senate Bill S5896

Amended

Relates to the special advisory review panel on Medicaid managed care

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Bill Status


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

  • 19 / Jun / 2013
    • REFERRED TO RULES
  • 08 / Jan / 2014
    • REFERRED TO HEALTH
  • 03 / Feb / 2014
    • AMEND AND RECOMMIT TO HEALTH
  • 03 / Feb / 2014
    • PRINT NUMBER 5896A

Summary

Relates to the membership and expands the duties of the special advisory review panel on Medicaid managed care by including other managed care programs.

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Bill Details

Versions:
S5896
S5896A
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd ยง364-jj, Soc Serv L
Versions Introduced in 2011-2012 Legislative Cycle:
A7651A

Sponsor Memo

BILL NUMBER:S5896

TITLE OF BILL: An act to amend the social services law, in relation
to the special advisory review panel on Medicaid managed care

PURPOSE OR GENERAL IDEA OF BILL:

To update the composition and the charge of the Medicaid Managed Care
Advisory Review Panel (MMCARP).

SUMMARY OF SPECIFIC PROVISIONS:

The bill amends section 364-jj of the Social Services Law to add Child
Health Plus, Family Health Pius, Managed Long Term Care and other
public managed-health care plans to the charge of the MMCARP and add
two public members with expertise in disabilities and pediatrics. The
bill would also have MMCARP review issues of the appropriateness and
timeliness of se/vices, the integration of federal health care reform,
trends in service denials and demographic data, review of the federal
waiver, as well as public information for choosing among managed long
term care plans.

JUSTIFICATION:

Since the statute's enactment in 1996,the MMCARP has performed an
important function collaboratively working with numerous state
officials in monitoring mandatory Medicaid managed care. Provisions
in the 2011-2012 budget will result in the expansion of mandatory
Medicaid managed care to vulnerable populations who were previously
covered by fee-for-service, including physically and developmentally
disabled individuals, children in foster care, and homeless families.
There will also be a significant increase in home care beneficiaries
enrolled by mandate into managed long term care plans, forcing
individuals with complex needs to manage their care in a new delivery
system. It is increasingly important that the MMCARP provide an
opportunity for monitoring of these programs by a diverse group of
stakeholders including consumer advocates, consumers, health plans and
providers of services.

This bill will charge MMCARP with monitoring the phase-in schedule for
the enrollment of new populations in Medicaid managed care as well as
the availability of essential services for these populations. In
addition, this bill will increase the public's role in providing
feedback on the significant changes soon to be implemented in the
Medicaid delivery system. Active monitoring by stakeholders is
increasingly important as both amendments to state law and federal
health reform lead to increased enrollment in managed care and the
implementation of new service delivery models for an increasingly
diverse beneficiary population.

PRIOR LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS:

None to the state


EFFECTIVE DATE:

Immediately

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

                                  5896

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 19, 2013
                               ___________

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 social services law,  in  relation  to  the  special
  advisory review panel on Medicaid managed care

