S07800 Summary:

BILL NOS07800
 
SAME ASSAME AS A08470
 
SPONSORRIVERA
 
COSPNSRBRISPORT, CLEARE, COMRIE, FERNANDEZ, GONZALEZ, HARCKHAM, HINCHEY, HOYLMAN-SIGAL, JACKSON, KENNEDY, MAY, MAYER, PARKER, RAMOS, SALAZAR, SKOUFIS, STAVISKY
 
MLTSPNSR
 
Rpld & add §4403-f, rpld §2807-x, amd §§2801-e, 2807-v, 3605, 3614 & 4409, Pub Health L; amd §§365-a, 364-j, 364-jj, 365-f, 365-h & 366, Soc Serv L; amd §218, Eld L; amd §13.40, Ment Hyg L
 
Repeals managed long term care provisions for Medicaid recipients; establishes provisions for fully integrated plans for long term care including PACE and MAP plans.
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S07800 Actions:

BILL NOS07800
 
12/11/2023REFERRED TO RULES
01/03/2024REFERRED TO HEALTH
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S07800 Committee Votes:

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S07800 Floor Votes:

There are no votes for this bill in this legislative session.
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S07800 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7800
 
                               2023-2024 Regular Sessions
 
                    IN SENATE
 
                                    December 11, 2023
                                       ___________
 
        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules
 
        AN ACT to amend the public health law,  the  social  services  law,  the
          elder  law  and  the mental hygiene law, in relation to long term care
          options; and to repeal certain provisions of  the  public  health  law
          relating to managed long term care
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Legislative intent.   The state, as part  of  an  ambitious
     2  effort  to  move  all  Medicaid recipients to some form of managed care,
     3  moved those in need of home and community-based long term care  services
     4  for  over  a  one  hundred twenty day period into managed long term care
     5  plans on a mandatory basis over ten years ago. The  original  intent  of
     6  the MLTC program was that the managed long term care plans would develop
     7  into fully capitated plans over time. This has not happened.
     8    Therefore, it is the intent of the legislature to repeal the partially
     9  capitated  managed long term care program and instead, provide appropri-
    10  ate home and community-based long term care benefits  under  a  fee-for-
    11  service  arrangement.  Fully capitated programs such as the PACE program
    12  shall continue to be an option. This transition shall not be implemented
    13  until the commissioner of health is satisfied  that  all  necessary  and
    14  appropriate transition planning has occurred, and federal approvals have
    15  been obtained.
    16    §  2.  Section  4403-f  of the public health law is REPEALED and a new
    17  section 4403-f is added to read as follows:
    18    § 4403-f. Long term care options. 1.  The following words or  phrases,
    19  as used in this section, shall have the following meanings:
    20    (a)  "Program  of all-inclusive care of the elderly" or "PACE" means a
    21  fully capitated federally recognized model  of  comprehensive  care  for
    22  persons  fifty-five years of age or older that are eligible for medicaid
    23  and may also be eligible  for  Medicare,  qualifying  for  nursing  home
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13640-07-3

        S. 7800                             2
 
     1  levels of care who wish to remain in their community (see, Sections 1894
     2  and  1934  to Title XVIII of the Social Security Act; 42 CFR 460), which
     3  are licensed to operate under article twenty-nine-ee of this chapter.
     4    (b) "Medicaid advantage plus program" or "MAP" means a fully capitated
     5  state  developed  model of comprehensive care for persons eighteen years
     6  of age or older that are eligible for Medicaid  and  also  eligible  for
     7  medicare, qualifying for nursing home levels of care.
     8    (c)  "Care  coordination  entity"  means  an  entity that has obtained
     9  approval from the commissioner based on guidelines  established  by  the
    10  department  to  promote  continuity of care and coordination of services
    11  for all enrollees.   The entity  may  be  organized  as  a  health  home
    12  specially   certified  by the  commissioner to serve home and community-
    13  based services eligible recipients, but this shall  not  preclude  other
    14  organizational structures as determined by the commissioner.
    15    2.  The  commissioner  shall submit the appropriate waivers, including
    16  but not limited to those authorized pursuant to sections eleven  hundred
    17  fifteen  and nineteen hundred fifteen of the federal social security act
    18  or successor provisions, and any other waivers necessary to  require  on
    19  or after April first, two thousand twenty-six, medical assistance recip-
    20  ients  who  are eighteen years of age or older and who require long term
    21  care services, as specified by the commissioner, for a continuous period
    22  of more than one hundred twenty days, to receive such  services  through
    23  an  available  fully  integrated  plan  including a PACE or MAP plan, or
    24  through a fee-for-service based model with  services  coordinated  by  a
    25  care coordination entity. The commissioner shall establish guidelines on
    26  the  establishment  and  operation  of  care coordination entities. Such
    27  guidelines shall  address  the  payment  methods  that  ensure  provider
    28  accountability for cost effective quality outcomes. Copies of such waiv-
    29  er  applications  and amendments thereto shall be provided to the chairs
    30  of the senate finance committee, the assembly ways and  means  committee
    31  and the senate and assembly health committees before their submission to
    32  the federal government.
    33    3.  Persons  that  are  determined  eligible to receive long term care
    34  services through PACE or MAP, or through a fee-for-service  based  model
    35  with  services  coordinated  by  a  care coordination entity established
    36  pursuant to subdivision two of this section shall have  at least  thirty
    37  days  to  select a PACE or MAP provider, or care coordination entity and
    38  shall  be provided with information to make an informed choice. Where  a
    39  participant  has not selected such a provider or care coordination enti-
    40  ty,  the commissioner shall assign such participant to  a  care  coordi-
    41  nation  entity taking into account consistency with any prior community-
    42  based direct care workers having recently served the recipient,  quality
    43  performance criteria, capacity and geographic accessibility.
    44    §  3.  Subdivision  2  of  section 365-a of the social services law is
    45  amended by adding two new paragraphs (mm) and (nn) to read as follows:
    46    (mm) The department shall  promulgate  regulations  for  all  Medicaid
    47  enrollees receiving services through a fee-for-service model pursuant to
    48  section forty-four hundred three-f of the public health law that include
    49  the establishment and operation of care coordination entities to promote
    50  continuity  of  care  and  coordination  of services to ensure that each
    51  enrollee has an ongoing source of care appropriate  to  their  needs  as
    52  required  by  42  CFR § 438.208. The regulations shall include conflict-
    53  free case management protections to ensure that assessment  and  coordi-
    54  nation  of services are separate from the delivery of those services. In
    55  selecting providers of case management services,  the  department  shall

