;
    38    (D) The total number of complaints, grievances, plan appeals, external
    39  appeals, and fair hearings for each plan, broken down by:
    40    (I)  the  number  and percentage of cases decided wholly in enrollee's
    41  favor, partially in enrollee's favor, wholly against the  enrollee,  and
    42  the number still pending;
    43    (II) the type of service involved in the complaint or appeal; and
    44    (III)  the issue of the complaint or appeal, including denial of a new
    45  service, denial of an increase in a service,  reduction  of  a  service,
    46  termination of a service, lateness, lack of staffing, or other issue;
    47    (E)   Metrics to track timely access to authorized services, including
    48  but not limited to:
    49    (I) the number of enrollees whose plans of care are unstaffed  or  not
    50  fully staffed for periods of time that the commissioner shall determine,
    51  from  one  day  to  more than sixty days, and the total number of member
    52  days per month for which plans of care are not fully staffed; and
    53    (II) the wait time for personal care, consumer directed personal  care
    54  under  section three hundred-sixty-five-f of the social services law, or
    55  private duty nursing services to be initiated after authorization; and
        S. 707                              3

     1    (F)  Metrics tracking rebalancing from institutional care to  communi-
     2  ty-based care, including:
     3    (I)  for  each plan, statewide and by region, the rate of admission of
     4  enrollees from the community to nursing facilities;
     5    (II) of each plan's enrollees admitted  to  a  nursing  facility,  the
     6  percentage  successfully  discharged to the community, meaning remaining
     7  in the community for sixty days or more, and the percentage  disenrolled
     8  from  the  plan pursuant to clause thirteen of subparagraph (v) of para-
     9  graph (b) of this subdivision  and the percentage disenrolled because of
    10  death or for other reasons, categorized by length of nursing home stay;
    11    (III) the rate of enrollment of new enrollees who,  prior  to  enroll-
    12  ment, were in a nursing home, by length of nursing home stay;
    13    (IV)  the  rate of re-enrollment of enrollees who had been disenrolled
    14  from the plan within the prior six months because of a long-term nursing
    15  home stay (under clause thirteen of subparagraph (v) of paragraph (b) of
    16  this subdivision).
    17    (3) The commissioner shall publish  the  report  on  the  department's
    18  website and provide notice to the temporary president of the senate, the
    19  speaker  of  the assembly, the chair of the senate standing committee on
    20  health, the chair of the assembly  health  committee  and  the  Medicaid
    21  Managed  Care Advisory Review Panel upon availability of the report. The
    22  initial report shall  be  provided  by  September  first,  two  thousand
    23  twelve.  The reports shall be made available by each February first, and
    24  September first thereafter. Such reports shall  be  formatted  to  allow
    25  comparisons between plans.
    26    (4) The commissioner shall make the final audited versions of all past
    27  annual  managed  long  term  care cost reports available for download in
    28  full in CSV format on the department's website, and shall make the final
    29  audited versions of all future annual cost reports available  for  down-
    30  load within thirty days of completion of the final audited report.
    31    §  2.  This act shall take effect immediately; provided, however, that
    32  the amendments to section 4403-f  of  the  public  health  law  made  by
    33  section  one    of this act shall not affect the repeal of such  section
    34  and  shall be deemed repealed therewith; and provided, further, that the
    35  amendments to paragraph (b) of subdivision 7 of section  4403-f  of  the
    36  public  health  law made by section one of this act shall not affect the
    37  expiration of such paragraph and shall expire  and  be  deemed  repealed
    38  therewith.