Assembly Bill A6675

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

                                 6675--A

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             March 11, 2009
                               ___________

Introduced  by  M. of A. SCHIMMINGER, DelMONTE, GABRYSZAK -- Multi-Spon-
  sored by -- M. of  A.  HOOPER,  MAGEE,  N. RIVERA  --  read  once  and
  referred to the Committee on Health -- recommitted to the Committee on
  Health  in  accordance  with  Assembly  Rule  3,  sec.  2 -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the  social  services  law,  in  relation  to  mandatory
  managed care for certain recipients of medical assistance

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

  Section 1. Paragraph (b) of subdivision 1  of  section  364-j  of  the
social  services  law,  as  amended  by chapter 649 of the laws of 1996,
subparagraphs (i) and (ii) as amended by chapter  433  of  the  laws  of
1997, is amended to read as follows:
  (b)  "Managed  care provider". An entity that provides or arranges for
the provision of medical assistance services  and  supplies  to  partic-
ipants  directly  or  indirectly (including by referral), including case
management; and:
  (i) is authorized to operate under article forty-four  of  the  public
health  law  or article forty-three of the insurance law and provides or
arranges, directly or indirectly (including  by  referral)  for  covered
comprehensive health services on a full capitation basis; [or]
  (ii)  is  authorized  as  a  partially  capitated  program pursuant to
section three hundred sixty-four-f of this title or  section  forty-four
hundred  three-e of the public health law or section 1915b of the social
security act;
  (III) IS A RURAL HEALTH NETWORK  AS  DEFINED  IN  SUBDIVISION  TWO  OF
SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW; OR
  (IV)  HOLDS  A  COMPREHENSIVE  HIV  SPECIAL  NEEDS PLAN CERTIFICATE OF
AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-C OF  THE  PUBLIC
HEALTH LAW.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09602-04-0
              

A. 6675--A                          2

  S  2.  Paragraph  (g)  of subdivision 3 of section 364-j of the social
services law, as amended by chapter 649 of the laws  of  1996,  subpara-
graph  (i)  as amended by section 30 of part C of chapter 58 of the laws
of 2008, is amended to read as follows:
  (g)  The following categories of individuals will [not] be required to
enroll with a managed care program [until]  FOLLOWING  THE  APPROVAL  OF
program  features  and reimbursement rates [are approved] by the commis-
sioner of health and, as appropriate, the commissioner of mental health:
  (i) an individual dually eligible for medical assistance and  benefits
under  the  federal  Medicare program and enrolled in a Medicare managed
care plan offered by an entity that is also  a  managed  care  provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):
  (a) if the individual changes his or her Medicare managed care plan as
authorized  by  title  XVIII  of  the  federal  social security act, and
enrolls in another Medicare managed care plan that  is  also  a  managed
care  provider, the individual shall be (if required by the commissioner
under this paragraph) enrolled in that managed care provider;
  (b) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII  of  the  federal  social  security  act,  but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider  in  which he or she was enrolled and withdraw from the managed
care program;
  (c) if the individual disenrolls from his or her Medicare managed care
plan as authorized by title XVIII of the federal  social  security  act,
and  does not enroll in another Medicare managed care plan, the individ-
ual shall be disenrolled from the managed care provider in which  he  or
she was enrolled and withdraw from the managed care program;
  (d)  nothing  herein shall require an individual enrolled in a managed
long term care plan, pursuant to section forty-four hundred  three-f  of
the public health law, to disenroll from such program.
  (ii) an individual eligible for supplemental security income;
  (iii) HIV positive individuals; and
  (iv)  persons with serious mental illness and children and adolescents
with serious emotional disturbances[, as defined in  section  forty-four
hundred one of the public health law].
  S 3. Section 364-j of the social services law is amended by adding two
new subdivisions 25 and 26 to read as follows:
  25.  THE  COMMISSIONER OF HEALTH SHALL TAKE ALL MEASURES NECESSARY AND
CONVENIENT TO CAUSE ALL SOCIAL  SERVICES  DISTRICTS  IN  THE  STATE  NOT
ALREADY DOING SO TO PROVIDE MEDICAL ASSISTANCE AND IMPLEMENT THE STATE'S
MANAGED  CARE PROGRAM AND PARTICIPATE IN SUCH PROGRAM AUTHORIZED BY THIS
SECTION.
  26. THE COMMISSIONER OF HEALTH SHALL SUBMIT THE  APPROPRIATE  WAIVERS,
STATE PLAN AMENDMENTS AND FEDERAL APPLICATIONS, INCLUDING BUT NOT LIMIT-
ED  TO,  WAIVER  REQUESTS AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED
FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT,
OR SUCCESSOR PROVISIONS, AS THE COMMISSIONER OF HEALTH SHALL DEEM NECES-
SARY TO SECURE APPROPRIATE FEDERAL FINANCIAL SUPPORT FOR THE COST  OF  A
PROGRAM  TO  AUTHORIZE  MANDATORY  MANAGED  CARE  FOR MEDICAL ASSISTANCE
RECIPIENTS RESIDING IN ALL AREAS OF THE STATE, INCLUDING  RECIPIENTS  OF
SUPPLEMENTAL INCOME AND PERSONS ENROLLED OR ELIGIBLE TO BE ENROLLED IN A
MEDICARE TEFRA PLAN.
  S  4.  Section  two of this act shall not take effect unless and until
the commissioner of health receives all necessary approvals under feder-

A. 6675--A                          3

al law and regulation to implement its  provisions,  and  provided  that
such  provisions do not prevent the receipt of federal financial partic-
ipation under the medical assistance program. The commissioner of health
shall  submit  such  waiver applications and/or state plan amendments as
may be necessary to obtain such approvals and to ensure continued feder-
al financial participation.
  S 5. This act shall take effect immediately; provided,  however,  that
the  amendments  to  section  364-j  of  the social services law made by
sections one, two and three of this act shall not affect the  repeal  of
such  section  pursuant  to chapter 710 of the laws of 1988, as amended,
and shall be deemed repealed therewith; provided that  the  commissioner
of health shall notify the legislative bill drafting commission upon the
occurrence  of  the enactment of the legislation provided for in section
two of this act in order that the commission may  maintain  an  accurate
and  timely  effective data base of the official text of the laws of the
state of New York in furtherance of effecting the provisions of  section
44 of the legislative law and section 70-b of the public officers law.