        S. 7800                             3
 
     1  prioritize  providers with proven experience serving populations receiv-
     2  ing home and personal care services.
     3    (nn)  The  department  shall conduct an evaluation of the viability of
     4  utilizing care coordination entities operating pursuant to this  section
     5  for  assessments  or  reassessments required for determining an individ-
     6  ual's needs for services that are controlled by the independent assessor
     7  established pursuant to subdivision ten of section three hundred  sixty-
     8  five-a of this title.
     9    §  4.  Stakeholder  engagement.  1.  The  commissioner of health shall
    10  convene an advisory group composed of stakeholder representatives  which
    11  shall  seek  input from representatives of home and community-based long
    12  term care services  providers,  including  representative  associations,
    13  recipients,  the  department of health, local social services districts,
    14  and the direct care workforce, among others, to:
    15    (a) further evaluate and promote the transition of persons in  receipt
    16  of home and community-based long term care services into fee-for-service
    17  arrangements,  where  appropriate,  and  to  develop guidelines for such
    18  care; and
    19    (b) determine a process to transition  providers,  including  but  not
    20  limited  to  licensed home care services agencies, certified home health
    21  agencies, and fiscal intermediaries, to a fee-for-service  reimbursement
    22  system.
    23    2.  In  implementing  the  transition  to  a fee-for-service model the
    24  commissioner of health, in consultation with the advisory group,  shall,
    25  to  the  extent  practicable,  consider and select programs and policies
    26  that seek to maximize continuity of care and minimize disruption to  the
    27  provider  labor  workforce,  and  shall  continue  to support providers,
    28  licensed home care services agencies, and fiscal intermediaries that are
    29  based on a commitment to quality and value;  provided  that  nothing  in
    30  this  subdivision  shall supersede or invalidate any contracts or awards
    31  provided to fiscal intermediaries pursuant to subdivision 4-a of section
    32  365-f of the social services law, provided that the provisions of subdi-
    33  vision 4-b of section 365-f of  the  social  services  law  shall  still
    34  apply,  or  contracts  or awards provided to licensed home care services
    35  agencies pursuant to section 3605-c of the public health law.
    36    3. The commissioner of health shall report biannually on the implemen-
    37  tation of this section. The reports shall include, but  not  be  limited
    38  to: (a) satisfaction of enrollees with care coordination/case management
    39  and  timeliness  of care; (b) service utilization data including changes
    40  in the level, hours, frequency, and types of services and providers; (c)
    41  enrollment data; (d) quality  data;  and  (e)  continuity  of  care  for
    42  participants  as  they  move  out of managed long term care and into the
    43  fee-for-service model. The commissioner shall publish the report on  the
    44  department's  website  and  provide notice to the temporary president of
    45  the senate, the speaker of the assembly, the chair of the senate  stand-
    46  ing committee on health and the chair of the assembly health committee.
    47    4. The commissioner of health shall seek input from representatives of
    48  home  and community-based long term care services providers, recipients,
    49  and the Medicaid managed care advisory review panel,  among  others,  to
    50  assist in the development of guidelines for the establishment and opera-
    51  tion  of  care  coordination  entities pursuant to section 4403-f of the
    52  public health law. The guidelines shall be finalized and posted  on  the
    53  department  of  health's website no later than November first, two thou-
    54  sand twenty-five.

