Relates to the performance standards that must be met by managed long term care plans; enables managed long term care plans operated by organizations that also operate an Institutional Special Needs Plan (ISNP) or a PACE program, but not a Medicare Dual Eligible Special Needs Plan, to continue to meet managed long term care plans performance standards.
STATE OF NEW YORK
________________________________________________________________________
7554
2023-2024 Regular Sessions
IN ASSEMBLY
May 25, 2023
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to the performance
standards that must be met by managed long term care plans
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph (a) of subdivision 6-a of section 4403-f of the
2 public health law, as added by section 4 of part I of chapter 57 of the
3 laws of 2023, is amended to read as follows:
4 (a) On or before January first, two thousand twenty-four, each managed
5 long term care plan that has been issued a certificate of authority
6 pursuant to this section shall have an active Institutional Special
7 Needs Plan or a Medicare Dual Eligible Special Needs Plan in operation
8 whose H-contract either has a current quality star rating from the
9 Centers for Medicare and Medicaid Services of three stars or higher, or
10 has not been issued a quality star rating from the Centers for Medicare
11 and Medicaid Services, or a Program of All-Inclusive Care for the Elder-
12 ly (PACE). In addition, the managed long term care plan shall suffi-
13 ciently demonstrate success in the following performance categories:
14 (i) in addition to meeting the requirements of paragraph (j) of subdi-
15 vision seven of this section, in order to ensure network adequacy a
16 commitment to contracting with an adequate number of licensed home care
17 service agencies needed to provide necessary personal care services to
18 the greatest practicable number of enrollees, and with an adequate
19 number of fiscal intermediaries needed to provide necessary consumer
20 directed personal assistance services to the greatest practicable number
21 of enrollees in accordance with section three hundred sixty-five-f of
22 the social services law;
23 (ii) readiness to timely implement and adhere to maximum wait time
24 criteria for key categories of service in accordance with laws, rules
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11574-01-3
A. 7554 2
1 and regulations of the department or the Centers for Medicare and Medi-
2 caid Services;
3 (iii) commitment to quality improvement;
4 (iv) accessibility and geographic distribution of network providers,
5 taking into account the needs of persons with disabilities and the
6 differences between rural, suburban, and urban settings;
7 (v) demonstrated cultural and language competencies specific to the
8 population of participants;
9 (vi) ability to serve enrollees across the continuum of care, as
10 demonstrated by the type and number of products the managed long term
11 care operates or has applied to operate, including integrated care for
12 participants who are dually eligible for Medicaid and Medicare[, and
13 those operated under title one-A of article twenty-five of this chapter
14 and section three hundred sixty-nine-gg of the social services law]; and
15 (vii) value based care readiness and experience.
16 § 2. This act shall take effect immediately; provided, however, that
17 the amendments to section 4403-f of the public health law made by
18 section one of this act shall not affect the repeal of such section and
19 shall be deemed repealed therewith.
