senate Bill S4885A

2013-2014 Legislative Session

Creates the managed care for persons with developmental disabilities advocacy program

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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
Feb 04, 2014 reported and committed to finance
Jan 08, 2014 referred to mental health and developmental disabilities
Jun 03, 2013 print number 4885a
amend and recommit to finance
May 08, 2013 reported and committed to finance
Apr 30, 2013 referred to mental health and developmental disabilities

Votes

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Feb 5, 2014 - Mental Health and Developmental Disabilities committee Vote

S4885A
11
0
committee
11
Aye
0
Nay
0
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show Mental Health and Developmental Disabilities committee vote details

Mental Health and Developmental Disabilities Committee Vote: Feb 5, 2014

May 8, 2013 - Mental Health and Developmental Disabilities committee Vote

S4885
6
0
committee
6
Aye
0
Nay
5
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show committee vote details

Committee Vote: May 8, 2013

Bill Amendments

Original
A (Active)
Original
A (Active)

Co-Sponsors

S4885 - Bill Details

See Assembly Version of this Bill:
A6962A
Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §13.40, Ment Hyg L

S4885 - Bill Texts

view summary

Creates the managed care for persons with developmental disabilities advocacy program.

view sponsor memo
BILL NUMBER:S4885

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
the creation of the managed care for persons with developmental
disabilities advocacy program

PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to establish the Managed Care for Persons
with Developmental Disabilities Advocacy Program for purposes of
assisting persons receiving services from the Office of People-with
Developmental Disabilities (OPWDD) to navigate the managed care
system.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill creates the Managed Care for Persons with
Developmental Disabilities Advocacy Program. The advocacy program
shall advise individuals of applicable rights and responsibilities,
provide information, referrals and technical assistance to address the
needs of the individual, and pursue legal, administrative and other
appropriate remedies or approaches to ensure the protection of and
advocacy for the rights of the enrollees.

Section 2 of the bill is the effective date.

JUSTIFICATION:

The 2013-14 state budget authorizes the State to enroll individuals
receiving OPWDD services to risk bearing Medicaid managed care plans
starting in 2014. This is a significant change to the OPWDD system
which has historically been a fee for service system.

Currently, OPWDD recipients receive care coordination from an
independent third party, known as the Medicaid Service Coordination
(MSC) program. As OPWDD services transition to managed care, many
functions of this program will be assumed by managed care companies.
Managed care companies cannot reasonably assume certain advocacy
functions of the MSC program because the managed care company will
often have a financial interest in denying certain services. For this
reason, many stakeholders have expressed the need for additional
outside advocates to be available to assist enrollees.

This bill ensures that persons receiving OPWDD services continue to
receive independent advocacy after being enrolled in a managed care
plan by creating a Managed Care for Persons with Developmental
Disabilities Advocacy Program. The program will advise individuals of
applicable rights and responsibilities, including, but not limited to,
the right to treatment, person centered care, care in the most
integrated setting, and the right to contest decisions made by a
managed care company; provide information, referrals and technical
assistance to address the needs of individuals with disabilities; and
pursue legal, administrative and other appropriate remedies or
approaches to ensure the protection of and advocacy for the rights of
the enrollees. This program will help ensure that enrollees continue
to receive adequate care and that they have adequate input in their
plan of care.


PRIOR LEGISLATIVE HISTORY:

New bill.

FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:

This act shall take effect immediately.

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

                                  4885

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 30, 2013
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed to the Committee on Mental Health and Develop-
  mental Disabilities

AN ACT to amend the mental hygiene law, in relation to the  creation  of
  the  managed care for persons with developmental disabilities advocacy
  program