        S. 7800                             4
 
     1    § 5. Paragraph (o) of subdivision 2 of section  365-a  of  the  social
     2  services law, as added by chapter 659 of the laws of 1997, is amended to
     3  read as follows:
     4    (o)  care  and services furnished by a [managed long term care plan or
     5  approved managed long term care demonstration pursuant to the provisions
     6  of] PACE or MAP plan as such terms are  defined  by  section  forty-four
     7  hundred three-f of the public health law to eligible individuals [resid-
     8  ing  in  the  geographic area] served by such entity, when such services
     9  are furnished in accordance with an agreement  with  the  department  of
    10  health  and  meet  the  applicable requirements of federal law and regu-
    11  lation.
    12    § 6. Subparagraph (iii) of paragraph (e) of subdivision 2  of  section
    13  365-a  of  the social services law, as amended by section 36-a of part B
    14  of chapter 57 of the laws of 2015, is amended to read as follows:
    15    (iii) the commissioner shall provide assistance to  persons  receiving
    16  services  under  this  paragraph who are transitioning to receiving care
    17  from a [managed long term care plan certified pursuant to] PACE  or  MAP
    18  plan  as such terms are defined by section forty-four hundred three-f of
    19  the public health law, consistent with subdivision thirty-one of section
    20  three hundred sixty-four-j of this title;
    21    § 7. Subdivision 10 of section 365-a of the social  services  law,  as
    22  amended  by  section  1 of part QQ of chapter 57 of the laws of 2022, is
    23  amended to read as follows:
    24    10. The department of health shall establish or procure  the  services
    25  of  an  independent assessor or assessors no later than October 1, 2022,
    26  in a manner and schedule as determined by the commissioner of health, to
    27  take over from local departments  of  social  services[,]  and  Medicaid
    28  Managed  Care  providers,  [and  Medicaid  managed long term care plans]
    29  including a MAP plan, or a PACE plan if the PACE plan elects to  utilize
    30  the independent assessor as such terms are defined by section forty-four
    31  hundred three-f of the public health law, the performance of assessments
    32  and  reassessments  required  for  determining  individuals'  needs  for
    33  personal care services,  including  as  provided  through  the  consumer
    34  directed  personal  assistance  program,  and other services or programs
    35  available pursuant to the state's medical assistance program  as  deter-
    36  mined  by  such  commissioner  for  the purpose of improving efficiency,
    37  quality, and reliability in assessment [and  to  determine  individuals'
    38  eligibility  for Medicaid managed long term care plans]. Notwithstanding
    39  the provisions of section one hundred sixty-three of the  state  finance
    40  law,  or  sections  one hundred forty-two and one hundred forty-three of
    41  the  economic  development  law,  or  any  contrary  provision  of  law,
    42  contracts  may  be  entered or the commissioner may amend and extend the
    43  terms of a contract awarded prior to the effective date and entered into
    44  to conduct enrollment broker and conflict-free evaluation  services  for
    45  the  Medicaid program, if such contract or contract amendment is for the
    46  purpose of procuring such assessment services from an independent asses-
    47  sor. Contracts entered into,  amended,  or  extended  pursuant  to  this
    48  subdivision shall not remain in force beyond September 30, 2025.
    49    § 8. Paragraph (d) of subdivision 1 and paragraph (h) of subdivision 3
    50  of  section 218 of the elder law, as amended by section 1 of chapter 259
    51  of the laws of 2018, are amended to read as follows:
    52    (d) "Long-term care facilities" shall  mean  residential  health  care
    53  facilities  as  defined  in  subdivision  three  of section twenty-eight
    54  hundred one of the public health law; adult care facilities  as  defined
    55  in  subdivision  twenty-one  of  section two of the social services law,
    56  including those adult homes and enriched housing  programs  licensed  as

        S. 7800                             5
 
     1  assisted  living  residences,  pursuant  to  article  forty-six-B of the
     2  public health law; or any facilities which hold themselves out or adver-
     3  tise themselves as providing assisted  living  services  and  which  are
     4  required  to  be  licensed or certified under the social services law or
     5  the public health law. Within the amounts appropriated therefor,  "long-
     6  term  care facilities" shall also mean [managed long-term care plans and
     7  approved managed long-term care or operating demonstrations] a  PACE  or
     8  MAP plan as such terms are defined in section forty-four hundred three-f
     9  of the public health law and the term "resident", "residents", "patient"
    10  and "patients" shall also include enrollees of such plans.
    11    (h) Within the amounts appropriated therefor, the state long-term care
    12  ombudsman  program shall include services specifically designed to serve
    13  persons enrolled in [managed long-term care plans  or  approved  managed
    14  long-term  care  or operating demonstrations authorized under] a PACE or
    15  MAP plan as such terms are defined by section forty-four hundred three-f
    16  of the  public  health  law,  and  shall  also  review  and  respond  to
    17  complaints  relating  to  marketing  practices  by such plans and demon-
    18  strations.
    19    § 9. Subdivisions (a), (c), (d), (f), the opening paragraph of  subdi-
    20  vision  (g)  and  subdivision (h) of section 13.40 of the mental hygiene
    21  law, subdivisions (a), (d), (f) and the opening paragraph of subdivision
    22  (g) as added by section 72-b of part A of chapter  56  of  the  laws  of
    23  2013,  subdivision  (c) as amended by section 17 of part Z of chapter 57
    24  of the laws of 2018, and subdivision (h) as added by section 1 of part D
    25  of chapter 58 of the laws of 2014, are amended to read as follows:
    26    (a) The commissioner and the  commissioner  of  health  shall  jointly
    27  establish  a  people  first  waiver program for purposes of developing a
    28  care coordination model that integrates various  long-term  habilitation
    29  supports  and/or  health  care.  The  people  first waiver program shall
    30  include the use of developmental disability individual support and  care
    31  coordination  organizations,  herein  referred to as DISCOs, pursuant to
    32  section forty-four hundred three-g of  the  public  health  law,  health
    33  maintenance   organizations,  herein  referred  to  as  HMOs,  providing
    34  services under subdivision eight of section forty-four hundred three  of
    35  the  public  health  law,  and  [managed]  long term care [plans, herein
    36  referred to as MLTCs] options, providing or coordinating services  under
    37  [subdivisions  twelve,  thirteen  and  fourteen  of]  section forty-four
    38  hundred three-f of the public health law.  Services shall be provided as
    39  described in section forty-four hundred three-g  of  the  public  health
    40  law, subdivision eight of section forty-four hundred three of the public
    41  health  law, and [subdivisions twelve, thirteen and fourteen of] section
    42  forty-four hundred three-f of the public health law.
    43    (c) No person with a developmental  disability  who  is  receiving  or
    44  applying  for  medical  assistance  and who is receiving, or eligible to
    45  receive, services operated, funded, certified, authorized or approved by
    46  the office, shall be required to enroll in a DISCO, HMO or  [MLTC]  long
    47  term  care  option  in  order  to  receive  such  services until program
    48  features and reimbursement rates are approved by  the  commissioner  and
    49  the  commissioner of health, and until such commissioners determine that
    50  a sufficient number of plans that are authorized to coordinate care  for
    51  individuals  pursuant  to this section or that are authorized to operate
    52  and to exclusively enroll persons with developmental disabilities pursu-
    53  ant to subdivision twenty-seven of section three hundred sixty-four-j of
    54  the social services law are operating in such person's county  of  resi-
    55  dence  to meet the needs of persons with developmental disabilities, and
    56  that such entities meet the standards of this section. No  person  shall

