S T A T E O F N E W Y O R K
________________________________________________________________________
7651--A
Cal. No. 257
2011-2012 Regular Sessions
I N A S S E M B L Y
May 12, 2011
___________
Introduced by M. of A. GOTTFRIED, P. RIVERA -- read once and referred to
the Committee on Health -- advanced to a third reading, amended and
ordered reprinted, retaining its place on the order of third reading
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 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 MEDI-
CAID CONSUMERS WITH DISABILITIES, AND ONE OF WHICH SHALL BRING EXPERTISE
IN ACCESS ISSUES FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICI-
ARY; 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 leader of the assembly. [All members shall be appointed no
later than September first, nineteen hundred ninety-six.] Members shall
serve without 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 established herein. THE PANEL SHALL BE REQUIRED TO SEEK PUBLIC
COMMENT ON MATTERS WITHIN ITS JURISDICTION. PANEL MEETING TIMES, AGEN-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11134-04-2
A. 7651--A 2
DAS, 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; 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; AND
(XI) examine other issues as it deems appropriate.
(c) Commencing January first, [nineteen hundred ninety-seven] TWO
THOUSAND THIRTEEN 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. This act shall take effect immediately.