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

  Section  1.  Section  13.40  of  the  mental hygiene law is amended by
adding a new subdivision (h) to read as follows:
  (H) THE COMMISSIONER AND THE  COMMISSIONER  OF  HEALTH  SHALL  JOINTLY
ESTABLISH  THE  MANAGED CARE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
ADVOCACY PROGRAM, HEREINAFTER REFERRED TO AS THE ADVOCACY  PROGRAM.  THE
ADVOCACY  PROGRAM  MAY  BE  INTEGRATED  WITH AND PROVIDED IN ADDITION TO
INDEPENDENT MEDICAID MANAGED CARE OMBUDS SERVICES  PROVIDED  TO  PERSONS
WITH  DISABILITIES  ENROLLING  IN  MEDICAID  MANAGED  CARE. THE ADVOCACY
PROGRAM SHALL: ADVISE INDIVIDUALS OF APPLICABLE RIGHTS AND  RESPONSIBIL-
ITIES,  INCLUDING,  BUT  NOT  LIMITED TO, THE RIGHT TO TREATMENT, PERSON
CENTERED CARE, CARE IN THE MOST INTEGRATED SETTING,  AND  THE  RIGHT  TO
CONTEST  DECISIONS  MADE BY A MANAGED CARE COMPANY; PROVIDE INFORMATION,
REFERRALS AND TECHNICAL ASSISTANCE TO ADDRESS THE NEEDS  OF  INDIVIDUALS
WITH  DISABILITIES; AND PURSUE LEGAL, ADMINISTRATIVE AND OTHER APPROPRI-
ATE REMEDIES OR APPROACHES TO ENSURE THE PROTECTION OF AND ADVOCACY  FOR
THE  RIGHTS  OF  THE  ENROLLEES. THE ADVOCACY PROGRAM SHALL ALSO PROVIDE
SUPPORT TO ELIGIBLE INDIVIDUALS  ENROLLING  IN  DISCOS,  HMOS  PROVIDING
SERVICES  PURSUANT  TO  SUBDIVISION  EIGHT OF SECTION FORTY-FOUR HUNDRED
THREE OF THE PUBLIC HEALTH LAW, AND MANAGED LONG TERM CARE PLANS PROVID-
ING SERVICES UNDER SUBDIVISIONS TWELVE, THIRTEEN AND FOURTEEN OF SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW; SUPPORT DURING  THE
PERSON-CENTERED PLANNING PROCESS AND RELATED PROCESSES INCLUDING UPDATES
TO  THE PERSON-CENTERED CARE PLAN; AND ASSISTANCE WITH SECURING HOUSING,

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10533-01-3

S. 4885                             2

EMPLOYMENT, AND COMMUNITY-BASED SUPPORTS AND SERVICES THAT FALL  OUTSIDE
OF THE SCOPE OF DISCO SERVICES AND SUPPORTS.
  THE  COMMISSIONERS  SHALL  JOINTLY  DESIGNATE AN INDEPENDENT AGENCY OR
ORGANIZATION TO ADMINISTER THE ADVOCACY PROGRAM. SUCH AGENCY MAY BE  THE
AGENCY   COORDINATING  THE  INDEPENDENT  MEDICAID  MANAGED  CARE  OMBUDS
SERVICES, OR A SUB-CONTRACTOR OF THAT AGENCY. THE ADVOCACY PROGRAM SHALL
BE ADVISED BY A BOARD, WHOSE MEMBERSHIP SHALL REFLECT REPRESENTATION  OF
THE DEVELOPMENTAL DISABILITY POPULATION.
  S 2. This act shall take effect immediately.

Co-Sponsors

S4885A (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A6962A
Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §13.40, Ment Hyg L

S4885A (ACTIVE) - Bill Texts

view summary

Creates the managed care for persons with developmental disabilities advocacy program.

view sponsor memo
BILL NUMBER:S4885A

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
the creation of the managed care for persons with developmental
disabilities advocacy program

PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to establish the Managed Case for Persons
with Developmental Disabilities Advocacy Program for purposes of
assisting persons receiving services from the Office of People with
Developmental Disabilities (OPWDD) to navigate the managed care
system.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill creates the Managed Case for Persons with
Developmental Disabilities Advocacy Program. The advocacy program
shall advise individuals of applicable rights and responsibilities,
provide information, referrals and technical assistance to address the
needs of the individual, and pursue legal, administrative and other
appropriate remedies or approaches to ensure the protection of and
advocacy for the rights of the enrollees.

Section 2. Clarifies that the bill does not intend to transfer to the
advocacy program any current duties, including Medicaid Service
Coordination, of state employees employed by OPWDD.

Section 3 of the bill is the effective date.

JUSTIFICATION:

The 2013-14 state budget authorizes the State to enroll individuals
receiving OPWDD services to risk bearing Medicaid managed care plans
starting in 2014. This is a significant change to the OPWDD system
which has historically been a fee for service system.

Currently, OPWDD recipients receive care coordination from an
independent third party, known as the Medicaid Service Coordination
(MSC) program. As OPWDD services transition to managed care, many
functions of this program will be assumed by managed care companies.
Managed care companies cannot reasonably assume certain advocacy
functions of the MSC program because the managed care company will
often have a financial interest in denying certain services. For this
reason, many stakeholders have expressed the need for additional
outside advocates to be available to assist enrollees.

This bill ensures that persons receiving OPWDD services continue to
receive independent advocacy after being enrolled in a managed care
plan by creating a Managed Care for Persons with Developmental
Disabilities Advocacy Program. The program will advise individuals of
applicable rights and responsibilities, including, but not limited to,
the right to treatment, person centered care, care in the most
integrated setting, and the right to contest decisions made by a
managed care company; ' provide information, referrals and technical
assistance to address the needs of individuals with disabilities; and
pursue legal, administrative and other appropriate remedies or


approaches to ensure the protection of and advocacy for the rights of
the enrollees. This program will help ensure that enrollees continue
to receive adequate care and that they have adequate input in their
plan of care.

PRIOR LEGISLATIVE HISTORY:

New bill.

FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:

This act shall take effect immediately.

