S T A T E O F N E W Y O R K
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2737--A
2013-2014 Regular Sessions
I N S E N A T E
January 23, 2013
___________
Introduced by Sen. RANZENHOFER -- read twice and ordered printed, and
when printed to be committed to the Committee on Health -- recommitted
to the Committee on Health in accordance with Senate Rule 6, sec. 8 --
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,
subparagraph (i) as amended by section 35-a and subparagraph (ii) as
amended and subparagraph (iii) as added by section 77 of part A of chap-
ter 56 of the laws of 2013, 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, including a
special needs managed care plan or comprehensive HIV special needs plan
CERTIFICATE OF AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-C
OF THE PUBLIC HEALTH LAW; [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; [or]
(iii) is authorized to operate under section forty-four hundred
three-g of the public health law[.]; OR
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05160-03-4
S. 2737--A 2
(IV) IS A RURAL HEALTH NETWORK AS DEFINED IN SUBDIVISION TWO OF
SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW.
S 2. Paragraph (e) of subdivision 3 of section 364-j of the social
services law, as amended by section 38 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
(e) The following categories of individuals [may] SHALL be required to
enroll with a managed care program [when] FOLLOWING THE APPROVAL OF
program features and reimbursement rates [are approved] by the commis-
sioner of health and, as appropriate, the commissioners of the office of
mental health, the office for people with developmental disabilities,
the office of children and family services, and the office of alcoholism
and substance abuse services:
(i) an individual dually eligible for medical assistance and benefits
under the federal Medicare program; provided, however, nothing herein
shall: (a) 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; or (b) make enrollment in a
Medicare managed care plan a condition of the individual's participation
in the managed care program pursuant to this section, or affect the
individual's entitlement to payment of applicable Medicare managed care
or fee for service coinsurance and deductibles by the individual's
managed care provider.
(ii) an individual eligible for supplemental security income;
(iii) HIV positive individuals;
(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];
(v) a person receiving services provided by a residential alcohol or
substance abuse program or facility for the developmentally disabled;
(vi) a person receiving services provided by an intermediate care
facility for the developmentally disabled or who has characteristics and
needs similar to such persons;
(vii) a person with a developmental or physical disability who
receives home and community-based services or care-at-home services
through existing waivers under section nineteen hundred fifteen (c) of
the federal social security act or who has characteristics and needs
similar to such persons;
(viii) a person who is eligible for medical assistance pursuant to
subparagraph twelve or subparagraph thirteen of paragraph (a) of subdi-
vision one of section three hundred sixty-six of this title;
(ix) a person receiving services provided by a long term home health
care program, or a person receiving inpatient services in a state-oper-
ated psychiatric facility or a residential treatment facility for chil-
dren and youth;
(x) certified blind or disabled children living or expected to be
living separate and apart from the parent for thirty days or more;
(xi) residents of nursing facilities;
(xii) a foster child in the placement of a voluntary agency or in the
direct care of the local social services district;
(xiii) a person or family that is homeless;
(xiv) individuals for whom a managed care provider is not geograph-
ically accessible so as to reasonably provide services to the person. A
managed care provider is not geographically accessible if the person
cannot access the provider's services in a timely fashion due to
distance or travel time;
S. 2737--A 3
(xv) a person eligible for Medicare participating in a capitated
demonstration program for long term care;
(xvi) an infant living with an incarcerated mother in a state or local
correctional facility as defined in section two of the correction law;
(xvii) a person who is expected to be eligible for medical assistance
for less than six months;
(xviii) a person who is eligible for medical assistance benefits only
with respect to tuberculosis-related services;
(xix) individuals receiving hospice services at time of enrollment;
provided, however, that this clause shall not be construed to require an
individual enrolled in a managed long term care plan or another care
coordination model, who subsequently elects hospice, to disenroll from
such program;
(xx) a person who has primary medical or health care coverage avail-
able from or under a third-party payor which may be maintained by
payment, or part payment, of the premium or cost sharing amounts, when
payment of such premium or cost sharing amounts would be cost-effective,
as determined by the local social services district;
(xxi) a person receiving family planning services pursuant to subpara-
graph six of paragraph (b) of subdivision one of section three hundred
sixty-six of this title;
(xxii) a person who is eligible for medical assistance pursuant to
paragraph (d) of subdivision four of section three hundred sixty-six of
this title;
(xxiii) individuals with a chronic medical condition who are being
treated by a specialist physician that is not associated with a managed
care provider in the individual's social services district; and
(xxiv) Native Americans.
S 3. Section 364-j of the social services law is amended by adding two
new subdivisions 29 and 30 to read as follows:
29. 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.
30. 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-
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:
S. 2737--A 4
(a) the amendments to section 364-j of the social services law made by
sections two and three of this act shall not affect the repeal of such
section and shall be deemed repealed therewith;
(b) the amendment to subparagraphs (ii) and (iii) of paragraph (b) of
section 364-j of the social services law shall not affect the expiration
or repeal of such subparagraphs and the repeal of such section;
(c) provided that the commissioner of health shall notify the legisla-
tive 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.