STATE OF NEW YORK
________________________________________________________________________
985
2021-2022 Regular Sessions
IN ASSEMBLY
January 6, 2021
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the social services law and the public health law, in
relation to adverse determination notices to Medicaid recipients
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 9 of section 364-j of the social services law,
2 as amended by a chapter of the laws of 2020 amending the social
3 services law and the public health law relating to adverse determination
4 notices to Medicaid recipients, as proposed in legislative bills numbers
5 S.7241 and A.9538, is amended to read as follows:
6 9. Managed care providers shall inform participants of such provider's
7 grievance procedure and utilization review procedures under section
8 forty-four hundred eight-a and article forty-nine of the public health
9 law. A managed care provider or local social services district, as
10 appropriate, shall provide notice to participants of their respective
11 rights to a fair hearing and aid continuing in accordance with applica-
12 ble state and federal law. Managed care providers shall provide [writ-
13 ten] notice of the name, address, phone number and website of the
14 department of health designated independent consumer assistance program
15 and the independent substance use disorder and mental health ombudsman
16 established by section 33.27 of the mental hygiene law [on all] within
17 notices of adverse [determinations,] grievances and appeals determi-
18 nations.
19 § 2. Paragraph (b) of subdivision 2 and subdivision 7 of section
20 4408-a of the public health law, as amended by a chapter of the laws of
21 2020 amending the social services law and the public health law relat-
22 ing to adverse determination notices to Medicaid recipients, as proposed
23 in legislative bills numbers S.7241 and A.9538, are amended to read as
24 follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07169-01-1
A. 985 2
1 (b) The notice to an enrollee describing the grievance process shall
2 explain: (i) the process for filing a grievance with the organization;
3 (ii) the timeframes within which a grievance determination must be made;
4 (iii) the right of an enrollee to designate a representative to file a
5 grievance on behalf of the enrollee; and (iv) notice of the name,
6 address, phone number and website of the department designated consumer
7 assistance program and the independent substance use disorder and mental
8 health ombudsman established by section 33.27 of the mental hygiene law
9 [on all] within notices of adverse [determinations,] grievances and
10 appeals determinations.
11 7. The notice of a determination shall include: (i) the detailed
12 reasons for the determination; (ii) in cases where the determination has
13 a clinical basis, the clinical rationale for the determination; (iii)
14 the procedures for the filing of an appeal of the determination, includ-
15 ing a form for the filing of such an appeal; and (iv) notice of the
16 name, address, phone number and website of the department designated
17 consumer assistance program and the independent substance use disorder
18 and mental health ombudsman established by section 33.27 of the mental
19 hygiene law [on all] within notices of adverse [determinations,] griev-
20 ances and appeals determinations.
21 § 3. This act shall take effect on the same date and in the same
22 manner as a chapter of the laws of 2020 amending the social services
23 law and the public health law relating to adverse determination notices
24 to Medicaid recipients, as proposed in legislative bills numbers S.7241
25 and A.9538, takes effect; provided, however, the amendments to subdivi-
26 sion 9 of section 364-j of the social services law made by
27 section one of this act shall not affect the repeal of such section, and
28 shall be deemed repealed therewith.
