S T A T E O F N E W Y O R K
________________________________________________________________________
4827
2009-2010 Regular Sessions
I N A S S E M B L Y
February 6, 2009
___________
Introduced by M. of A. MORELLE -- read once and referred to the Commit-
tee on Health
AN ACT to amend chapter 530 of the laws of 1988 authorizing the depart-
ment of social services to contract for chronic care case management
demonstration programs, in relation to extending the effectiveness of
such programs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 1 of chapter 530 of the laws of 1988 authorizing
the department of social services to contract for chronic care case
management demonstration programs, as amended by chapter 610 of the laws
of 1996, is amended to read as follows:
Section 1. Chronic care management demonstration program. 1. The
department of [social services] HEALTH, with the advice and consent of
the [department of health and the] county of Monroe, is hereby author-
ized to enter into a contract with chronic care management demonstration
programs sponsored by Greater Rochester Health System, Inc.[,] AND Inde-
pendent Living for Seniors, Inc., OR THEIR SUCCESSOR ST. ANN'S PACE
PROGRAM, INC., and providers licensed by article twenty-eight, thirty-
six or forty-four of the public health law for the purposes of testing
cost-effective methods of coordinating the arrangement and provision of
services and to determine the effectiveness of such programs in meeting
the needs of persons requiring chronic or long term care, however,
notwithstanding anything in article thirty-six of the public health law,
for the purposes of the chronic care demonstration program, the commis-
sioner of health may authorize a sponsor to provide a long term home
health care program regardless of whether the sponsor is otherwise
licensed under article twenty-eight, thirty-six or forty-four of the
public health law.
2. The department of [social services] HEALTH with the advice and
consent of the [department of health and the] office for the aging, as
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08498-01-9
A. 4827 2
appropriate, shall promulgate regulations to effectuate the provisions
of this section, including, but not limited to:
(a) eligibility criteria for chronic care management clients;
(b) the responsibilities of the chronic care management programs spon-
sored by Greater Rochester Health System, Inc. OR ST. ANN'S PACE
PROGRAM, INC., and others selected pursuant to subdivision one of this
section, which may include, but need not be limited to, the management
of comprehensive long term care services, assessment of the client's
needs, provision of or arrangement for services, coordination of
resources and measures to control costs and monitoring of the quality of
care and the efficiency with which services are delivered;
(c) services to be provided or arranged, which may include housing,
inpatient and outpatient hospital services, nursing home care, home
health care, adult day care, hospice care, respite care, personal care,
homemaker services, diagnostic laboratory services, therapeutic and
diagnostic radiologic services, emergency services, emergency alarm
systems, home delivered meals, physical adaptations to the client's
home, physician care (including consultant and referral services),
ancillary services, case management services, transportation and related
medical services; and
(d) different reimbursement mechanisms which may be utilized, includ-
ing, but not limited to, reimbursement initially on a cost-related,
fee-for-service basis, progressing in phases to a prepaid system or
incentive-based system whereby the chronic care management programs
would share in any savings or losses. The chronic care management demon-
stration programs, including those sponsored by Greater Rochester Health
System, Inc. OR ST. ANN'S PACE PROGRAM, INC., and others selected pursu-
ant to subdivision one of this section shall be entitled to receive
reimbursement for the services of the programs, whether provided direct-
ly or under arrangements. The commissioner of social services may waive
provisions of the social services law and regulations thereof and the
commissioner of health may waive provisions of the public health law and
regulations thereof as may be necessary to utilize different reimburse-
ment mechanisms.
