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A04062 Summary:

BILL NO    A04062B

SAME AS    SAME AS S05896-A

SPONSOR    Gottfried

COSPNSR    Jaffee, Jacobs

MLTSPNSR   McDonald

Amd S364-jj, Soc Serv L

Relates to the membership and expands the duties of the special advisory review
panel on Medicaid managed care by including other managed care programs.
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A04062 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                        4062--B
                                                               Cal. No. 196

                              2013-2014 Regular Sessions

                                 I N  A S S E M B L Y

                                   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    S  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    S  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    S 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    S  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.
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