Relates to the membership and expands the duties of the special advisory review panel on Medicaid managed care by including other managed care programs.
STATE OF NEW YORK
________________________________________________________________________
4062--B
Cal. No. 196
2013-2014 Regular Sessions
IN ASSEMBLY
January 30, 2013
___________
Introduced by M. of A. GOTTFRIED, JAFFEE -- Multi-Sponsored by -- M. of
A. McDONALD -- read once and referred to the Committee on Health --
reported and referred to the Committee on Ways and Means -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- advanced to a third reading, amended and ordered
reprinted, retaining its place on the order of third reading
AN ACT to amend the social services law, in relation to the special
advisory review panel on Medicaid managed care
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 364-jj of the social services law, as amended by
2 section 80-a of part A of chapter 56 of the laws of 2013, is amended to
3 read as follows:
4 § 364-jj. Special advisory review panel on Medicaid managed care. (a)
5 There is hereby established a special advisory review panel on Medicaid
6 managed care and related public health insurance programs, including
7 Child Health Plus, Family Health Plus, managed long term care programs
8 and related care coordination models, managed care programs directed at
9 coordinating care for dually eligible Medicaid and Medicare enrollees,
10 and other public health coverage care management programs, including but
11 not limited to health homes and medical homes. The panel shall consist
12 of [twelve] thirteen members who shall be appointed as follows: [four]
13 five by the governor, one of which shall serve as the chair, two of
14 which shall bring expertise in access issues facing Medicaid consumers
15 with disabilities, and one of which shall being expertise in access
16 issues facing children, and one shall be a Medicaid beneficiary; three
17 each by the temporary president of the senate and the speaker of the
18 assembly; and one each by the minority leader of the senate and the
19 minority leader of the assembly. At least three members of such panel
20 shall be members of the joint advisory panel established under section
21 13.40 of the mental hygiene law. Members shall serve without compen-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01605-05-4
A. 4062--B 2
1 sation but shall be reimbursed for appropriate expenses. The department
2 shall provide technical assistance and access to data as is required for
3 the panel to effectuate the mission and purposes established herein. The
4 panel shall be required to seek public comment on matters within its
5 jurisdiction. Panel meeting times, agendas, and minutes shall be posted
6 publicly on the department's website at least one week prior to each
7 meeting.
8 (b) The panel shall meet no less than six times per year, with addi-
9 tional subcommittee meetings as deemed necessary to address specialized
10 issues, in order to:
11 (i) determine whether there is sufficient managed care provider
12 participation in the Medicaid managed care program and related programs;
13 (ii) determine whether managed care providers meet proper enrollment
14 targets that permit as many Medicaid recipients as possible to make
15 their own health plan decisions, thus minimizing the number of automatic
16 assignments;
17 (iii) review and determine the appropriateness of the phase-in sched-
18 ule, and the availability of specialty services for enrollment[,] of
19 additional populations and managed care providers under both the volun-
20 tary and mandatory programs and evaluate steps taken to ensure continui-
21 ty of care during and after the transition;
22 (iv) assess the impact of managed care provider marketing and enroll-
23 ment strategies, [and the] including public education [campaign
24 conducted in New York city, on enrollees] campaigns, enrollee partic-
25 ipation in Medicaid managed care plans and related programs;
26 (v) evaluate the adequacy of managed care provider capacity by review-
27 ing established capacity measurements and monitoring actual access to
28 plan practitioners, including timely access to specialty care for people
29 with disabilities and others in need of such care, with particular
30 attention to capacity for services previously provided in the tradi-
31 tional fee for service environment;
32 (vi) examine the [cost] implications of [populations excluded and
33 exempted from Medicaid managed care] federal health care reform on the
34 Medicaid managed care program and related programs, with particular
35 attention to the integration of public program functions with subsidized
36 products available in any potential state insurance exchange and any
37 other subsidized products, such as a basic health plan;
38 (vii) in accordance with the recommendations of the joint advisory
39 council established pursuant to section 13.40 of the mental hygiene law,
40 advise the commissioners of health and developmental disabilities with
41 respect to the oversight of DISCOs and of health maintenance organiza-
42 tions and managed long term care plans providing services authorized,
43 funded, approved or certified by the office for people with develop-
44 mental disabilities, and review all managed care options provided to
45 persons with developmental disabilities, including: the adequacy of
46 support for habilitation services; the record of compliance with
47 requirements for person-centered planning, person-centered services and
48 community integration; the adequacy of rates paid to providers in
49 accordance with the provisions of paragraph [1] (l) of subdivision four
50 of section forty-four hundred [three] three-g of the public health law,
51 paragraph (a-2) of subdivision eight of section forty-four hundred three
52 of the public health law or paragraph (a-2) of subdivision twelve of
53 section forty-four hundred three-f of the public health law; and the
54 quality of life, health, safety and community integration of persons
55 with developmental disabilities enrolled in managed care; [and]
A. 4062--B 3
1 (viii) evaluate trends in service denials by Medicaid managed care
2 plans and related programs, assess effectiveness of grievance and appeal
3 mechanisms for consumers;
4 (ix) evaluate data collection and reporting on health care access and
5 quality by race, ethnicity, language, disability and other factors and
6 the availability of services and programs that address the disparities
7 in access to care and outcomes of care;
8 (x) evaluate implementation of consumer protections;
9 (xi) review waiver applications before any draft proposals are submit-
10 ted to the federal government and amendments and state plan amendments
11 related to topics and programs within its jurisdiction, and solicit
12 public involvement in the proposals;
13 (xii) review and determine the adequacy and appropriateness of program
14 materials and plan-finding aids, including but not limited to, network,
15 contract provisions, eligibility and benefit appeal procedures; and
16 (xiii) examine other issues as it deems appropriate.