        S. 7800                             6
 
     1  be required to enroll in a DISCO, HMO or [MLTC] long term care option in
     2  order  to  receive  services  operated, funded, certified, authorized or
     3  approved by the office until there are at least two  entities  operating
     4  under  this section in such person's county of residence, unless federal
     5  approval is secured to require enrollment when there are less  than  two
     6  such entities operating in such county. Notwithstanding the foregoing or
     7  any other law to the contrary, any health care provider: (i) enrolled in
     8  the  Medicaid program and (ii) rendering hospital services, as such term
     9  is defined in section twenty-eight hundred one of the public health law,
    10  to an individual with a developmental disability who is  enrolled  in  a
    11  DISCO, HMO or [MLTC] long term care option, or a prepaid health services
    12  plan  operating  pursuant  to  section forty-four hundred three-a of the
    13  public health law, including, but not limited to, an individual  who  is
    14  enrolled in a plan authorized by section three hundred sixty-four-j [or]
    15  of the social services law, shall accept as full reimbursement the nego-
    16  tiated  rate or, in the event that there is no negotiated rate, the rate
    17  of payment that the applicable government agency would otherwise pay for
    18  such rendered hospital services.
    19    (d) DISCOs, HMOs and [MLTCs] long term care  options  operating  under
    20  this  section  shall  ensure,  to  the greatest extent practicable, that
    21  their assessment, services, and the grievance and appeals processes  are
    22  culturally and linguistically competent.
    23    (f) There shall be a joint advisory council chaired by the commission-
    24  er  and  the  commissioner of health that shall be charged with advising
    25  both commissioners in regard to the oversight of DISCOs, HMOs  providing
    26  services  under subdivision eight of section forty-four hundred three of
    27  the public health law, and [MLTCs]  long  term  care  options  providing
    28  services  under  [subdivisions twelve, thirteen and fourteen of] section
    29  forty-four hundred three-f of the public health law. The joint  advisory
    30  council may be comprised of the members of existing advisory councils or
    31  similar entities serving the office, provided that it shall be comprised
    32  of  twelve  members,  including individuals with developmental disabili-
    33  ties, family members of, advocates for, and  providers  of  services  to
    34  people with developmental disabilities. Three members of the joint advi-
    35  sory  council shall also be members of the special advisory review panel
    36  on medicaid managed care established under section three hundred  sixty-
    37  four-jj  of  the  social  services law. The joint advisory council shall
    38  review all managed care options provided to  individuals  with  develop-
    39  mental  disabilities,  including: the adequacy of habilitation services;
    40  the record of compliance with person-centered planning,  person-centered
    41  services  and  community  integration;  the  adequacy  of  rates paid to
    42  providers in accordance with the provisions of [paragraph one of  subdi-
    43  vision  four  of]  section forty-four hundred three of the public health
    44  law, paragraph [a-two] (a-2) of subdivision eight of section  forty-four
    45  hundred  three  of the public health law or [paragraph a-two of subdivi-
    46  sion twelve of] section forty-four hundred three-f of the public  health
    47  law;  and  quality  of life, health, safety and community integration of
    48  individuals with developmental disabilities enrolled  in  managed  care.
    49  The commissioner and commissioner of the office for people with develop-
    50  mental  disabilities or their designees shall attend all meetings of the
    51  joint advisory council. The joint  advisory  council  shall  report  its
    52  findings,  recommendations,  and  any  proposed  amendments to pertinent
    53  sections of the law to the commissioner and the commissioner of  health,
    54  the  senate majority leader and speaker of the assembly. The joint advi-
    55  sory council shall have access to any and all information  that  may  be