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

  Section 1. Section 364-jj of the social services law,  as  amended  by
section  80-a of part A of chapter 56 of the laws of 2013, is amended to
read as follows:
  S 364-jj. Special advisory review panel on Medicaid managed care.  (a)
There  is hereby established a special advisory review panel on Medicaid
managed care AND RELATED PUBLIC  HEALTH  INSURANCE  PROGRAMS,  INCLUDING
CHILD  HEALTH  PLUS, FAMILY HEALTH PLUS, MANAGED LONG TERM CARE PROGRAMS
AND RELATED CARE COORDINATION MODELS, MANAGED CARE PROGRAMS DIRECTED  AT
COORDINATING  CARE  FOR DUALLY ELIGIBLE MEDICAID AND MEDICARE ENROLLEES,
AND OTHER PUBLIC HEALTH COVERAGE CARE MANAGEMENT PROGRAMS, INCLUDING BUT
NOT LIMITED TO HEALTH HOMES AND MEDICAL HOMES.  The panel shall  consist
of  [twelve]  THIRTEEN members who shall be appointed as follows: [four]
FIVE by the governor, one of which shall serve  as  the  chair,  TWO  OF
WHICH  SHALL  BRING EXPERTISE IN ACCESS ISSUES FACING MEDICAID CONSUMERS
WITH DISABILITIES, AND ONE OF WHICH  SHALL  BEING  EXPERTISE  IN  ACCESS
ISSUES  FACING  CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY; three
each by the temporary president of the senate and  the  speaker  of  the
assembly;  and  one  each  by  the minority leader of the senate and the
minority leader of the assembly. At least three members  of  such  panel
shall  be  members of the joint advisory panel established under section
13.40 of the mental hygiene law. Members  shall  serve  without  compen-
sation but shall be reimbursed for appropriate expenses.  The department
shall provide technical assistance and access to data as is required for
the panel to effectuate the mission and purposes established herein. THE
PANEL  SHALL  BE  REQUIRED  TO SEEK PUBLIC COMMENT ON MATTERS WITHIN ITS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01605-04-3

S. 5896                             2

JURISDICTION. PANEL MEETING TIMES, AGENDAS, AND MINUTES SHALL BE  POSTED
PUBLICLY  ON  THE  DEPARTMENT'S  WEBSITE AT LEAST ONE WEEK PRIOR TO EACH
MEETING.
  (b)  The  panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS  SPECIALIZED
ISSUES, IN ORDER TO:
  (i)  determine  whether  there  is  sufficient  managed  care provider
participation in the Medicaid managed care program AND RELATED PROGRAMS;
  (ii) determine whether managed care providers meet  proper  enrollment
targets  that  permit  as  many  Medicaid recipients as possible to make
their own health plan decisions, thus minimizing the number of automatic
assignments;
  (iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in  sched-
ule,  AND  THE  AVAILABILITY  OF SPECIALTY SERVICES for enrollment[,] of
ADDITIONAL POPULATIONS AND managed care providers under both the  volun-
tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
TY OF CARE DURING AND AFTER THE TRANSITION;
  (iv)  assess the impact of managed care provider marketing and enroll-
ment  strategies,  [and  the]  INCLUDING  public   education   [campaign
conducted  in  New  York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
ipation in Medicaid managed care plans AND RELATED PROGRAMS;
  (v) evaluate the adequacy of managed care provider capacity by review-
ing established capacity measurements and monitoring  actual  access  to
plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
WITH  DISABILITIES  AND  OTHERS  IN  NEED  OF SUCH CARE, WITH PARTICULAR
ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY  PROVIDED  IN  THE  TRADI-
TIONAL FEE FOR SERVICE ENVIRONMENT;
  (vi)  examine  the  [cost]  implications  of [populations excluded and
exempted from Medicaid managed care] FEDERAL HEALTH CARE REFORM  ON  THE
MEDICAID  MANAGED  CARE  PROGRAM  AND  RELATED PROGRAMS, WITH PARTICULAR
ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
PRODUCTS AVAILABLE IN ANY POTENTIAL STATE  INSURANCE  EXCHANGE  AND  ANY
OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
  (vii)  in  accordance  with  the recommendations of the joint advisory
council established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental  disabilities  with
respect  to  the oversight of DISCOs and of health maintenance organiza-
tions and managed long term care plans  providing  services  authorized,
funded,  approved  or  certified  by the office for people with develop-
mental disabilities, and review all managed  care  options  provided  to
persons  with  developmental  disabilities,  including:  the adequacy of
support  for  habilitation  services;  the  record  of  compliance  with
requirements  for person-centered planning, person-centered services and
community integration; the  adequacy  of  rates  paid  to  providers  in
accordance  with the provisions of paragraph [1] (B) of subdivision four
of section forty-four hundred [three] THREE-F of the public health  law,
paragraph (a-2) of subdivision eight of section forty-four hundred three
of  the  public  health  law or paragraph (a-2) of subdivision twelve of
section forty-four hundred three-f of the public  health  law;  and  the
quality  of  life,  health,  safety and community integration of persons
with developmental disabilities enrolled in managed care; [and]
  (viii) EVALUATE TRENDS IN SERVICE DENIALS  BY  MEDICAID  MANAGED  CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
  (IX)  EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS AND
QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER  FACTORS  AND

