BILL NO A04062A
SAME AS No same as
SPONSOR Gottfried
COSPNSR Jaffee
MLTSPNSR
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.
S T A T E O F N E W Y O R K
________________________________________________________________________
4062--A
2013-2014 Regular Sessions
I N A S S E M B L Y
January 30, 2013
___________
Introduced by M. of A. GOTTFRIED, JAFFEE -- 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
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-
22 sation but shall be reimbursed for appropriate expenses. The department
23 shall provide technical assistance and access to data as is required for
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01605-03-3
A. 4062--A 2
1 the panel to effectuate the mission and purposes established herein. THE
2 PANEL SHALL BE REQUIRED TO SEEK PUBLIC COMMENT ON MATTERS WITHIN ITS
3 JURISDICTION. PANEL MEETING TIMES, AGENDAS, AND MINUTES SHALL BE POSTED
4 PUBLICLY ON THE DEPARTMENT'S WEBSITE AT LEAST ONE WEEK PRIOR TO EACH
5 MEETING.
6 (b) The panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
7 TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS SPECIALIZED
8 ISSUES, IN ORDER TO:
9 (i) determine whether there is sufficient managed care provider
10 participation in the Medicaid managed care program AND RELATED PROGRAMS;
11 (ii) determine whether managed care providers meet proper enrollment
12 targets that permit as many Medicaid recipients as possible to make
13 their own health plan decisions, thus minimizing the number of automatic
14 assignments;
15 (iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in sched-
16 ule, AND THE AVAILABILITY OF SPECIALTY SERVICES for enrollment[,] of
17 ADDITIONAL POPULATIONS AND managed care providers under both the volun-
18 tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
19 TY OF CARE DURING AND AFTER THE TRANSITION;
20 (iv) assess the impact of managed care provider marketing and enroll-
21 ment strategies, [and the] INCLUDING public education [campaign
22 conducted in New York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
23 ipation in Medicaid managed care plans AND RELATED PROGRAMS;
24 (v) evaluate the adequacy of managed care provider capacity by review-
25 ing established capacity measurements and monitoring actual access to
26 plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
27 WITH DISABILITIES AND OTHERS IN NEED OF SUCH CARE, WITH PARTICULAR
28 ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY PROVIDED IN THE TRADI-
29 TIONAL FEE FOR SERVICE ENVIRONMENT;
30 (vi) examine the [cost] implications of [populations excluded and
31 exempted from Medicaid managed care] FEDERAL HEALTH CARE REFORM ON THE
32 MEDICAID MANAGED CARE PROGRAM AND RELATED PROGRAMS, WITH PARTICULAR
33 ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
34 PRODUCTS AVAILABLE IN ANY POTENTIAL STATE INSURANCE EXCHANGE AND ANY
35 OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
36 (vii) in accordance with the recommendations of the joint advisory
37 council established pursuant to section 13.40 of the mental hygiene law,
38 advise the commissioners of health and developmental disabilities with
39 respect to the oversight of DISCOs and of health maintenance organiza-
40 tions and managed long term care plans providing services authorized,
41 funded, approved or certified by the office for people with develop-
42 mental disabilities, and review all managed care options provided to
43 persons with developmental disabilities, including: the adequacy of
44 support for habilitation services; the record of compliance with
45 requirements for person-centered planning, person-centered services and
46 community integration; the adequacy of rates paid to providers in
47 accordance with the provisions of paragraph 1 of subdivision four of
48 section forty-four hundred [three] THREE-F of the public health law,
49 paragraph (a-2) of subdivision eight of section forty-four hundred three
50 of the public health law or paragraph (a-2) of subdivision twelve of
51 section forty-four hundred three-f of the public health law; and the
52 quality of life, health, safety and community integration of persons
53 with developmental disabilities enrolled in managed care; [and]
54 (viii) EVALUATE TRENDS IN SERVICE DENIALS BY MEDICAID MANAGED CARE
55 PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
56 MECHANISMS FOR CONSUMERS;
A. 4062--A 3
1 (IX) EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS AND
2 QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER FACTORS AND
3 THE AVAILABILITY OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARITIES
4 IN ACCESS TO CARE AND OUTCOMES OF CARE;
5 (X) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
6 (XI) REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
7 TED TO THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE PLAN AMENDMENTS
8 RELATED TO TOPICS AND PROGRAMS WITHIN ITS JURISDICTION, AND SOLICIT
9 PUBLIC INVOLVEMENT IN THE PROPOSALS;
10 (XII) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
11 MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
12 CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
13 (XIII) examine other issues as it deems appropriate.
14 (c) Commencing January first, [nineteen hundred ninety-seven] TWO
15 THOUSAND FOURTEEN and quarterly thereafter the panel shall [submit a
16 report regarding the status of Medicaid managed care in the state and
17 provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
18 AS IT deems appropriate to the governor, the temporary president and the
19 minority leader of the senate, and the speaker and the minority leader
20 of the assembly ON MATTERS WITHIN ITS JURISDICTION.