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

                                 4885--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 30, 2013
                               ___________

Introduced  by Sens. CARLUCCI, GRISANTI -- read twice and ordered print-
  ed, and when printed to be committed to the Committee on Mental Health
  and Developmental Disabilities -- reported favorably from said commit-
  tee and committed to the Committee on Finance -- committee discharged,
  bill amended, ordered reprinted as amended  and  recommitted  to  said
  committee

AN  ACT  to amend the mental hygiene law, in relation to the creation of
  the managed care for persons with developmental disabilities  advocacy
  program

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

  Section 1. Section 13.40 of the  mental  hygiene  law  is  amended  by
adding a new subdivision (h) to read as follows:
  (H)  THE  COMMISSIONER  AND  THE  COMMISSIONER OF HEALTH SHALL JOINTLY
ESTABLISH THE MANAGED CARE FOR PERSONS WITH  DEVELOPMENTAL  DISABILITIES
ADVOCACY  PROGRAM,  HEREINAFTER REFERRED TO AS THE ADVOCACY PROGRAM. THE
ADVOCACY PROGRAM SHALL BE INTEGRATED WITH AND PROVIDED  IN  ADDITION  TO
INDEPENDENT  MEDICAID  MANAGED  CARE OMBUDS SERVICES PROVIDED TO PERSONS
WITH DISABILITIES ENROLLING  IN  MEDICAID  MANAGED  CARE.  THE  ADVOCACY
PROGRAM  SHALL: ADVISE INDIVIDUALS OF APPLICABLE RIGHTS AND RESPONSIBIL-
ITIES, INCLUDING, BUT NOT LIMITED TO, THE  RIGHT  TO  TREATMENT,  PERSON
CENTERED  CARE,  CARE  IN  THE MOST INTEGRATED SETTING, AND THE RIGHT TO
CONTEST DECISIONS MADE BY A MANAGED CARE COMPANY;  PROVIDE  INFORMATION,
REFERRALS  AND  TECHNICAL ASSISTANCE TO ADDRESS THE NEEDS OF INDIVIDUALS
WITH DISABILITIES; AND PURSUE LEGAL, ADMINISTRATIVE AND OTHER  APPROPRI-
ATE  REMEDIES OR APPROACHES TO ENSURE THE PROTECTION OF AND ADVOCACY FOR
THE RIGHTS OF THE ENROLLEES. THE ADVOCACY  PROGRAM  SHALL  ALSO  PROVIDE
SUPPORT  TO  ELIGIBLE  INDIVIDUALS  ENROLLING  IN DISCOS, HMOS PROVIDING
SERVICES PURSUANT TO SUBDIVISION EIGHT  OF  SECTION  FORTY-FOUR  HUNDRED
THREE  OF  THE PUBLIC HEALTH LAW, MANAGED LONG TERM CARE PLANS PROVIDING
SERVICES UNDER SUBDIVISIONS TWELVE, THIRTEEN  AND  FOURTEEN  OF  SECTION

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10533-06-3

S. 4885--A                          2

FORTY-FOUR  HUNDRED  THREE-F  OF THE PUBLIC HEALTH LAW, FULLY INTEGRATED
DUAL ADVANTAGE PROVIDING  SERVICES  UNDER  SUBDIVISION  TWENTY-SEVEN  OF
SECTION  THREE  HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, AND ANY
OTHER  MANAGED  CARE ENTITY; SUPPORT DURING THE PERSON-CENTERED PLANNING
PROCESS AND RELATED PROCESSES INCLUDING UPDATES TO  THE  PERSON-CENTERED
CARE  PLAN; AND ASSISTANCE WITH SECURING HOUSING, EMPLOYMENT, AND COMMU-
NITY-BASED SUPPORTS AND SERVICES THAT FALL OUTSIDE OF THE SCOPE OF DISCO
SERVICES AND SUPPORTS.
  THE COMMISSIONERS SHALL JOINTLY DESIGNATE  AN  INDEPENDENT  AGENCY  OR
ORGANIZATION  TO  ADMINISTER  THE ADVOCACY PROGRAM. SUCH AGENCY SHALL BE
THE AGENCY COORDINATING THE INDEPENDENT  MEDICAID  MANAGED  CARE  OMBUDS
SERVICES, OR A SUB-CONTRACTOR OF THAT AGENCY. THE ADVOCACY PROGRAM SHALL
BE  ADVISED BY A BOARD, WHOSE MEMBERSHIP SHALL REFLECT REPRESENTATION OF
THE DEVELOPMENTAL DISABILITY POPULATION.
  S 2. Nothing in this act is intended to transfer to the  developmental
disabilities  advocacy  program  created  by  subdivision (h) of section
13.40 of the mental hygiene law any current duties,  including  Medicaid
service  coordination, of state employees who are employed by the office
for people with developmental disabilities.
  S 3. This act shall take effect immediately.

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