|SAME AS||SAME AS S07523|
|Amd §4403-f, Pub Health L; amd §366-a, Soc Serv L|
|Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.|
|01/10/2020||referred to health|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9017 SPONSOR: Gottfried
TITLE OF BILL: An act to amend the public health law and the social services law, in relation to automatic enrollment and recertification simplification for Medicaid eligible recipients   PURPOSE OR GENERAL IDEA OF BILL: To shorten and simplify Medicaid long term care eligibility processes.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends Public Health Law § 4403-f to enable auto-assignment in a managed long term care plan when a person determined to be eligible has not chosen a plan within the first 75 days of eligibility, and extends that eligibility if auto-assignment is not completed within 75th days. Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid recertification process less burdensome and error-prone by allowing attestation of resources that are unchanged or have diminished, and providing automatic recertification for Managed Long Term Care (MLTC) enrollees, mainstream managed care members receiving personal care services, enrollees in the Aged, Blind, and Disabled Category without excess income and Medicare Savings Program recipients.   JUSTIFICATION: People who have successfully applied for Medicaid in order to enroll in a MLTC plan face many hurdles and delays before they are effectively enrolled. First, an in-home eligibility assessment by a nurse can take several weeks to schedule and this assessment is valid for only 75 days. After that assessment is completed, the Medicaid recipient will schedule in-home assessments with prospective MLTC plans to determine the level of care each will provide. It can take several weeks to schedule and complete those visits. Once the recipient agrees to a plan, the plan will process enrollment, which is effective either the first of the following month, or, if it is already after the 18th, effective the first of the month after the following month. If 75 days have lapsed at this point, the process restarts at the beginning, resulting in care delays. Currently, Medicaid recipients complete a mail renewal form, attesting to their income, once a year in order to continue to receive health care coverage. This is true even if the recipient is on a fixed income. The recertification process is so prone to errors that it frequently results in a discontinuance of eligibility. The recipient may not receive the discontinuance notice on time or at all, or may not be able to request a fair hearing within 10 days, which automatically triggers dis-enroll- ment. In 2011, the Medicaid program recognized the problems and initi- ated a demonstration program to automate renewals for Aged, Blind and Disabled Medicaid recipients with fixed incomes. This bill extends the benefits of that demonstration to the rest of the program.   PRIOR LEGISLATIVE HISTORY: 2019: A.7578A -- Vetoed   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: 180 days after enactment.
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STATE OF NEW YORK ________________________________________________________________________ 9017 IN ASSEMBLY January 10, 2020 ___________ Introduced by M. of A. GOTTFRIED, DINOWITZ -- read once and referred to the Committee on Health AN ACT to amend the public health law and the social services law, in relation to automatic enrollment and recertification simplification for Medicaid eligible recipients 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 (iii) to read 3 as follows: 4 (iii) Where a person determined eligible for Medicaid ("Medicaid 5 recipient") has been determined by the commissioner or his or her desig- 6 nee to require community-based long term care services for more than a 7 continuous period of one hundred twenty days, and the Medicaid recipient 8 has not selected and enrolled in a managed long term care plan prior to 9 any expiration date of such determination of need for long term care, 10 after being provided with information to make an informed choice, the 11 commissioner shall assign the recipient to a managed long term care 12 plan, taking into account consistency with any prior community-based 13 direct care workers having recently served the recipient, quality 14 performance criteria, capacity, and geographic accessibility. The 15 commissioner may assign participants pursuant to such criteria on a 16 weighted basis. A recipient assigned to a managed long term care plan 17 under this subparagraph shall be deemed to have been determined to be in 18 need of long term care services for more than a continuous period of one 19 hundred twenty days and eligible to be enrolled in a managed long term 20 care plan. 21 § 2. Paragraph (b) of subdivision 2 of section 366-a of the social 22 services law, as added by section 51 of part A of chapter 1 of the laws 23 of 2002, is amended to read as follows: 24 (b) Notwithstanding the provisions of paragraph (a) of this subdivi- 25 sion, an applicant or recipient may attest to the amount of his or her 26 accumulated resources, unless such applicant or recipient is seeking 27 medical assistance payment for long term care services for the first EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11182-05-0A. 9017 2 1 time. A recipient who has already provided documentation of resources 2 may attest to the amount of accumulated resources if it has remained the 3 same or is less than the amount originally documented. For purposes of 4 this paragraph, long term care services shall mean care, treatment, 5 maintenance, and services described in paragraph (b) of subdivision [ 1] 6 one of section three hundred sixty-seven-f of this title, with the 7 exception of short term rehabilitation, as defined by the commissioner 8 of health. 9 § 3. Paragraph (d) of subdivision 5 of section 366-a of the social 10 services law, as amended by section 12 of part D of chapter 56 of the 11 laws of 2013, is relettered paragraph (e) and three new paragraphs (f), 12 (g) and (h) are added to read as follows: 13 (f) Notwithstanding paragraph (b) of subdivision two of this section 14 and paragraphs (a), (b), (c) and (d) of this subdivision, the following 15 recipients will be recertified automatically, unless there has been a 16 finding of lack of eligibility for Medicaid: 17 (i) enrollees in Medicaid managed long term care plans as defined in 18 section forty-four hundred three-f of the public health law; 19 (ii) enrollees in Medicaid managed care plans as defined in section 20 three hundred sixty-four-j of this title who receive personal care 21 services pursuant to paragraph (e) of subdivision two of section three 22 hundred sixty-five-a of this title or consumer directed personal assist- 23 ance services pursuant to section three hundred sixty-five-f of this 24 title; 25 (iii) enrollees receiving Medicaid in the Aged, Blind and Disabled 26 category who receive fixed income from the Social Security Adminis- 27 tration (SSA); and 28 (iv) Medicare Savings Program (MSP) recipients who have a fixed income 29 from the Social Security Administration (SSA). 30 (g) Nothing in paragraph (e) of this subdivision should be construed 31 to alter a Medicaid recipient's obligation to inform the public welfare 32 district of changes in income or other factors that might impact eligi- 33 bility pursuant to subdivision four of this section. 34 (h) Upon a finding of lack of eligibility, recipients identified in 35 paragraph (e) of this subdivision will be entitled to notice and hearing 36 rights as provided in section twenty-two of this chapter. 37 § 4. This act shall take effect on the one hundred eightieth day after 38 it shall have become a law; provided that the amendments to paragraph 39 (b) of subdivision 7 of section 4403-f of the public health law made by 40 section one of this act shall be subject to the expiration and reversion 41 of such paragraph and shall expire and be deemed repealed therewith and 42 provided further that such amendments shall not affect the repeal of 43 such section and shall expire and be deemed repealed therewith. Effec- 44 tive immediately, the commissioner of health shall make regulations and 45 take other actions reasonably necessary to implement this act on that 46 date.