21 S 2. Section 364-jj of the social services law, as added by chapter
22 649 of the laws of 1996, is amended to read as follows:
23 S 364-jj. Special advisory review panel on Medicaid managed care. (a)
24 There is hereby established a special advisory review panel on Medicaid
25 managed care AND RELATED PUBLIC HEALTH INSURANCE PROGRAMS, INCLUDING
26 CHILD HEALTH PLUS, FAMILY HEALTH PLUS, MANAGED LONG TERM CARE PROGRAMS
27 AND RELATED CARE COORDINATION MODELS, MANAGED CARE PROGRAMS DIRECTED AT
28 COORDINATING CARE FOR DUALLY ELIGIBLE MEDICAID AND MEDICARE ENROLLEES,
29 AND OTHER PUBLIC HEALTH COVERAGE CARE MANAGEMENT PROGRAMS, INCLUDING BUT
30 NOT LIMITED TO HEALTH HOMES AND MEDICAL HOMES. The panel shall consist
31 of [nine] ELEVEN members who shall be appointed as follows: [three] FIVE
32 by the governor, one of which shall serve as the chair, TWO OF WHICH
33 SHALL BRING EXPERTISE IN ACCESS ISSUES FACING MEDICAID CONSUMERS WITH
34 DISABILITIES, AND ONE OF WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES
35 FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY; two each by
36 the temporary president of the senate and the speaker of the assembly;
37 and one each by the minority leader of the senate and the minority lead-
38 er of the assembly. [All members shall be appointed no later than
39 September first, nineteen hundred ninety-six.] Members shall serve with-
40 out compensation but shall be reimbursed for appropriate expenses. The
41 department shall provide technical assistance and access to data as is
42 required for the panel to effectuate the mission and purposes estab-
43 lished herein. THE PANEL SHALL BE REQUIRED TO SEEK PUBLIC COMMENT ON
44 MATTERS WITHIN ITS JURISDICTION. PANEL MEETING TIMES, AGENDAS, AND
45 MINUTES SHALL BE POSTED PUBLICLY ON THE DEPARTMENT'S WEBSITE AT LEAST
46 ONE WEEK PRIOR TO EACH MEETING.
47 (b) The panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
48 TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS SPECIALIZED
49 ISSUES, IN ORDER TO:
50 (i) determine whether there is sufficient managed care provider
51 participation in the Medicaid managed care program AND RELATED PROGRAMS;
52 (ii) determine whether managed care providers meet proper enrollment
53 targets that permit as many Medicaid recipients as possible to make
54 their own health plan decisions, thus minimizing the number of automatic
55 assignments;
A. 4062--A 4
1 (iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in sched-
2 ule, AND THE AVAILABILITY OF SPECIALTY SERVICES for enrollment[,] of
3 ADDITIONAL POPULATIONS AND managed care providers under both the volun-
4 tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
5 TY OF CARE DURING AND AFTER THE TRANSITION;
6 (iv) assess the impact of managed care provider marketing and enroll-
7 ment strategies, [and the] INCLUDING public education [campaign
8 conducted in New York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
9 ipation in Medicaid managed care plans AND RELATED PROGRAMS;
10 (v) evaluate the adequacy of managed care provider capacity by review-
11 ing established capacity measurements and monitoring actual access to
12 plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
13 WITH DISABILITIES AND OTHERS IN NEED OF SUCH CARE, WITH PARTICULAR
14 ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY PROVIDED IN THE TRADI-
15 TIONAL FEE FOR SERVICE ENVIRONMENT;
16 (vi) examine the [cost] implications of [populations excluded and
17 exempted from Medicaid managed care; and] FEDERAL HEALTH CARE REFORM ON
18 THE MEDICAID MANAGED CARE PROGRAM AND RELATED PROGRAMS, WITH PARTICULAR
19 ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
20 PRODUCTS AVAILABLE IN ANY POTENTIAL STATE INSURANCE EXCHANGE AND ANY
21 OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
22 (vii) EVALUATE TRENDS IN SERVICE DENIALS BY MEDICAID MANAGED CARE
23 PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
24 MECHANISMS FOR CONSUMERS;
25 (VIII) EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS
26 AND QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER FACTORS
27 AND THE AVAILABILITY OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARI-
28 TIES IN ACCESS TO CARE AND OUTCOMES OF CARE;
29 (IX) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
30 (X) REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
31 TED TO THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE PLAN AMENDMENTS
32 RELATED TO TOPICS AND PROGRAMS WITHIN ITS JURISDICTION, AND SOLICIT
33 PUBLIC INVOLVEMENT IN THE PROPOSALS;
34 (XI) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
35 MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
36 CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
37 (XII) examine other issues as it deems appropriate.
38 (c) Commencing January first, [nineteen hundred ninety-seven] TWO
39 THOUSAND FOURTEEN and quarterly thereafter the panel shall [submit a
40 report regarding the status of Medicaid managed care in the state and
41 provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
42 AS IT deems appropriate to the governor, the temporary president and the
43 minority leader of the senate, and the speaker and the minority leader
44 of the assembly ON MATTERS WITHIN ITS JURISDICTION.
45 S 3. This act shall take effect immediately; provided that the amend-
46 ments to section 364-jj of the social services law made by section one
47 of this act shall be subject to the expiration and reversion of such
48 section pursuant to section 84 of part A of chapter 56 of the laws of
49 2013, as amended, when upon such date the provisions of section two of
50 this act shall take effect.
