senate Bill S5896A

2013-2014 Legislative Session

Relates to the special advisory review panel on Medicaid managed care

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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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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Feb 03, 2014 print number 5896a
amend and recommit to health
Jan 08, 2014 referred to health
Jun 19, 2013 referred to rules

Bill Amendments

Original
A (Active)
Original
A (Active)

S5896 - Bill Details

Current Committee:
Law Section:
Social Services Law
Laws Affected:
Amd §364-jj, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:
A7651A

S5896 - Bill Texts

view summary

Relates to the membership and expands the duties of the special advisory review panel on Medicaid managed care by including other managed care programs.

view sponsor memo
BILL NUMBER:S5896

TITLE OF BILL: An act to amend the social services law, in relation
to the special advisory review panel on Medicaid managed care

PURPOSE OR GENERAL IDEA OF BILL:

To update the composition and the charge of the Medicaid Managed Care
Advisory Review Panel (MMCARP).

SUMMARY OF SPECIFIC PROVISIONS:

The bill amends section 364-jj of the Social Services Law to add Child
Health Plus, Family Health Pius, Managed Long Term Care and other
public managed-health care plans to the charge of the MMCARP and add
two public members with expertise in disabilities and pediatrics. The
bill would also have MMCARP review issues of the appropriateness and
timeliness of se/vices, the integration of federal health care reform,
trends in service denials and demographic data, review of the federal
waiver, as well as public information for choosing among managed long
term care plans.

JUSTIFICATION:

Since the statute's enactment in 1996,the MMCARP has performed an
important function collaboratively working with numerous state
officials in monitoring mandatory Medicaid managed care. Provisions
in the 2011-2012 budget will result in the expansion of mandatory
Medicaid managed care to vulnerable populations who were previously
covered by fee-for-service, including physically and developmentally
disabled individuals, children in foster care, and homeless families.
There will also be a significant increase in home care beneficiaries
enrolled by mandate into managed long term care plans, forcing
individuals with complex needs to manage their care in a new delivery
system. It is increasingly important that the MMCARP provide an
opportunity for monitoring of these programs by a diverse group of
stakeholders including consumer advocates, consumers, health plans and
providers of services.

This bill will charge MMCARP with monitoring the phase-in schedule for
the enrollment of new populations in Medicaid managed care as well as
the availability of essential services for these populations. In
addition, this bill will increase the public's role in providing
feedback on the significant changes soon to be implemented in the
Medicaid delivery system. Active monitoring by stakeholders is
increasingly important as both amendments to state law and federal
health reform lead to increased enrollment in managed care and the
implementation of new service delivery models for an increasingly
diverse beneficiary population.

PRIOR LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS:

None to the state


EFFECTIVE DATE:

Immediately

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

                                  5896

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 19, 2013
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

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  amended  by
section  80-a of part A of chapter 56 of the laws of 2013, 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  [twelve]  THIRTEEN members who shall be appointed as follows: [four]
FIVE by the governor, one of which shall serve  as  the  chair,  TWO  OF
WHICH  SHALL  BRING EXPERTISE IN ACCESS ISSUES FACING MEDICAID CONSUMERS
WITH DISABILITIES, AND ONE OF WHICH  SHALL  BEING  EXPERTISE  IN  ACCESS
ISSUES  FACING  CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY; three
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. At least three members  of  such  panel
shall  be  members of the joint advisory panel established under section
13.40 of the mental hygiene law. Members  shall  serve  without  compen-
sation 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01605-04-3

S. 5896                             2

JURISDICTION. PANEL MEETING TIMES, AGENDAS, 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] 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)  in  accordance  with  the recommendations of the joint advisory
council established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental  disabilities  with
respect  to  the oversight of DISCOs and of health maintenance organiza-
tions and managed long term care plans  providing  services  authorized,
funded,  approved  or  certified  by the office for people with develop-
mental disabilities, and review all managed  care  options  provided  to
persons  with  developmental  disabilities,  including:  the adequacy of
support  for  habilitation  services;  the  record  of  compliance  with
requirements  for person-centered planning, person-centered services and
community integration; the  adequacy  of  rates  paid  to  providers  in
accordance  with the provisions of paragraph [1] (B) of subdivision four
of section forty-four hundred [three] THREE-F of the public health  law,
paragraph (a-2) of subdivision eight of section forty-four hundred three
of  the  public  health  law or paragraph (a-2) of subdivision twelve of
section forty-four hundred three-f of the public  health  law;  and  the
quality  of  life,  health,  safety and community integration of persons
with developmental disabilities enrolled in managed care; [and]
  (viii) EVALUATE TRENDS IN SERVICE DENIALS  BY  MEDICAID  MANAGED  CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
  (IX)  EVALUATE DATA COLLECTION AND REPORTING ON HEALTH CARE ACCESS AND
QUALITY BY RACE, ETHNICITY, LANGUAGE, DISABILITY AND OTHER  FACTORS  AND

