senate Bill S4885A

Creates the managed care for persons with developmental disabilities advocacy program

download pdf

Sponsor

Co-Sponsors

Bill Status


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

actions

  • 30 / Apr / 2013
    • REFERRED TO MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
  • 08 / May / 2013
    • REPORTED AND COMMITTED TO FINANCE
  • 03 / Jun / 2013
    • AMEND AND RECOMMIT TO FINANCE
  • 03 / Jun / 2013
    • PRINT NUMBER 4885A
  • 08 / Jan / 2014
    • REFERRED TO MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
  • 04 / Feb / 2014
    • REPORTED AND COMMITTED TO FINANCE

Summary

Creates the managed care for persons with developmental disabilities advocacy program.

do you support this bill?

Bill Details

See Assembly Version of this Bill:
A6962A
Versions:
S4885
S4885A
Legislative Cycle:
2013-2014
Current Committee:
Senate Finance
Law Section:
Mental Hygiene Law
Laws Affected:
Amd ยง13.40, Ment Hyg L

Votes

Sponsor Memo

BILL NUMBER:S4885A

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
the creation of the managed care for persons with developmental
disabilities advocacy program

PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to establish the Managed Case for Persons
with Developmental Disabilities Advocacy Program for purposes of
assisting persons receiving services from the Office of People with
Developmental Disabilities (OPWDD) to navigate the managed care
system.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill creates the Managed Case for Persons with
Developmental Disabilities Advocacy Program. The advocacy program
shall advise individuals of applicable rights and responsibilities,
provide information, referrals and technical assistance to address the
needs of the individual, and pursue legal, administrative and other
appropriate remedies or approaches to ensure the protection of and
advocacy for the rights of the enrollees.

Section 2. Clarifies that the bill does not intend to transfer to the
advocacy program any current duties, including Medicaid Service
Coordination, of state employees employed by OPWDD.

Section 3 of the bill is the effective date.

JUSTIFICATION:

The 2013-14 state budget authorizes the State to enroll individuals
receiving OPWDD services to risk bearing Medicaid managed care plans
starting in 2014. This is a significant change to the OPWDD system
which has historically been a fee for service system.

Currently, OPWDD recipients receive care coordination from an
independent third party, known as the Medicaid Service Coordination
(MSC) program. As OPWDD services transition to managed care, many
functions of this program will be assumed by managed care companies.
Managed care companies cannot reasonably assume certain advocacy
functions of the MSC program because the managed care company will
often have a financial interest in denying certain services. For this
reason, many stakeholders have expressed the need for additional
outside advocates to be available to assist enrollees.

This bill ensures that persons receiving OPWDD services continue to
receive independent advocacy after being enrolled in a managed care
plan by creating a Managed Care for Persons with Developmental
Disabilities Advocacy Program. The program will advise individuals of
applicable rights and responsibilities, including, but not limited to,
the right to treatment, person centered care, care in the most
integrated setting, and the right to contest decisions made by a
managed care company; ' provide information, referrals and technical
assistance to address the needs of individuals with disabilities; and
pursue legal, administrative and other appropriate remedies or


approaches to ensure the protection of and advocacy for the rights of
the enrollees. This program will help ensure that enrollees continue
to receive adequate care and that they have adequate input in their
plan of care.

PRIOR LEGISLATIVE HISTORY:

New bill.

FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:

This act shall take effect immediately.

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

                                 4885--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 30, 2013
                               ___________

Introduced  by Sens. CARLUCCI, GRISANTI -- read twice and ordered print-
  ed, and when printed to be committed to the Committee on Mental Health
  and Developmental Disabilities -- reported favorably from said commit-
  tee and committed to the Committee on Finance -- committee discharged,
  bill amended, ordered reprinted as amended  and  recommitted  to  said
  committee

AN  ACT  to amend the mental hygiene law, in relation to the creation of
  the managed care for persons with developmental disabilities  advocacy
  program

