senate Bill S3912A

Signed by Governor

Directs the department of health to provide oversight of the transitioning of individuals to managed long term care operated by health maintenance organizations

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed by Governor
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actions

  • 26 / Feb / 2013
    • REFERRED TO HEALTH
  • 02 / May / 2013
    • AMEND AND RECOMMIT TO HEALTH
  • 02 / May / 2013
    • PRINT NUMBER 3912A
  • 07 / May / 2013
    • 1ST REPORT CAL.572
  • 08 / May / 2013
    • 2ND REPORT CAL.
  • 20 / May / 2013
    • ADVANCED TO THIRD READING
  • 22 / May / 2013
    • PASSED SENATE
  • 22 / May / 2013
    • DELIVERED TO ASSEMBLY
  • 22 / May / 2013
    • REFERRED TO HEALTH
  • 20 / Jun / 2013
    • SUBSTITUTED FOR A7636
  • 20 / Jun / 2013
    • ORDERED TO THIRD READING RULES CAL.548
  • 20 / Jun / 2013
    • PASSED ASSEMBLY
  • 20 / Jun / 2013
    • RETURNED TO SENATE
  • 09 / Oct / 2013
    • DELIVERED TO GOVERNOR
  • 21 / Oct / 2013
    • SIGNED CHAP.396

Summary

Directs the department of health to provide oversight of the transitioning of individuals to managed long term care plans operated by health maintenance organizations.

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Bill Details

See Assembly Version of this Bill:
A7636
Versions:
S3912
S3912A
Legislative Cycle:
2013-2014
Law Section:
Public Health Law
Laws Affected:
Amd §4403-f, Pub Health L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S7773, S7773
2013-2014: S3912A

Sponsor Memo

BILL NUMBER:S3912A

TITLE OF BILL: An act to amend the public health law, in relation to
managed long term care plans operated by health maintenance
organizations

PURPOSE: This bill directs the Department of Health to provide
over-sight of the transitioning of individuals to managed long term
care.

SUMMARY OF PROVISIONS: Section one amends § 4403-f of the Public
Health Law by adding a new subdivision 11-a to require the Department
of Health to provide oversight in the transition of individuals to
managed long term care by ensuring: access to quality care; adequate
notice and enrollment assistance; accountability from providers;
periodic assessments of plans and providers; mechanisms to prevent
waste and abuse; and incentives for such indicators as appropriate
enrollment and quality.

Section two provides that this act shall take effect immediately and
shall expire and be deemed related with the remainder of the section

JUSTIFICATION: As part of New York's Medicaid reform, dually eligible
individuals (those in receipt of Medicare and Medicaid) who are 21
years of age or older and are in need of community based long term
care services for more than 120 days are or will soon have their care
provided through managed long term care plans (MLTCPs) or care
coordination models (CCMs). This is a major transformation for
Medicaid recipients, service providers, health insurers and the state.
This legislation will ensure the state provides oversight of the
enrollment, quality, adequacy and cost of care as health plans take on
many of the roles formerly held by the state under the traditional
Medicaid fee for service system of care.

According to the Department of Health's February 2013 report on
Managed Long Term Care Mandatory Enrollment, approximately 75,000
Medicaid recipients statewide were enrolled in a managed long term
care plan (MLTCP) as of December 2012. This number has more than
doubled in two years and is expected to continue to grow as the
phase-in continues and ultimately nursing home residents are included.
In addition to many more individuals being placed in MLTCPs, the
number of plans approved by the department has also risen sharply.

While the Department's report indicates high customer satisfaction
with MLTCPs, concerns have been raised about appropriate services and
enrollment. It is imperative that the Department of Health continue to
be vigilant in ensuring individuals transition smoothly into managed
long term care and that appropriate oversight is in place as this
legislation provides

PRIOR LEGISLATIVE HISTORY: Similar to S.7773 of 2012

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately and shall expire and be deemed related
with the remainder of the section.


view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 3912--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            February 26, 2013
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed  to  the  Committee  on  Health  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT to amend the public health law, in relation to managed long term
  care plans operated by health maintenance organizations

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Section  4403-f  of  the  public health law is amended by
adding a new subdivision 11-a to read as follows:
  11-A. IN TRANSITIONING INDIVIDUALS TO  MANAGED  LONG  TERM  CARE,  THE
DEPARTMENT  SHALL  PROVIDE OVERSIGHT OF LONG TERM MANAGED CARE BY ENSUR-
ING:
  (A) PARTICIPANTS ARE APPROPRIATELY NOTIFIED OF THE UPCOMING CHANGES TO
THEIR HEALTH CARE, AND THEIR RIGHTS AND OPTIONS;
  (B) ACCESS TO APPROPRIATE ENROLLMENT ASSISTANCE,  CONSUMER  ASSISTANCE
AND COMPLAINT MECHANISMS;
  (C)  ACCESS  TO  QUALITY  CARE  BY  REQUIRING NETWORK TRANSPARENCY AND
CHOICE OF LONG TERM CARE PLANS, ALLOWING PATIENTS  TO  CHOOSE  THE  PLAN
THAT BEST FITS THEIR NEEDS;
  (D)  TRANSPARENCY  AND  ACCOUNTABILITY  FROM  PROVIDERS,  WHICH  SHALL
INCLUDE A MECHANISM BY WHICH STAFF, PARTICIPANTS AND FAMILY MEMBERS  CAN
CONFIDENTIALLY  REPORT  CONCERNS RELATING TO QUALITY TO THE PLAN AND THE
STATE;
  (E)  PLANS  AND  PROVIDERS  ARE  ASSESSED  PERIODICALLY  AND  DATA  IS
PUBLISHED  REGARDING  ENROLLMENT  IN  INTEGRATED  CARE  DESIGNS, NETWORK
ADEQUACY, NEW SERVICE DESIGNS, OUTCOME MEASURES, INCLUDING THE EXTENT TO
WHICH CARE PLANS ARE CONTINUED OR ALTERED BASED UPON  NEW  COMPREHENSIVE
ASSESSMENTS,  AND  THE  TYPES  AND AMOUNTS OF SERVICES HEALTH PLANS HAVE
AUTHORIZED;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09297-03-3

S. 3912--A                          2

  (F) MECHANISMS ARE IN PLACE  TO  STATE  OVERSIGHT  OF  ENROLLMENT  AND
SERVICES  TO  PREVENT  WASTE  AND  ABUSE  IN  THE MANAGED LONG TERM CARE
SYSTEM; AND
  (G) INCENTIVES ARE PROVIDED FOR A VARIETY OF INDICATORS, INCLUDING BUT
NOT  LIMITED  TO,  SMOOTH  PATIENT  TRANSITIONS, APPROPRIATE ENROLLMENT,
QUALITY CARE, HIGH STAFF RETENTION AND  POSITIVE  HEALTH  CARE  OUTCOMES
ACHIEVED AT A LOW COST.
  S  2. This act shall take effect immediately; provided that the amend-
ments to section 4403-f of the public health law made by section one  of
this act shall not affect the expiration and repeal of such section, and
shall expire and be deemed repealed therewith.

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