        S. 7800                             7
 
     1  lawfully  disclosed to it and that is necessary to perform its functions
     2  under this section.
     3    Notwithstanding  any  inconsistent  provision  of sections one hundred
     4  twelve and one hundred sixty-three of the state finance law, or  section
     5  one  hundred forty-two of the economic development law, or any other law
     6  to the contrary, the commissioner and the  commissioner  of  health  are
     7  authorized  to  enter  into a contract or contracts under section forty-
     8  four hundred three-g of the public  health  law,  subdivision  eight  of
     9  section forty-four hundred three of the public health law, and [subdivi-
    10  sion  twelve of] section forty-four hundred three-f of the public health
    11  law, provided, however, that:
    12    (h) Consistent with and subject to the terms of federal approval,  the
    13  commissioner  shall establish the managed care for persons with develop-
    14  mental disabilities advocacy program, hereinafter  referred  to  as  the
    15  advocacy  program. The activities of the advocacy program shall be coor-
    16  dinated with the  independent  Medicaid  managed  care  ombuds  services
    17  provided  to  persons  with  disabilities  enrolling in Medicaid managed
    18  care. The advocacy program shall advise individuals of applicable rights
    19  and responsibilities, provide information and assistance to address  the
    20  needs of individuals with disabilities, and pursue legal, administrative
    21  and other appropriate remedies or approaches to ensure the protection of
    22  and advocacy for the rights of the enrollees. The advocacy program shall
    23  provide  support to eligible individuals with developmental disabilities
    24  enrolling in developmental disability individual support and care  coor-
    25  dination organizations pursuant to section forty-four hundred three-g of
    26  the  public  health  law,  health  maintenance  organizations  providing
    27  services pursuant to subdivision eight  of  section  forty-four  hundred
    28  three of the public health law, [managed long term care plans] long term
    29  care options providing services under [subdivisions twelve, thirteen and
    30  fourteen  of]  section  forty-four  hundred three-f of the public health
    31  law, and fully integrated dual advantage plans providing services  under
    32  subdivision  twenty-seven  of  section three hundred sixty-four-j of the
    33  social services law. The commissioner shall select an independent organ-
    34  ization or organizations to provide advocacy services under this  subdi-
    35  vision.
    36    §  10.  Paragraph (c) of subdivision 6 of section 2801-e of the public
    37  health law, as amended by chapter 257 of the laws of 2005, is amended to
    38  read as follows:
    39    (c) The commissioner may, as necessary, waive  existing  methodologies
    40  for  determining  public  need under this article, article thirty-six of
    41  this chapter and article seven of the social services law[, as  well  as
    42  enrollment  limitations under section forty-four hundred three-f of this
    43  chapter,] to accommodate permanent conversions of beds to other programs
    44  or services on the basis that any such increases in capacity are  linked
    45  to  commensurate  reductions  in  the  number of residential health care
    46  facility beds.
    47    § 11. The opening paragraph of paragraph (ccc)  of  subdivision  1  of
    48  section  2807-v  of  the  public health law, as amended by section 12 of
    49  part C of chapter 57 of the laws of 2023, is amended to read as follows:
    50    Funds shall be deposited by the commissioner, within amounts appropri-
    51  ated, and the state comptroller is hereby  authorized  and  directed  to
    52  receive for the deposit to the credit of the state special revenue funds
    53  -  other, HCRA transfer fund, medical assistance account, or any succes-
    54  sor fund or  account,  for  purposes  of  funding  the  state  share  of
    55  increases  in  the  rates  for certified home health agencies, long term
    56  home health care programs, AIDS home care programs, hospice programs and

        S. 7800                             8
 
     1  [managed] long term care [plans and  approved  managed  long  term  care
     2  operating  demonstrations  as  defined in] options in section forty-four
     3  hundred three-f of this chapter for recruitment and retention of  health
     4  care workers pursuant to subdivisions nine and ten of section thirty-six
     5  hundred  fourteen of this chapter from the tobacco control and insurance
     6  initiatives pool established for the following periods in the  following
     7  amounts:
     8    § 12. Section 2807-x of the public health law is REPEALED.
     9    §  13.  Subdivision  8  of  section  3605 of the public health law, as
    10  amended by section 49 of part D of chapter 56 of the laws  of  2012,  is
    11  amended to read as follows:
    12    8. Agencies licensed pursuant to this section but not certified pursu-
    13  ant  to  section  [three  thousand six hundred eight] thirty-six hundred
    14  eight of this article, shall not be qualified to participate as  a  home
    15  health  agency under the provisions of title XVIII or XIX of the federal
    16  Social Security Act provided, however, an agency which  has  a  contract
    17  with a state agency or its locally designated office or, as specified by
    18  the  commissioner, with a managed care organization participating in the
    19  managed care program  established  pursuant  to  section  three  hundred
    20  sixty-four-j  of  the  social  services law or with a [managed long term
    21  care plan established pursuant to] PACE or MAP plan as  such  terms  are
    22  defined  by  section  forty-four  hundred  three-f  of this chapter, may
    23  receive reimbursement under title XIX of  the  federal  Social  Security
    24  Act.
    25    §  14.  The  opening paragraph of subdivision 9 of section 3614 of the
    26  public health law, as amended by section 56 of part A of chapter  56  of
    27  the laws of 2013, is amended to read as follows:
    28    Notwithstanding  any  law  to  the  contrary,  the commissioner shall,
    29  subject to the availability of federal financial  participation,  adjust
    30  medical  assistance  rates of payment for certified home health agencies
    31  for such services provided to children under eighteen years of  age  and
    32  for services provided to a special needs population of medically complex
    33  and  fragile  children,  adolescents and young disabled adults by a CHHA
    34  operating under a pilot program approved by the  department,  long  term
    35  home  health care programs, AIDS home care programs established pursuant
    36  to this article, hospice programs established  under  article  forty  of
    37  this  chapter  and  for  [managed]  long  term  care [plans and approved
    38  managed long term care operating demonstrations as defined  in]  options
    39  under  section  forty-four hundred three-f of this chapter. Such adjust-
    40  ments shall be for  purposes  of  improving  recruitment,  training  and
    41  retention  of  home  health aides or other personnel with direct patient
    42  care responsibility in the following aggregate amounts for the following
    43  periods:
    44    § 15. Paragraph (a) of subdivision 10 of section 3614  of  the  public
    45  health law, as amended by section 57 of part A of chapter 56 of the laws
    46  of 2013, is amended to read as follows:
    47    (a)  Such  adjustments to rates of payments shall be allocated propor-
    48  tionally based on each certified home  health  agency,  long  term  home
    49  health  care  program,  AIDS home care and hospice program's home health
    50  aide or other  direct  care  services  total  annual  hours  of  service
    51  provided  to  medicaid  patients, as reported in each such agency's most
    52  recently available cost report as submitted to the department or for the
    53  purpose of the [managed] long term  care  [program]  option  a  suitable
    54  proxy  developed  by  the department in consultation with the interested
    55  parties. Payments made pursuant to this section shall not be subject  to
    56  subsequent  adjustment or reconciliation; provided that such adjustments