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

  Section 1. Section 13.40 of the  mental  hygiene  law  is  amended  by
adding a new subdivision (h) to read as follows:
  (H)  THE  COMMISSIONER  AND  THE  COMMISSIONER OF HEALTH SHALL JOINTLY
ESTABLISH THE MANAGED CARE FOR PERSONS WITH  DEVELOPMENTAL  DISABILITIES
ADVOCACY  PROGRAM,  HEREINAFTER REFERRED TO AS THE ADVOCACY PROGRAM. THE
ADVOCACY PROGRAM SHALL BE INTEGRATED WITH AND PROVIDED  IN  ADDITION  TO
INDEPENDENT  MEDICAID  MANAGED  CARE OMBUDS SERVICES PROVIDED TO PERSONS
WITH DISABILITIES ENROLLING  IN  MEDICAID  MANAGED  CARE.  THE  ADVOCACY
PROGRAM  SHALL: ADVISE INDIVIDUALS OF APPLICABLE RIGHTS AND RESPONSIBIL-
ITIES, INCLUDING, BUT NOT LIMITED TO, THE  RIGHT  TO  TREATMENT,  PERSON
CENTERED  CARE,  CARE  IN  THE MOST INTEGRATED SETTING, AND THE RIGHT TO
CONTEST DECISIONS MADE BY A MANAGED CARE COMPANY;  PROVIDE  INFORMATION,
REFERRALS  AND  TECHNICAL ASSISTANCE TO ADDRESS THE NEEDS OF INDIVIDUALS
WITH DISABILITIES; AND PURSUE LEGAL, ADMINISTRATIVE AND OTHER  APPROPRI-
ATE  REMEDIES OR APPROACHES TO ENSURE THE PROTECTION OF AND ADVOCACY FOR
THE RIGHTS OF THE ENROLLEES. THE ADVOCACY  PROGRAM  SHALL  ALSO  PROVIDE
SUPPORT  TO  ELIGIBLE  INDIVIDUALS  ENROLLING  IN DISCOS, HMOS PROVIDING
SERVICES PURSUANT TO SUBDIVISION EIGHT  OF  SECTION  FORTY-FOUR  HUNDRED
THREE  OF  THE PUBLIC HEALTH LAW, MANAGED LONG TERM CARE PLANS PROVIDING
SERVICES UNDER SUBDIVISIONS TWELVE, THIRTEEN  AND  FOURTEEN  OF  SECTION

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10533-06-3

S. 4885--A                          2

FORTY-FOUR  HUNDRED  THREE-F  OF THE PUBLIC HEALTH LAW, FULLY INTEGRATED
DUAL ADVANTAGE PROVIDING  SERVICES  UNDER  SUBDIVISION  TWENTY-SEVEN  OF
SECTION  THREE  HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, AND ANY
OTHER  MANAGED  CARE ENTITY; SUPPORT DURING THE PERSON-CENTERED PLANNING
PROCESS AND RELATED PROCESSES INCLUDING UPDATES TO  THE  PERSON-CENTERED
CARE  PLAN; AND ASSISTANCE WITH SECURING HOUSING, EMPLOYMENT, AND COMMU-
NITY-BASED SUPPORTS AND SERVICES THAT FALL OUTSIDE OF THE SCOPE OF DISCO
SERVICES AND SUPPORTS.
  THE COMMISSIONERS SHALL JOINTLY DESIGNATE  AN  INDEPENDENT  AGENCY  OR
ORGANIZATION  TO  ADMINISTER  THE ADVOCACY PROGRAM. SUCH AGENCY SHALL BE
THE AGENCY COORDINATING THE INDEPENDENT  MEDICAID  MANAGED  CARE  OMBUDS
SERVICES, OR A SUB-CONTRACTOR OF THAT AGENCY. THE ADVOCACY PROGRAM SHALL
BE  ADVISED BY A BOARD, WHOSE MEMBERSHIP SHALL REFLECT REPRESENTATION OF
THE DEVELOPMENTAL DISABILITY POPULATION.
  S 2. Nothing in this act is intended to transfer to the  developmental
disabilities  advocacy  program  created  by  subdivision (h) of section
13.40 of the mental hygiene law any current duties,  including  Medicaid
service  coordination, of state employees who are employed by the office
for people with developmental disabilities.
  S 3. This act shall take effect immediately.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.