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A02442 Summary:

COSPNSRLupardo, Raia, D'Urso, Woerner
Amd 364-j, Soc Serv L
Provides that services to medical assistance recipients suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services shall be provided outside of managed programs.
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A02442 Actions:

01/20/2017referred to health
01/31/2017reported referred to ways and means
01/03/2018referred to ways and means
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A02442 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2442           Revised 02/02/17
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the social services law, in relation to the provision of services to certain persons suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services   PURPOSE OF THE BILL: To prevent waivered Medicaid services provided to persons suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services from being provided to Medicaid recipients through managed care programs.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends section 364-j of the social services law to amend paragraph (d-2) preventing service provided pursuant to the Trau- matic Brain Injury and Nursing Home Transition and Diversion (TBI/NHTD) Waiver programs from being provided through Medicaid Managed Care and directing the Commissioner of Health to take any action necessary to continue provisions of these services through waivers. Section 2 of the bill provides for an immediate effective date.   JUSTIFICATION: Individuals who suffer from traumatic brain injury (TBI) and are served by a Medicaid waiver or who have some other disabilities that qualify them for the Nursing Home Transition and Diversion Waiver (NHTD) have varied physical and cognitive disabilities that make them particularly vulnerable to institutionalization. The Federal Medicaid Waivers were established many years ago because the state recognized these vulner- abilities and needs for special services and supports to help individ- uals live in the most integrated setting. These programs have served as a national model. Given the unique needs of this small population of Medicaid recipients, the legislature introduced legislation in 2015 to delay the move of the TBI/NHTD waivered population into managed care and require that a work group of stakeholders be convened to make recommendations on transition of these services into managed care. The Department of Health ultimately committed to delay the transition until January 2017 and created a work group. In January 2016 the Department shared its draft transition plan with the workgroup and concerns were raised that the draft transition plan did not reflect the workgroup's recommendations nor conversations with the Department. A series of further weekly meetings were scheduled as a result. Of particular concern has been the assessment tool; how existing services fit into managed care; and the process by which plans would qualify individuals and determine approved services, particularly for individuals who may find themselves with a traumatic brain injury or other disability after the move to Medicaid managed care. Managed Long Term Care Plans have expressed concerns about taking on this population. New York is still in the midst of moving other popu- lations into managed care and those transitions are far from complete or without concerns. Managed Long Term Care Plans, who would enroll TBI/NHTD individuals, are self-reporting that they are already in a fragile state with many of those plans experiencing operating losses. In July 2015, New York moved the nursing home benefit into MLTC and the affect of that high acuity population being added to MLTC plans is putting additional pressures on the system Adding yet another high acui- ty population such as TBI/NHTD to plans will undoubtedly place some plans in further peril and ultimately consumers in jeopardy. As part of the SFY 2016-17 budget, the date for transitioning the TBI/NHTD program participants into managed care was further extended until at least January 1, 2018. There are no cost savings associated with moving TBI/NHTD into managed care and given the vast changes the Medicaid program is currently undergoing, the State would be best served by placing all its attention on the populations it has already begun moving into managed care. Moving the vulnerable populations served under the TBI/NHTD waiver into managed care at this time would be a tremendous disservice to all involved.   LEGISLATIVE HISTORY: 2016: A9397 referred to Health; passed Senate   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: Immediately
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A02442 Text:

                STATE OF NEW YORK
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    January 20, 2017
        Introduced by M. of A. GOTTFRIED, LUPARDO, RAIA -- Multi-Sponsored by --
          M. of A.  LOPEZ -- read once and referred to the Committee on Health
        AN ACT to amend the social services law, in relation to the provision of
          services to certain persons suffering from traumatic brain injuries or
          qualifying for nursing home diversion and transition services

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1.  Paragraph (d-2) of subdivision 3 of section 364-j  of  the
     2  social services law, as added by section 20-a of part B of chapter 59 of
     3  the laws of 2016, is amended to read as follows:
     4    (d-2)  Services  provided  pursuant  to  waivers,  granted pursuant to
     5  subsection (c) of section 1915 of the federal social  security  act,  to
     6  persons  suffering from traumatic brain injuries or qualifying for nurs-
     7  ing home diversion and transition services, shall  not  be  provided  to
     8  medical  assistance  recipients  through managed care programs [until at
     9  least January first, two thousand eighteen] established pursuant to this
    10  section, and shall continue to  be  provided  outside  of  managed  care
    11  programs  and in accordance with such waiver programs as they existed on
    12  January first, two thousand fifteen; provided, further that the  commis-
    13  sioner of health is hereby directed to take any action required, includ-
    14  ing but not limited to filing waivers and waiver extensions as necessary
    15  with the federal government, to continue the provision of such services.
    16    §  2. This act shall take effect immediately, provided that the amend-
    17  ments to section 364-j of the social services law, made by  section  one
    18  of this act, shall not affect the expiration and repeal of such section,
    19  and shall expire and be deemed repealed therewith.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
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