Relates to the transition of traumatic brain injury waiver and nursing home transition and diversion waiver program services to Medicaid managed care programs.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7598
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law, in relation to
the transition of traumatic brain injury waiver and nursing home transi-
tion and diversion waiver program services to Medicaid managed care
programs
PURPOSE OR GENERAL IDEA OF BILL:
This bill delays the transition of persons receiving services under the
traumatic brain injury (TBI) waiver or nursing home transition and
diversion (NHTD) waiver into Medicaid managed care and creates a work
group to develop recommendations relating to that transition.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Adds a new sub-paragraph (v-a) to paragraph (b) of subsection
(7) of section 4403-f of the public health law delaying the transition
of TBI and NHTD waiver populations into Medicaid managed care until at
least April 1, 2017; provides that the commissioner shall convene a work
group to develop recommendations on transitioning these populations and
spells out membership and responsibilities of the work group.
Section 2. Effective date - immediate
JUSTIFICATION:
Over the past 20 years, the traumatic brain injury (TBI) waiver and
nursing home transition and diversion (NHTD) waiver have allowed highly
sensitive populations to be cared for by specialized providers in the
community, avoiding costly institutionalized care. Patients' families
and providers have raised concerns about the scheduled transition of
these populations out of the TBI and NHTD programs and into Medicaid
managed care. While the State plans to transfer these populations into
Medicaid managed care in January 2016 (NHTD) and April 2016 (TBI), many
questions remain about these populations' access to appropriate provid-
ers and ability to stay in the community under the new system.
The 1999 Supreme Court Olmstead decision ruled that unjustified segre-
gation of persons with disabilities constitutes discrimination in
violation of the Americans with Disabilities Act. Consistent with the
State's obligations under Olmstead, to ensure that these populations
continue receiving community-based services whenever possible and are
not inadvertently redirected to nursing home settings, this bill would
delay implementation for a year and establish a transparent process
through which consumers, providers, payers and other stakeholders could
provide input in developing an operationally viable transition plan.
PRIOR LEGISLATIVE HISTORY:
New bill
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
Immediate
STATE OF NEW YORK
________________________________________________________________________
7598
2015-2016 Regular Sessions
IN ASSEMBLY
May 20, 2015
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, in relation to the transition of
traumatic brain injury waiver and nursing home transition and diver-
sion waiver program services to Medicaid managed care programs
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 7 of section 4403-f of the
2 public health law is amended by adding a new subparagraph (v-a) to read
3 as follows:
4 (v-a) Notwithstanding subparagraph (v) of this paragraph, no person
5 receiving services under the traumatic brain injury waiver or nursing
6 home transition and diversion waiver may be required to enroll in a
7 managed care or managed long term care program before April first, two
8 thousand seventeen; and provided further that the commissioner shall
9 convene a work group to develop recommendations on transition of these
10 waiver services to managed care. Membership of the work group shall
11 include payers, consumer representatives and providers of such services,
12 and the chairs of the assembly and senate health committees. In develop-
13 ing recommendations on transitioning these populations to a managed care
14 environment, the work group shall consider:
15 (1) tracking of legacy waiver populations to ensure continued access
16 to community-based services and identify aggregate costs of care;
17 (2) ongoing tracking and identification of people with a diagnosis of
18 a brain injury and similar populations to ensure that necessary communi-
19 ty-based services will be provided to these populations and identify
20 aggregate costs of care;
21 (3) how continuity of services will be accomplished beyond an initial
22 transition period of ninety days;
23 (4) ensuring access to a qualified workforce, experienced working with
24 these populations;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11174-01-5
A. 7598 2
1 (5) development of actuarially sound capitation reflecting the high
2 acuity of these populations; and
3 (6) development of annual reporting by the commissioner on, among
4 other things, aggregate costs of care for these populations and whether
5 the transition of these populations in managed care has increased utili-
6 zation of nursing home or other institutionalized care.
7 The recommendations of such work group shall be due to the commission-
8 er and the legislature on or before December thirty-first, two thousand
9 sixteen. To the extent the department's final implementation plan does
10 not reflect one or more recommendations of the work group, the commis-
11 sioner shall provide a written explanation for such omission or vari-
12 ation.
13 § 2. This act shall take effect immediately; provided however, that
14 the amendments to paragraph (b) of subdivision 7 of section 4403-f of
15 the public health law made by section one of this act shall not affect
16 the repeal of such section and shall be deemed repealed therewith.