17 (c) Commencing January first, [nineteen hundred ninety-seven] two
18 thousand fifteen and quarterly thereafter the panel shall [submit a
19 report regarding the status of Medicaid managed care in the state and
20 provide recommendations if it] provide written recommendations and input
21 as it deems appropriate to the governor, the temporary president and the
22 minority leader of the senate, and the speaker and the minority leader
23 of the assembly on matters within its jurisdiction.
24 § 2. Section 364-jj of the social services law, as added by chapter
25 649 of the laws of 1996, is amended to read as follows:
26 § 364-jj. Special advisory review panel on Medicaid managed care. (a)
27 There is hereby established a special advisory review panel on Medicaid
28 managed care and related public health insurance programs, including
29 Child Health Plus, Family Health Plus, managed long term care programs
30 and related care coordination models, managed care programs directed at
31 coordinating care for dually eligible Medicaid and Medicare enrollees,
32 and other public health coverage care management programs, including but
33 not limited to health homes and medical homes. The panel shall consist
34 of [nine] eleven members who shall be appointed as follows: [three] five
35 by the governor, one of which shall serve as the chair, two of which
36 shall bring expertise in access issues facing Medicaid consumers with
37 disabilities, and one of which shall bring expertise in access issues
38 facing children, and one shall be a Medicaid beneficiary; two each by
39 the temporary president of the senate and the speaker of the assembly;
40 and one each by the minority leader of the senate and the minority lead-
41 er of the assembly. [All members shall be appointed no later than
42 September first, nineteen hundred ninety-six.] Members shall serve with-
43 out compensation but shall be reimbursed for appropriate expenses. The
44 department shall provide technical assistance and access to data as is
45 required for the panel to effectuate the mission and purposes estab-
46 lished herein. The panel shall be required to seek public comment on
47 matters within its jurisdiction. Panel meeting times, agendas, and
48 minutes shall be posted publicly on the department's website at least
49 one week prior to each meeting.
50 (b) The panel shall meet no less than six times per year, with addi-
51 tional subcommittee meetings as deemed necessary to address specialized
52 issues, in order to:
53 (i) determine whether there is sufficient managed care provider
54 participation in the Medicaid managed care program and related programs;
55 (ii) determine whether managed care providers meet proper enrollment
56 targets that permit as many Medicaid recipients as possible to make
A. 4062--B 4
1 their own health plan decisions, thus minimizing the number of automatic
2 assignments;
3 (iii) review and determine the appropriateness of the phase-in sched-
4 ule, and the availability of specialty services for enrollment[,] of
5 additional populations and managed care providers under both the volun-
6 tary and mandatory programs and evaluate steps taken to ensure continui-
7 ty of care during and after the transition;
8 (iv) assess the impact of managed care provider marketing and enroll-
9 ment strategies, [and the] including public education [campaign
10 conducted in New York city, on enrollees] campaigns, enrollee partic-
11 ipation in Medicaid managed care plans and related programs;
12 (v) evaluate the adequacy of managed care provider capacity by review-
13 ing established capacity measurements and monitoring actual access to
14 plan practitioners, including timely access to specialty care for people
15 with disabilities and others in need of such care, with particular
16 attention to capacity for services previously provided in the tradi-
17 tional fee for service environment;
18 (vi) examine the [cost] implications of [populations excluded and
19 exempted from Medicaid managed care; and] federal health care reform on
20 the Medicaid managed care program and related programs, with particular
21 attention to the integration of public program functions with subsidized
22 products available in any potential state insurance exchange and any
23 other subsidized products, such as a basic health plan;
24 (vii) evaluate trends in service denials by Medicaid managed care
25 plans and related programs, assess effectiveness of grievance and appeal
26 mechanisms for consumers;
27 (viii) evaluate data collection and reporting on health care access
28 and quality by race, ethnicity, language, disability and other factors
29 and the availability of services and programs that address the dispari-
30 ties in access to care and outcomes of care;
31 (ix) evaluate implementation of consumer protections;
32 (x) review waiver applications before any draft proposals are submit-
33 ted to the federal government and amendments and state plan amendments
34 related to topics and programs within its jurisdiction, and solicit
35 public involvement in the proposals;
36 (xi) review and determine the adequacy and appropriateness of program
37 materials and plan-finding aids, including but not limited to, network,
38 contract provisions, eligibility and benefit appeal procedures; and
39 (xii) examine other issues as it deems appropriate.
40 (c) Commencing January first, [nineteen hundred ninety-seven] two
41 thousand fifteen and quarterly thereafter the panel shall [submit a
42 report regarding the status of Medicaid managed care in the state and
43 provide recommendations if it] provide written recommendations and input
44 as it deems appropriate to the governor, the temporary president and the
45 minority leader of the senate, and the speaker and the minority leader
46 of the assembly on matters within its jurisdiction.
47 § 3. This act shall take effect immediately; provided that the amend-
48 ments to section 364-jj of the social services law made by section one
49 of this act shall be subject to the expiration and reversion of such
50 section pursuant to section 84 of part A of chapter 56 of the laws of
51 2013, as amended, when upon such date the provisions of section two of
52 this act shall take effect.
