A07598 Summary:

BILL NO    A07598 

SAME AS    SAME AS S05535

SPONSOR    Gottfried

COSPNSR    Lupardo

MLTSPNSR   

Amd S4403-f, Pub Health L

Relates to the transition of traumatic brain injury waiver and nursing home
transition and diversion waiver program services to Medicaid managed care
programs.
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A07598 Actions:

BILL NO    A07598 

05/20/2015 referred to health
05/28/2015 reported referred to ways and means
06/08/2015 reported referred to rules
06/10/2015 reported 
06/10/2015 rules report cal.291
06/10/2015 ordered to third reading rules cal.291
06/15/2015 passed assembly
06/15/2015 delivered to senate
06/15/2015 REFERRED TO RULES
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A07598 Votes:

A07598 06/15/2015 145/1
AbbateYClarkERGanttYKimYMorelleYRichardYStecY
AbinantYColtonYGarbariYKolbYMosleyYRiveraYSteckY
ArroyoYCookYGiglioYLalorYMoyaYRobertsYStirpeY
AubryYCorwinYGjonajYLavineYMurrayYRobinsoYTediscoY
BarclayYCrespoYGlickYLawrencYNojayNORodriguYTenneyY
BarrettYCrouchYGoldfedYLentolYNolanYRosenthYThieleY
BarronYCurranYGoodellYLiftonYOaksYRozicYTitoneY
BenedetYCusickYGottfriYLinaresYO'DonneYRussellYTitusY
BichottYCymbrowYGrafYLopezYOrtizYRyanYWalkerY
BlakeYDavilaYGuntherYLupardoYOtisYSaladinYWalterY
BlankenYDenDekkYHawleyYLupinacYPalmesaYSantabaYWeinsteY
BorelliYDilanYHevesiYMageeYPalumboYSchimelYWeprinY
BrabeneYDinowitYHikindYMagnareYPaulinYSchimmiYWoernerY
BraunstYDiPietrYHooperYMalliotYPeoplesYSeawrigYWozniakY
BrennanYDupreyYJaffeeYMarkeyYPerryYSepulveYWrightY
BrindisYEnglebrYJean-PiYMayerYPersaudERSilverYZebrowsY
BronsonYFahyYJohnsYMcDonalYPichardYSimanowYMr SpkrY
Brook-KYFarrellYJoynerYMcDonouYPretlowYSimonY
BuchwalYFinchYKaminskYMcKevitYQuartYSimotasY
ButlerYFitzpatYKatzERMcLaughYRaYSkartadY
CahillYFriendYKavanagYMillerYRaiaYSkoufisY
CerettoYGalefYKearnsYMontesaYRamosYSolagesY

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A07598 Memo:

BILL NUMBER:A7598

TITLE OF BILL:  An act to amend the public health law, in relation to
the transition of traumatic brain injury waiver and nursing home
transition 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 providers and ability to stay in the community
under the new system.

The 1999 Supreme Court Olmstead decision ruled that unjustified
segregation 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
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A07598 Text:

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

                                         7598

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                     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    S  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.
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