S. 5896                             3

THE  AVAILABILITY  OF SERVICES AND PROGRAMS THAT ADDRESS THE DISPARITIES
IN ACCESS TO CARE AND OUTCOMES OF CARE;
  (X) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
  (XI) 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;
  (XII) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS  AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XIII) examine other issues as it deems appropriate.
  (c) Commencing January  first,  [nineteen  hundred  ninety-seven]  TWO
THOUSAND  FOURTEEN  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. 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  MEDICAID  CONSUMERS  WITH
DISABILITIES,  AND  ONE  OF WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES
FACING CHILDREN, AND ONE SHALL BE A MEDICAID BENEFICIARY;  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 lead-
er of the assembly. [All  members  shall  be  appointed  no  later  than
September first, nineteen hundred ninety-six.] Members shall serve with-
out  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 estab-
lished herein.  THE PANEL SHALL BE REQUIRED TO SEEK  PUBLIC  COMMENT  ON
MATTERS  WITHIN  ITS  JURISDICTION.  PANEL  MEETING  TIMES, AGENDAS, 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-

S. 5896                             4

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;
  (XI) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF  PROGRAM
MATERIALS  AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO, NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XII) examine other issues as it deems appropriate.
  (c) Commencing January  first,  [nineteen  hundred  ninety-seven]  TWO
THOUSAND  FOURTEEN  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 3. This act shall take effect immediately; provided that the  amend-
ments  to  section 364-jj of the social services law made by section one
of this act shall be subject to the expiration  and  reversion  of  such
section  pursuant  to  section 84 of part A of chapter 56 of the laws of
2013, as amended, when upon such date the provisions of section  two  of
this act shall take effect.

S5896A (ACTIVE) - Bill Details

Current Committee:
Law Section:
Social Services Law
Laws Affected:
Amd §364-jj, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:
A7651A

S5896A (ACTIVE) - Bill Texts

view summary

Relates to the membership and expands the duties of the special advisory review panel on Medicaid managed care by including other managed care programs.

view sponsor memo
BILL NUMBER:S5896A

TITLE OF BILL: An act to amend the social services law, in relation
to the special advisory review panel on Medicaid managed care

PURPOSE OR GENERAL IDEA OF BILL: To update the composition and the
charge of the Medicaid Managed Care Advisory Review Panel (MMCARP).

SUMMARY OF SPECIFIC PROVISIONS: The bill amends section 364-jj of the
Social Services Law to add Child Health Plus, Family Health Plus,
Managed Long Term Care and other public managed-health care plans to
the charge of the MMCARP and add two public members with expertise in
disabilities and pediatrics. The bill would also have MMCARP review
issues of the appropriateness and timeliness of services, the
integration of federal health care reform, trends in service denials
and demographic data, review of the federal waiver, as well as public
information for choosing among managed long term care plans.

JUSTIFICATION: Since the statute's enactment. in 1996, the MMCARP has
performed an important function collaboratively working with numerous
state officials in monitoring mandatory Medicaid managed care.

Provisions in the 2011-2012 budget will result in the expansion of
mandatory Medicaid managed care to vulnerable populations who were
previously covered by fee-for-service, including physically and
developmentally disabled individuals, children in foster care, and
homeless families. There will also be a significant increase in home
care beneficiaries enrolled by mandate into managed long term care
plans, forcing individuals with complex needs to manage their care in
a new delivery system. It is increasingly important that the MMCARP
provide an opportunity for monitoring of these programs by a diverse
group of stakeholders including consumer advocates, consumers, health
plans and providers of services.

This bill will charge MMCARP with monitoring the phase-in schedule for
the enrollment of new populations in Medicaid managed care as well as
the availability of essential services for these populations. In
addition, this bill will increase the public's role in providing
feedback on the significant changes soon to be implemented in the
Medicaid delivery system. Active monitoring by stakeholders is
increasingly important as both amendments to state law and federal
health reform lead to increased enrollment in managed care and the
implementation of new service delivery models for an increasingly
diverse beneficiary population.