S. 5896                             3

THE  AVAILABILITY  OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARITIES
IN ACCESS TO CARE AND OUTCOMES OF CARE;
  (X) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
  (XI) REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
TED  TO  THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE PLAN AMENDMENTS
RELATED TO TOPICS AND PROGRAMS  WITHIN  ITS  JURISDICTION,  AND  SOLICIT
PUBLIC INVOLVEMENT IN THE PROPOSALS;
  (XII) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS  AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XIII) examine other issues as it deems appropriate.
  (c) Commencing January  first,  [nineteen  hundred  ninety-seven]  TWO
THOUSAND  FOURTEEN  and  quarterly  thereafter the panel shall [submit a
report regarding the status of Medicaid managed care in  the  state  and
provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
AS IT deems appropriate to the governor, the temporary president and the
minority  leader  of the senate, and the speaker and the minority leader
of the assembly ON MATTERS WITHIN ITS JURISDICTION.
  S 2. Section 364-jj of the social services law, as  added  by  chapter
649 of the laws of 1996, is amended to read as follows:
  S 364-jj. Special advisory review panel on Medicaid managed care.  (a)
There  is hereby established a special advisory review panel on Medicaid
managed care AND RELATED PUBLIC  HEALTH  INSURANCE  PROGRAMS,  INCLUDING
CHILD  HEALTH  PLUS, FAMILY HEALTH PLUS, MANAGED LONG TERM CARE PROGRAMS
AND RELATED CARE COORDINATION MODELS, MANAGED CARE PROGRAMS DIRECTED  AT
COORDINATING  CARE  FOR DUALLY ELIGIBLE MEDICAID AND MEDICARE ENROLLEES,
AND OTHER PUBLIC HEALTH COVERAGE CARE MANAGEMENT PROGRAMS, INCLUDING BUT
NOT LIMITED TO HEALTH HOMES AND MEDICAL HOMES.  The panel shall  consist
of [nine] ELEVEN members who shall be appointed as follows: [three] FIVE
by  the  governor,  one  of which shall serve as the chair, TWO OF WHICH
SHALL BRING EXPERTISE IN ACCESS ISSUES FACING  MEDICAID  CONSUMERS  WITH
DISABILITIES,  AND  ONE  OF WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES
FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY;  two  each  by
the  temporary  president of the senate and the speaker of the assembly;
and one each by the minority leader of the senate and the minority lead-
er of the assembly. [All  members  shall  be  appointed  no  later  than
September first, nineteen hundred ninety-six.] Members shall serve with-
out  compensation but shall be reimbursed for appropriate expenses.  The
department shall provide technical assistance and access to data  as  is
required  for  the  panel  to effectuate the mission and purposes estab-
lished herein.  THE PANEL SHALL BE REQUIRED TO SEEK  PUBLIC  COMMENT  ON
MATTERS  WITHIN  ITS  JURISDICTION.  PANEL  MEETING  TIMES, AGENDAS, AND
MINUTES SHALL BE POSTED PUBLICLY ON THE DEPARTMENT'S  WEBSITE  AT  LEAST
ONE WEEK PRIOR TO EACH MEETING.
  (b)  The  panel shall MEET NO LESS THAN SIX TIMES PER YEAR, WITH ADDI-
TIONAL SUBCOMMITTEE MEETINGS AS DEEMED NECESSARY TO ADDRESS  SPECIALIZED
ISSUES, IN ORDER TO:
  (i)  determine  whether  there  is  sufficient  managed  care provider
participation in the Medicaid managed care program AND RELATED PROGRAMS;
  (ii) determine whether managed care providers meet  proper  enrollment
targets  that  permit  as  many  Medicaid recipients as possible to make
their own health plan decisions, thus minimizing the number of automatic
assignments;
  (iii) review AND DETERMINE THE APPROPRIATENESS OF the phase-in  sched-
ule,  AND  THE  AVAILABILITY  OF SPECIALTY SERVICES for enrollment[,] of
ADDITIONAL POPULATIONS AND managed care providers under both the  volun-

