senate Bill S2737A

2013-2014 Legislative Session

Requires additional medicaid recipients throughout the state to participate in managed care plans

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Archive: Last Bill Status - In Committee


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 23, 2014 print number 2737a
amend and recommit to health
Jan 08, 2014 referred to health
Jan 23, 2013 referred to health

Bill Amendments

Original
A (Active)
Original
A (Active)

S2737 - Bill Details

Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, Soc Serv L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S4182
2009-2010: S7264A

S2737 - Bill Texts

view summary

Requires additional medicaid recipients throughout the state to participate in managed care plans; directs the commissioner of health to submit all appropriate waivers, state plan amendments, and federal applications to secure federal financial support.

view sponsor memo
BILL NUMBER:S2737

TITLE OF BILL: An act to amend the social services law, in relation to
mandatory managed care for certain recipients of medical assistance

PURPOSE OF THE BILL: This bill would require additional Medicaid recip-
ients, throughout the State, to participate in managed care plans.

SUMMARY OF SPECIFIC PROVISIONS: § 1- Amends Paragraph (b) of subdivi-
sion 1 of § 364-j of the Social Services Law to include rural health
networks and those providers who hold a comprehensive HIV special needs
plan certificate of authority as managed care providers.

§ 2- Amends paragraph (e) of subdivision 3 of § 364-j of the Social.
Services Law to expand the categories of individuals who are required to
enroll with a managed care program. Specifically, this bill would
require that the following categories of individuals be enrolled in
managed care programs: persons who are dually eligible for Medicaid and
Medicare and who are enrolled in a TEFRA plans; persons who are eligible
for S.S.I.; persons who are HIV positive; or persons with serious mental
illness and children and adolescents with serious emotional disturbances
be enrolled in managed care programs.

§ 3- Amends § 364-j of the Social Services Law to authorize the Commis-
sioner of Health to take all necessary measures to cause all social
services districts in the state not already doing so to provide Medicaid
services and implement the State's managed care program. In addition,
this section authorizes the Commissioner of Health to submit all appro-
priate waivers to implement this Plan.

§ 4- Stipulates that § 2 of this act shall not take effect unless and
until the Commissioner of Health receives all necessary approvals under
federal law.

§ 5- Effective date.

JUSTIFICATION: While implementing cost containment measures, managed
care programs incorporate comprehensive consumer protections to ensure
that all recipients obtain enrollment assistance and quality care, and
understand their rights and responsibilities under the managed care
plan. This bill expands the definition of managed care providers,
requires that all areas of the State provide Medicaid managed care
programs, and expands the categories of individuals who are required to
enroll in the programs.

PRIOR LEGISLATIVE HISTORY: 2011-2012 - S.4182/A.2338 - HEALTH/Health
2009-2010 - S.7264-A/A.6675-A -- HEALTH/Health 2007-2008 - S.3296/A.4673
2005-2006 - S.3541/A.5461

FISCAL IMPLICATIONS: Yet to be determined. Cost savings to both coun-
ties and the State are expected.

EFFECTIVE DATE: This act shall take effect immediately, with
provisions.

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

                                  2737

                       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

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.
  S  2.  Paragraph  (e)  of subdivision 3 of section 364-j of the social
services law, as amended by section 77-a of part H of chapter 59 of  the
laws of 2011, is amended to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05160-01-3

S. 2737                             2

  (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 depart-
ment  of  mental health, the office for persons with developmental disa-
bilities, the office of children and family services, and the office  of
alcohol and substance abuse services:
  (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;
  (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 mentally retarded;
  (vi)  a  person  receiving  services  provided by an intermediate care
facility for the mentally retarded 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;

S. 2737                             3

  (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; and
  (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 3. Section 364-j of the social services law is amended by adding two
new subdivisions 27 and 28 to read as follows:
  27.  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.
  28. 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
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.

S2737A (ACTIVE) - Bill Details

Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, Soc Serv L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S4182
2009-2010: S7264A

S2737A (ACTIVE) - Bill Texts

view summary

Requires additional medicaid recipients throughout the state to participate in managed care plans; directs the commissioner of health to submit all appropriate waivers, state plan amendments, and federal applications to secure federal financial support.

view sponsor memo
BILL NUMBER:S2737A

TITLE OF BILL: An act to amend the social services law, in relation
to mandatory managed care for certain recipients of medical assistance

PURPOSE OF THE BILL:

This bill would require additional Medicaid recipients, throughout the
state, to participate in managed care plans.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1- Amends Paragraph (b) of subdivision 1 of § 364-j of the
Social Services Law to include rural health networks and those
providers who hold a comprehensive HIV special needs plan certificate
of authority as managed care providers.

Section 2- Amends paragraph (e) of subdivision 3 of § 364-j of the
Social Services Law to expand the categories of individuals who are
required to enroll with a managed care program. Specifically, this
bill would require that the following categories of individuals be
enrolled in managed care programs: persons who are dually eligible for
Medicaid and Medicare and who are enrolled in a TEFRA plan; persons
who are eligible for S.S.I.; persons who are HIV positive; or persons
with serious mental illness and children and adolescents with serious
emotional disturbances.

Section 3- Amends § 364-j of the Social Services Law to authorize the
Commissioner of Health to take all necessary measures to cause all
social services districts in the state not already doing so to provide
Medicaid services and implement the state's managed care program. In
addition, this section authorizes the Commissioner of Health to submit
all appropriate waivers to implement this Plan.

Section 4- Stipulates that § 2 of this act shall not take effect
unless and until the Commissioner of Health receives all necessary
approvals under federal law.

Section 5- Effective date.

JUSTIFICATION:

While implementing cost containment measures, managed care programs
incorporate comprehensive consumer protections to ensure that all
recipients obtain enrollment assistance and quality care, and
understand their rights and responsibilities under the managed care
plan. This bill expands the definition of managed care providers,
requires that all areas of the state provide Medicaid managed care
programs, and expands the categories of individuals who are required
to enroll in the programs.

PRIOR LEGISLATIVE HISTORY:

2013 - S.2737 - HEALTH
2011-2012 - S.4182/A.2338 - HEALTH/Health
2009-2010 - S.7264-A/A.6675-A -- HEALTH/Health
2007-2008 - S.3296/A.4673


2005-2006 - S.3541/A.5461

FISCAL IMPLICATIONS:

To be determined. Cost savings to both counties and the state are
expected.

EFFECTIVE DATE:

This act shall take effect immediately, with provisions.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 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.

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