3. The provisions of article forty-four of the public health law shall
not be applicable to the demonstration programs [or] AND to Greater
Rochester Health System, Inc. OR ITS SUCCESSOR ST. ANN'S PACE PROGRAM,
INC., and others selected pursuant to subdivision one of this section or
any approved successor thereto, for the term of the demonstration herein
authorized; provided, however, the department of health[, in consulta-
tion with the department of social services,] shall be responsible for
regulating the quality, appropriateness and cost-effectiveness of the
programs by regulations promulgated pursuant to articles twenty-eight,
thirty-six and forty-four, as appropriate, of the public health law. THE
POWERS OF ST. ANN'S PACE PROGRAM, INC., HEREUNDER, IN ADDITION TO ANY
OTHER POWERS CONFERRED BY THE LAWS UNDER WHICH SUCH ORGANIZATION IS
CONSTRUCTED, SHALL INCLUDE THE PURCHASE, LEASE, CONSTRUCTION, RENO-
VATION, OPERATION AND/OR MAINTENANCE OF A DIAGNOSTIC AND TREATMENT
CENTER, SUBJECT TO THE PROVISIONS OF ARTICLE TWENTY-EIGHT OF THE PUBLIC
HEALTH LAW, AND, NOTWITHSTANDING ANY PROVISION OF LAW, THE PURCHASE,
OPERATION AND/OR MAINTENANCE OF A LONG TERM HEALTH CARE PROGRAM.
4. The commissioner of [social services, in consultation with the
commissioner of] health, shall approve only those plans submitted pursu-
ant to this section which;
A. 4827 3
(a) include a description of the quality-assurance mechanisms to be
implemented, as well as other mechanisms designed to protect recipient
rights under such programs;
(b) include a description of the enrollment process;
(c) include a description of the marketing plan; and
(d) include a description of the cost-effectiveness of the programs as
compared to the cost of services the client would otherwise have been
provided.
5. Demonstration programs including Greater Rochester Health System,
Inc. OR ITS SUCCESSOR ST. ANN'S PACE PROGRAM, INC. and others selected
pursuant to subdivision one of this section or any approved successors
thereto, as sponsor of the chronic care management demonstration
programs, shall not, by virtue of any reimbursement mechanism utilized
by such programs, be deemed to be engaged in the business of insurance
or to have entered into an insurance contract, and shall not require
licensure or other approvals pursuant to the insurance law.
6. The department of [social services, with the advice and consent of
the department of] health[,] shall utilize to the extent possible, all
potential sources of funding for such chronic care management demon-
stration programs including, but not limited to, funding available
through titles sixteen, eighteen, nineteen and twenty of the federal
social security act and the federal older Americans act of 1965, as
amended. Additional sources may include, but are not limited to, private
insurances, private payments, donations, etc. Services provided as part
of the chronic care management demonstration programs and related admin-
istrative expenses not otherwise eligible for coverage under these or
other funding sources shall be eligible for reimbursement under the
medical assistance program for the purposes of this demonstration as
long as federal financial participation is available. The department of
social services, with the advice and consent of the department of
health, shall take all steps necessary to secure such funding, which may
include a submission of waivers pursuant to section one thousand one
hundred fifteen and section one thousand nine hundred fifteen of the
federal social security act and any and all other waivers necessary to
provide services not otherwise eligible for reimbursement under the
medical assistance program and to allow for different reimbursement
mechanisms. Copies of waiver applications shall be provided to the
chairman of the senate finance committee and the chairman of the assem-
bly ways and means committee simultaneously with their submission to the
federal government.
7. The department of [social services] HEALTH shall make diligent
efforts to coordinate the activities of the department of health, the
county of Monroe social services office, and the chronic care management
demonstration programs, including Greater Rochester Health System,
Inc.[,] OR ITS SUCCESSOR ST. ANN'S PACE PROGRAM, INC., and others
selected pursuant to subdivision one of this section, in the implementa-
tion of these demonstration programs and to avoid any unnecessary dupli-
cation of activities or services. The department of health[, in consul-
tation with the department of social services,] shall be responsible for
reviewing the quality, appropriateness and cost-effectiveness of the
care provided by the demonstration programs.
S 2. This act shall take effect immediately; provided, however, that
the amendments to section 1 of chapter 530 of the laws of 1988 made by
section one of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.