        S. 7800                             9
 
     1  to rates of payments to certified home health agencies shall only be for
     2  that portion of services provided to children under  eighteen  years  of
     3  age and for services provided to a special needs population of medically
     4  complex and fragile children, adolescents and young disabled adults by a
     5  CHHA operating under a pilot program approved by the department.
     6    §  16.  Paragraph  (b)  of subdivision 2 of section 4409 of the public
     7  health law, as added by section 5 of part NN of chapter 57 of  the  laws
     8  of 2023, is amended to read as follows:
     9    (b)  The department is authorized to address to any health maintenance
    10  organization, and [managed long term care plan  with  a  certificate  of
    11  authority  pursuant  to] a PACE or MAP plan as such terms are defined by
    12  section forty-four hundred three-f of this article, or officers thereof,
    13  any inquiry in relation to its contracts with providers and other  enti-
    14  ties    providing   covered   services   to   the   health   maintenance
    15  organization's, or [managed long term care plan's] PACE  or  MAP  plans'
    16  enrollees, including but not limited to the rates of payment and payment
    17  terms  and conditions therein. Every entity or person so addressed shall
    18  reply in writing to such inquiry promptly and truthfully, and such reply
    19  shall be, if required by the department, signed by such  individual,  or
    20  by  such  officer  or officers of a corporation, as the department shall
    21  designate, and affirmed by them as true under penalty of perjury.  Fail-
    22  ure to comply with the requirements of this section shall be subject  to
    23  civil penalties under section twelve of this chapter. Each day after the
    24  deadline  established  by  the department for reply until such time that
    25  the provider submits a good faith response shall be considered  a  sepa-
    26  rate  and  subsequent violation. In accordance with the process outlined
    27  in this paragraph, employers shall provide any documents or materials in
    28  the employer's possession, custody, or control that are requested by the
    29  department as needed to support or verify the employer's reply.
    30    § 17. Subparagraph (i) of paragraph (e) of subdivision  3  of  section
    31  364-j  of the social services law, as amended by section 38 of part A of
    32  chapter 56 of the laws of 2013, is amended to read as follows:
    33    (i) an individual dually eligible for medical assistance and  benefits
    34  under  the  federal  Medicare program; provided, however, nothing herein
    35  shall: (a) require an individual enrolled in a [managed] long term  care
    36  [plan]  option,  pursuant  to  section forty-four hundred three-f of the
    37  public health law, to disenroll from such program; or (b)  make  enroll-
    38  ment  in  a  Medicare  managed care plan a condition of the individual's
    39  participation in the managed care program pursuant to this  section,  or
    40  affect  the  individual's  entitlement to payment of applicable Medicare
    41  managed care or [fee for service] fee-for-service coinsurance and deduc-
    42  tibles by the individual's managed care provider.
    43    § 18.  Paragraphs (b) and (c) of subdivision 27 of  section  364-j  of
    44  the  social services law, as added by section 72 of part A of chapter 56
    45  of the laws of 2013, are amended to read as follows:
    46    (b)  The  FIDA  program  shall   provide   targeted   populations   of
    47  [medicare/medicaid]   Medicare/Medicaid  dually  eligible  persons  with
    48  comprehensive health services that include the full range of  [medicare]
    49  Medicare  and  [medicaid]  Medicaid  covered services, including but not
    50  limited to primary and acute care, prescription drugs, behavioral health
    51  services,  care  coordination  services,  and  long-term  supports   and
    52  services,  as well as other services, through managed care providers, as
    53  defined in subdivision one of this section[, including managed long term
    54  care plans, certified pursuant to section forty-four hundred three-f  of
    55  the public health law].

        S. 7800                            10
 
     1    (c)  Under  the FIDA program established pursuant to this subdivision,
     2  up to three managed [long term] care plans may be authorized  to  exclu-
     3  sively  enroll individuals with developmental disabilities, as such term
     4  is defined in section 1.03 of the mental hygiene law.  The  commissioner
     5  of  health may waive any of the department's regulations as such commis-
     6  sioner, in consultation with the commissioner of the office  for  people
     7  with  developmental  disabilities, deems necessary to allow such managed
     8  [long term] care plans to provide or arrange for service for individuals
     9  with developmental disabilities that are  adequate  and  appropriate  to
    10  meet the needs of such individuals and that will ensure their health and
    11  safety.  The  commissioner  of  the office for people with developmental
    12  disabilities may waive any of the office for people  with  developmental
    13  disabilities' regulations as such commissioner, in consultation with the
    14  commissioner  of  health,  deems  necessary  to allow such managed [long
    15  term] care plans to provide or arrange for services for individuals with
    16  developmental disabilities that are adequate and appropriate to meet the
    17  needs of such individuals and that will ensure their health and safety.
    18    § 19.  Subdivision 31 of section 364-j of the social services law,  as
    19  added  by  section  36-b of part B of chapter 57 of the laws of 2015, is
    20  amended to read as follows:
    21    31. [(a)] The commissioner shall require managed care providers  under
    22  this section, [managed long-term care plans]  a PACE or MAP plan as such
    23  terms are defined under section forty-four hundred three-f of the public
    24  health  law  and  other  appropriate long-term service programs to adopt
    25  expedited procedures for approving personal care services for a  medical
    26  assistance  recipient  who  requires immediate personal care or consumer
    27  directed personal assistance  services  pursuant  to  paragraph  (e)  of
    28  subdivision  two  of section three hundred sixty-five-a of this title or
    29  section three hundred sixty-five-f of this title, respectively, or other
    30  long-term care, and provide such care or services as appropriate,  pend-
    31  ing approval by such provider or program.
    32    § 20. Paragraphs (a) and (c) of subdivision 32 of section 364-j of the
    33  social  services  law, as amended by section 1 of part KKK of chapter 56
    34  of the laws of 2020, are amended to read as follows:
    35    (a) The commissioner, or for the  purposes  of  subparagraph  (iv)  of
    36  paragraph  (c)  of  this  subdivision, the Medicaid inspector general in
    37  consultation with the commissioner, may, in his or her discretion, apply
    38  penalties to managed care organizations  subject  to  this  section  and
    39  article  forty-four  of  the  public health law, including [managed long
    40  term care plans] a PACE or MAP plan as such terms are defined by section
    41  forty-four hundred three-f of the public health  law,  for  untimely  or
    42  inaccurate  submission  of  encounter data; provided however, no penalty
    43  shall be assessed if the managed care organization or a PACE or MAP plan
    44  submits, in good faith, timely and accurate data and a  material  amount
    45  of  such data is not successfully received by the department as a result
    46  of department system failures or technical issues that  are  beyond  the
    47  control of the managed care organization.
    48    (c)  (i)  Penalties  assessed  pursuant  to this subdivision against a
    49  managed care organization other than a  [managed  long  term  care  plan
    50  certified  pursuant  to]  PACE  or MAP plan as such terms are defined by
    51  section forty-four hundred three-f of the public health law shall be  as
    52  follows:
    53    (A) for encounter data submitted or resubmitted past the deadlines set
    54  forth  in  the  model contract, the Medicaid capitated premiums shall be
    55  reduced by one-third percent; [and]