S. 5896                             4

tary and mandatory programs AND EVALUATE STEPS TAKEN TO ENSURE CONTINUI-
TY OF CARE DURING AND AFTER THE TRANSITION;
  (iv)  assess the impact of managed care provider marketing and enroll-
ment  strategies,  [and  the]  INCLUDING  public   education   [campaign
conducted  in  New  York city, on enrollees] CAMPAIGNS, ENROLLEE partic-
ipation in Medicaid managed care plans AND RELATED PROGRAMS;
  (v) evaluate the adequacy of managed care provider capacity by review-
ing established capacity measurements and monitoring  actual  access  to
plan practitioners, INCLUDING TIMELY ACCESS TO SPECIALTY CARE FOR PEOPLE
WITH  DISABILITIES  AND  OTHERS  IN  NEED  OF SUCH CARE, WITH PARTICULAR
ATTENTION TO CAPACITY FOR SERVICES PREVIOUSLY  PROVIDED  IN  THE  TRADI-
TIONAL FEE FOR SERVICE ENVIRONMENT;
  (vi)  examine  the  [cost]  implications  of [populations excluded and
exempted from Medicaid managed care; and] FEDERAL HEALTH CARE REFORM  ON
THE  MEDICAID MANAGED CARE PROGRAM AND RELATED PROGRAMS, WITH PARTICULAR
ATTENTION TO THE INTEGRATION OF PUBLIC PROGRAM FUNCTIONS WITH SUBSIDIZED
PRODUCTS AVAILABLE IN ANY POTENTIAL STATE  INSURANCE  EXCHANGE  AND  ANY
OTHER SUBSIDIZED PRODUCTS, SUCH AS A BASIC HEALTH PLAN;
  (vii)  EVALUATE  TRENDS  IN  SERVICE  DENIALS BY MEDICAID MANAGED CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
  (VIII) EVALUATE DATA COLLECTION AND REPORTING ON  HEALTH  CARE  ACCESS
AND  QUALITY  BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER FACTORS
AND THE AVAILABILITY OF SERVICES AND PROGRAMS THAT ADDRESS THE  DISPARI-
TIES IN ACCESS TO CARE AND OUTCOMES OF CARE;
  (IX) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
  (X)  REVIEW WAIVER APPLICATIONS BEFORE ANY DRAFT PROPOSALS ARE SUBMIT-
TED TO THE FEDERAL GOVERNMENT AND AMENDMENTS AND STATE  PLAN  AMENDMENTS
RELATED  TO  TOPICS  AND  PROGRAMS  WITHIN ITS JURISDICTION, AND SOLICIT
PUBLIC INVOLVEMENT IN THE PROPOSALS;
  (XI) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF  PROGRAM
MATERIALS  AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XII) examine other issues as it deems appropriate.
  (c) Commencing January  first,  [nineteen  hundred  ninety-seven]  TWO
THOUSAND  FOURTEEN  and  quarterly  thereafter the panel shall [submit a
report regarding the status of Medicaid managed care in  the  state  and
provide recommendations if it] PROVIDE WRITTEN RECOMMENDATIONS AND INPUT
AS IT deems appropriate to the governor, the temporary president and the
minority  leader  of the senate, and the speaker and the minority leader
of the assembly ON MATTERS WITHIN ITS JURISDICTION.
  S 3. This act shall take effect immediately; provided that the  amend-
ments  to  section 364-jj of the social services law made by section one
of this act shall be subject to the expiration  and  reversion  of  such
section  pursuant  to  section 84 of part A of chapter 56 of the laws of
2013, as amended, when upon such date the provisions of section  two  of
this act shall take effect.

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