STATE OF NEW YORK
________________________________________________________________________
7241
IN SENATE
January 13, 2020
___________
Introduced by Sen. RIVERA -- read twice and ordered printed, and when
printed to be committed 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 chapter 433 of the laws of 1997, is amended to read as
3 follows:
4 9. Managed care providers shall inform participants of such provider's
5 grievance procedure and utilization review procedures [required pursuant
6 to sections forty-four hundred eight-c and] under article forty-nine
7 [hundred] of the public health law. A managed care provider or local
8 social services district, as appropriate, shall provide notice to
9 participants of their respective rights to a fair hearing and aid
10 continuing in accordance with applicable state and federal law. Managed
11 care providers shall provide written notice of the name, address, phone
12 number and website of the department of health designated independent
13 consumer assistance program and the independent substance use disorder
14 and mental health ombudsman established by section 33.27 of the mental
15 hygiene law on all notices of adverse determinations, grievances and
16 appeals.
17 § 2. Paragraph (b) of subdivision 2 and subdivision 7 of section
18 4408-a of the public health law, as added by chapter 705 of the laws of
19 1996, are amended to read as follows:
20 (b) The notice to an enrollee describing the grievance process shall
21 explain: (i) the process for filing a grievance with the organization;
22 (ii) the timeframes within which a grievance determination must be made;
23 [and] (iii) the right of an enrollee to designate a representative to
24 file a grievance on behalf of the enrollee; and (iv) notice of the name,
25 address, phone number and website of the department designated consumer
26 assistance program and the independent substance use disorder and mental
27 health ombudsman established by section 33.27 of the mental hygiene law
28 on all notices of adverse determinations, grievances and appeals.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14155-02-9
S. 7241 2
1 7. The notice of a determination shall include: (i) the detailed
2 reasons for the determination; (ii) in cases where the determination has
3 a clinical basis, the clinical rationale for the determination; [and]
4 (iii) the procedures for the filing of an appeal of the determination,
5 including a form for the filing of such an appeal; and (iv) notice of
6 the name, address, phone number and website of the department designated
7 consumer assistance program and the independent substance use disorder
8 and mental health ombudsman established by section 33.27 of the mental
9 hygiene law on all notices of adverse determinations, grievances and
10 appeals.
11 § 3. This act shall take effect on the one hundred eightieth day after
12 it shall have become a law; provided, however, the amendments made to
13 subdivision 9 of section 364-j of the social services law made by
14 section one of this act shall not affect the repeal of such section, and
15 shall be deemed repealed therewith.