        S. 7800                            11
 
     1    (B) for incomplete or inaccurate encounter data, evaluated at a  cate-
     2  gory  of  service  level,  that fails to conform to department developed
     3  benchmarks for completeness and accuracy, the Medicaid capitated  premi-
     4  ums shall be reduced by one and one-third percent; and
     5    (C)  for  submitted data that results in a rejection rate in excess of
     6  ten percent of department  developed  volume  benchmarks,  the  Medicaid
     7  capitated premiums shall be reduced by one-third percent.
     8    (ii)  Penalties  assessed  pursuant to this [subdivisions] subdivision
     9  against a [managed] long term care [plan] option certified  pursuant  to
    10  section  forty-four hundred three-f of the public health law shall be as
    11  follows:
    12    (A) for encounter data submitted or resubmitted past the deadlines set
    13  forth in the model contract, the Medicaid capitated  premiums  shall  be
    14  reduced by one-quarter percent;
    15    (B)  for incomplete or inaccurate encounter data, evaluated at a cate-
    16  gory of service level, that fails to  conform  to  department  developed
    17  benchmarks  for completeness and accuracy, the Medicaid capitated premi-
    18  ums shall be reduced by one percent; and
    19    (C) for submitted data that results in a rejection rate in  excess  of
    20  ten  percent  of  department  developed  volume benchmarks, the Medicaid
    21  capitated premiums shall be reduced by one-quarter percent.
    22    (iii) For incomplete or inaccurate encounter data, identified  in  the
    23  course  of  an  audit, investigation or review by the Medicaid inspector
    24  general, the Medicaid capitated premiums shall be reduced  by  an  addi-
    25  tional one percent.
    26    § 21. Paragraph (x) of subdivision (b) of section 364-jj of the social
    27  services  law,  as  amended by section 39 of part C of chapter 60 of the
    28  laws of 2014, is amended to read as follows:
    29    (x) in accordance with the recommendations of the joint advisory coun-
    30  cil established pursuant to section 13.40 of  the  mental  hygiene  law,
    31  advise  the  commissioners of health and developmental disabilities with
    32  respect to the oversight of DISCOs and of health  maintenance  organiza-
    33  tions  and  [managed]  long term care [plans] options providing services
    34  authorized, funded, approved or certified by the office for people  with
    35  developmental disabilities, and review all managed care options provided
    36  to  persons  with developmental disabilities, including: the adequacy of
    37  support  for  habilitation  services;  the  record  of  compliance  with
    38  requirements  for person-centered planning, person-centered services and
    39  community integration; the  adequacy  of  rates  paid  to  providers  in
    40  accordance  with  the provisions of [paragraph 1 of] subdivision four of
    41  section forty-four hundred three of the  public  health  law,  paragraph
    42  (a-2)  of  subdivision  eight of section forty-four hundred three of the
    43  public health law or [paragraph (a-2) of subdivision twelve of]  section
    44  forty-four  hundred three-f of the public health law; and the quality of
    45  life, health, safety and community integration of persons with  develop-
    46  mental disabilities enrolled in managed care; and
    47    §  22.  Subdivision  6 of section 365-f of the social services law, as
    48  added by section 50 of part D of chapter 56 of  the  laws  of  2012,  is
    49  amended to read as follows:
    50    6.  Notwithstanding  any inconsistent provision of this section or any
    51  other contrary provision  of  law,  managed  care  programs  established
    52  pursuant  to  section  three  hundred  sixty-four-j  of  this  title and
    53  [managed] long term care [plans] options  and  other  care  coordination
    54  models  established  pursuant to section [four thousand four] forty-four
    55  hundred three-f of the public health law shall offer  consumer  directed
    56  personal assistance programs to enrollees.