PRIOR LEGISLATIVE HISTORY: 2011-2012: A.7651-A passed Assembly

FISCAL IMPLICATIONS: None to the state

EFFECTIVE DATE: Immediately

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

                                 5896--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 19, 2013
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules  --  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 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 amended by
section 80-a of part A of chapter 56 of the laws of 2013, 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 [twelve] THIRTEEN members who shall be appointed as  follows:  [four]
FIVE  by  the  governor,  one  of which shall serve as the chair, TWO OF
WHICH SHALL BRING EXPERTISE IN ACCESS ISSUES FACING  MEDICAID  CONSUMERS
WITH  DISABILITIES,  AND  ONE  OF  WHICH SHALL BEING EXPERTISE IN ACCESS
ISSUES FACING CHILDREN, AND ONE SHALL BE A MEDICAID  BENEFICIARY;  three
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. At least three members of such panel
shall be members of the joint advisory panel established  under  section
13.40  of  the  mental  hygiene law. Members shall serve without compen-
sation but shall be reimbursed for appropriate expenses.  The department

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01605-06-4

S. 5896--A                          2

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, AGENDAS, 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] 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)  in  accordance  with  the recommendations of the joint advisory
council established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental  disabilities  with
respect  to  the oversight of DISCOs and of health maintenance organiza-
tions and managed long term care plans  providing  services  authorized,
funded,  approved  or  certified  by the office for people with develop-
mental disabilities, and review all managed  care  options  provided  to
persons  with  developmental  disabilities,  including:  the adequacy of
support  for  habilitation  services;  the  record  of  compliance  with
requirements  for person-centered planning, person-centered services and
community integration; the  adequacy  of  rates  paid  to  providers  in
accordance  with the provisions of paragraph [1] (L) of subdivision four
of section forty-four hundred [three] THREE-G of the public health  law,
paragraph (a-2) of subdivision eight of section forty-four hundred three
of  the  public  health  law or paragraph (a-2) of subdivision twelve of
section forty-four hundred three-f of the public  health  law;  and  the
quality  of  life,  health,  safety and community integration of persons
with developmental disabilities enrolled in managed care; [and]

S. 5896--A                          3

  (viii) EVALUATE TRENDS IN SERVICE DENIALS  BY  MEDICAID  MANAGED  CARE
PLANS AND RELATED PROGRAMS, ASSESS EFFECTIVENESS OF GRIEVANCE AND APPEAL
MECHANISMS FOR CONSUMERS;
  (IX)  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 DISPARITIES
IN ACCESS TO CARE AND OUTCOMES OF CARE;
  (X) EVALUATE IMPLEMENTATION OF CONSUMER PROTECTIONS;
  (XI) 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;
  (XII) REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO,  NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XIII) examine other issues as it deems appropriate.
  (c)  Commencing  January  first,  [nineteen  hundred ninety-seven] TWO
THOUSAND FIFTEEN 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.  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 MEDICAID CONSUMERS WITH
DISABILITIES, AND ONE OF WHICH SHALL BRING EXPERTISE  IN  ACCESS  ISSUES
FACING  CHILDREN,  AND  ONE SHALL BE A MEDICAID BENEFICIARY; 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 lead-
er  of  the  assembly.  [All  members  shall  be appointed no later than
September first, nineteen hundred ninety-six.] Members shall serve with-
out 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  estab-
lished  herein.    THE PANEL SHALL BE REQUIRED TO SEEK PUBLIC COMMENT ON
MATTERS WITHIN ITS  JURISDICTION.  PANEL  MEETING  TIMES,  AGENDAS,  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

S. 5896--A                          4

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;
  (XI)  REVIEW AND DETERMINE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM
MATERIALS AND PLAN-FINDING AIDS, INCLUDING BUT NOT LIMITED TO,  NETWORK,
CONTRACT PROVISIONS, ELIGIBILITY AND BENEFIT APPEAL PROCEDURES; AND
  (XII) examine other issues as it deems appropriate.
  (c)  Commencing  January  first,  [nineteen  hundred ninety-seven] TWO
THOUSAND FIFTEEN 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  3. This act shall take effect immediately; provided that the amend-
ments to section 364-jj of the social services law made by  section  one
of  this  act  shall  be subject to the expiration and reversion of such
section pursuant to section 84 of part A of chapter 56 of  the  laws  of
2013,  as  amended, when upon such date the provisions of section two of
this act shall take effect.

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