        S. 7800                            12
 
     1    §  23.  Paragraph  (a) of subdivision 4 of section 365-h of the social
     2  services law, as amended by section 2 of part LL of chapter  56  of  the
     3  laws of 2020, is amended to read as follows:
     4    (a)  The commissioner of health is authorized to assume responsibility
     5  from a local social services official for the provision  and  reimburse-
     6  ment  of  transportation  costs  under this section. If the commissioner
     7  elects to assume such responsibility, the commissioner shall notify  the
     8  local  social  services official in writing as to the election, the date
     9  upon which the election shall be effective and such  information  as  to
    10  transition  of  responsibilities  as the commissioner deems prudent. The
    11  commissioner is authorized to contract with a transportation manager  or
    12  managers  to manage transportation services in any local social services
    13  district, other than transportation services provided  or  arranged  for
    14  enrollees  of  [managed  long  term  care  plans  issued certificates of
    15  authority under] a PACE or MAP plan as  defined  by  section  forty-four
    16  hundred  three-f of the public health law. Any transportation manager or
    17  managers selected by the commissioner to manage transportation  services
    18  shall  have proven experience in coordinating transportation services in
    19  a geographic and demographic area similar to the area in New York  state
    20  within which the contractor would manage the provision of services under
    21  this  section.  Such  a contract or contracts may include responsibility
    22  for: review, approval and processing of transportation  orders;  manage-
    23  ment  of  the  appropriate  level  of transportation based on documented
    24  patient medical need; and development of  new  technologies  leading  to
    25  efficient  transportation services. If the commissioner elects to assume
    26  such responsibility from a local social services district,  the  commis-
    27  sioner  shall examine and, if appropriate, adopt quality assurance meas-
    28  ures that may include, but are not limited to, global positioning track-
    29  ing system reporting requirements and service  verification  mechanisms.
    30  Any  and  all  reimbursement  rates developed by transportation managers
    31  under this subdivision shall be subject to the review  and  approval  of
    32  the commissioner.
    33    §  24.  Subparagraph (vi) of paragraph (b) of subdivision 4 of section
    34  365-h of the social services law, as added by section 2 of  part  LL  of
    35  chapter 56 of the laws of 2020, is amended to read as follows:
    36    (vi)  Responsibility  for transportation services provided or arranged
    37  for enrollees of [managed] long term care [plans issued certificates  of
    38  authority]  options  under  section  forty-four  hundred  three-f of the
    39  public health law, not including a program designated as  a  Program  of
    40  All-Inclusive  Care  for  the  Elderly  (PACE)  as authorized by Federal
    41  Public law 1053-33, subtitle I of title IV of the Balanced Budget Act of
    42  1997, and, at the commissioner's discretion, other plans that  integrate
    43  benefits  for  dually eligible Medicare and Medicaid beneficiaries based
    44  on a demonstration by the plan that inclusion of  transportation  within
    45  the  benefit  package  will  result  in  cost  efficiencies  and quality
    46  improvement, shall be transferred to a transportation management  broker
    47  that  has a contract with the commissioner in accordance with this para-
    48  graph. Providers of adult day health care may elect to, but shall not be
    49  required to, use the services of the transportation management broker.
    50    § 25. Subdivision 14 of section 366 of the  social  services  law,  as
    51  amended  by  section  1 of part NN of chapter 57 of the laws of 2021, is
    52  amended to read as follows:
    53    14. The commissioner of health may make any  available  amendments  to
    54  the  state  plan  for  medical  assistance submitted pursuant to section
    55  three hundred sixty-three-a of this title, or, if an  amendment  is  not
    56  possible,  develop  and submit an application for any waiver or approval

        S. 7800                            13
 
     1  under the federal social security act that may be necessary to disregard
     2  or exempt an amount of income, for the purpose of assisting with housing
     3  costs, for individuals receiving coverage of nursing  facility  services
     4  under this title, other than short-term rehabilitation services, and for
     5  individuals  in receipt of medical assistance while in an adult home, as
     6  defined in subdivision twenty-five of section two of this chapter,  who:
     7  are  (i)  discharged to the community; and (ii) if eligible, enrolled or
     8  required to enroll and have initiated the  process  of  enrolling  in  a
     9  [plan  certified]  long  term care option pursuant to section forty-four
    10  hundred three-f of the public health law; and  (iii)  do  not  meet  the
    11  criteria  to be considered an "institutionalized spouse" for purposes of
    12  section three hundred sixty-six-c of this title.
    13    § 26. This act shall take effect immediately; provided, however, that:
    14    (i) sections two, five, six, seven, eight, nine, ten, eleven,  twelve,
    15  thirteen,  fourteen,  fifteen,  sixteen,  seventeen, eighteen, nineteen,
    16  twenty, twenty-one, twenty-two, twenty-three,  twenty-four  and  twenty-
    17  five of this act shall take effect April 1, 2026.
    18    (ii) the amendments to paragraph (o) of subdivision 2 of section 365-a
    19  of  the  social  services law made by section five of this act shall not
    20  affect the expiration and/or repeal  of  such  paragraph  and  shall  be
    21  deemed to expire therewith;
    22    (iii)  the amendments to paragraph (h) of subdivision 3 of section 218
    23  of the elder law made by section eight of this act shall be  subject  to
    24  the  repeal  of  such  paragraph and shall expire and be deemed repealed
    25  therewith;
    26    (iv) the amendments to subparagraph (i) of paragraph (e)  of  subdivi-
    27  sion  3,  paragraphs  (b)  and (c) of subdivision 27, subdivision 31 and
    28  paragraphs (a) and (c) of subdivision 32 of section 364-j of the  social
    29  services  law  made by sections seventeen, eighteen, nineteen and twenty
    30  of this act shall be subject to the repeal of  such  section  and  shall
    31  expire and be deemed repealed therewith;
    32    (v)  the  amendments  to  paragraph  (x) of subdivision (b) of section
    33  364-jj of the social services law made by section twenty-one of this act
    34  shall be subject to the expiration of such section and shall expire  and
    35  be deemed repealed therewith; and
    36    (vi) the amendments to section 365-h  of  the social services law made
    37  by sections twenty-three and twenty-four of this act shall be subject to
    38  the  expiration  of such section and shall expire and be deemed repealed
    39  therewith.
    40    Effective immediately, the commissioner of health shall promulgate any
    41  rules and regulations and take steps, including requiring the submission
    42  of reports or surveys, submission and receipt of state plans, and neces-
    43  sary federal waivers, as may be necessary for the timely  implementation
    44  of this act on such effective date.
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