senate Bill S6583

2013-2014 Legislative Session

Relates to managed long term 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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Senate Actions - UPPERCASE
Feb 10, 2014 referred to health

S6583 - Bill Details

Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd ยงยง4403-f & 2999-o, Pub Health L

S6583 - Bill Texts

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Relates to prohibiting ownership or control of managed long term care plans by health maintenance organizations or insurers.

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BILL NUMBER:S6583

TITLE OF BILL: An act to amend the public health law, in relation to
managed long term care plans not being controlled or owned by
for-profit health maintenance organizations or insurers

PURPOSE OR GENERAL IDEA OF BILL: To assure that managed long term
care plans are primarily owned by not for profit providers or service
entities, to promote best practices consistent with the interests of
the recipient.

SUMMARY OF SPECIFIC PROVISIONS: Amends the definition of "eligible
applicant" for certification as a managed long, term care (MLTC) plan
to require eligible insurers and health maintenance organizations be
not-for-profit. An exception would recognize entities already
certified.

The bill clarifies that an MLTC, or other lawful combinations of long
term care providers can participate in accountable care organizations.

JUSTIFICATION: Medicaid long term care (over 120 days) has been
reformed to be delivered by care coordination entities, predominantly
through risk-bearing managed long term care plans. Currently, this
transition is applied to home and community-based services, with
institutional (nursing home) care contemplated to be phased in.

MLTCs have, until now been almost exclusively entities owned by long
term care providers, not by HMOs or insurance companies. When
participation in an MLTC was voluntary, there was little concern that
insurance carriers would enter the field. However, now participation
in an MLTC is mandatory for many and will become mandatory for more
long term care recipients. There is growing interest by for-profit
HMOs and insurance companies in forming MLTCs. With their economic
resources they could easily come to dominate the field. So there is
growing concern that patients may ultimately have no choice but to
enroll in for-profit insurance carrier-owned MLTCs.

The individuals affected by this transition are primarily those with
chronic conditions, many who are elderly or otherwise affected with
life-limiting illness. Care and service decisions for these
individuals should not be measured against profit margins of
shareholders. Other states' experience in this area has proven that
provider-based MLTCs, which most all of New York MLTCs currently are,
deliver both the quality and the savings expected.

PRIOR LEGISLATIVE HISTORY: New bill

FISCAL IMPLICATIONS: None

EFFECTIVE DATE: Immediately

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

                                  6583

                            I N  S E N A T E

                            February 10, 2014
                               ___________

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

AN ACT to amend the public health law, in relation to managed long  term
  care  plans not being controlled or owned by for-profit health mainte-
  nance organizations or insurers

  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 4403-f of the
public health law, as added by chapter 659  of  the  laws  of  1997,  is
amended to read as follows:
  (b) "Eligible applicant" means an entity controlled or wholly owned by
one  or  more of the following: a hospital as defined in subdivision one
of section twenty-eight hundred one of this chapter; a home care  agency
licensed  or  certified  pursuant to article thirty-six of this chapter;
[an] A NOT-FOR-PROFIT entity that has received a certificate of authori-
ty pursuant to sections forty-four  hundred  three,  forty-four  hundred
three-a or AN INTEGRATED DELIVERY SYSTEM THAT HAS RECEIVED A CERTIFICATE
OF  AUTHORITY  PURSUANT  TO  SECTION  forty-four hundred eight-a of this
article (as added by chapter six hundred  thirty-nine  of  the  laws  of
nineteen  hundred  ninety-six),  or  a NOT-FOR-PROFIT health maintenance
organization authorized under article forty-three of the insurance  law;
or  a  not-for-profit  organization  which has a history of providing or
coordinating health care services and long term  care  services  to  the
elderly  and  disabled;  PROVIDED,  HOWEVER,  THAT  AN  ENTITY  OWNED OR
CONTROLLED BY AN ENTITY THAT HAS RECEIVED  A  CERTIFICATE  OF  AUTHORITY
PURSUANT  TO  SECTION  FORTY-FOUR  HUNDRED  THREE  OR FORTY-FOUR HUNDRED
THREE-A OF THIS ARTICLE AND HAS  RECEIVED  A  CERTIFICATE  OF  AUTHORITY
UNDER  THIS  SECTION  PRIOR  TO THE EFFECTIVE DATE OF THE CHAPTER OF THE
LAWS OF TWO THOUSAND THIRTEEN WHICH ADDED THIS PROVISION SHALL BE DEEMED
TO BE AN ELIGIBLE APPLICANT.
  S 2. Section 4403-f of the public health law is amended  by  adding  a
new subdivision 15 to read as follows:
  15.  A MANAGED LONG TERM CARE PLAN MAY BE A PARTICIPANT IN AN ACCOUNT-
ABLE CARE ORGANIZATION UNDER ARTICLE TWENTY-NINE-E OF THIS CHAPTER.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04700-03-4

S. 6583                             2

  S 3. Subdivision 6 of section 2999-o of  the  public  health  law,  as
amended  by  chapter  461  of  the  laws  of 2012, is amended to read as
follows:
  6.  "Health  care  provider"  includes but is not limited to an entity
licensed or certified under article twenty-eight or thirty-six  of  this
chapter;  an entity licensed or certified under article sixteen, thirty-
one or thirty-two of the mental hygiene law; OR ANY  LAWFUL  COMBINATION
OF  SUCH  HEALTH  CARE PROVIDERS, INCLUDING BUT NOT LIMITED TO A MANAGED
LONG TERM CARE PLAN UNDER SECTION FORTY-FOUR  HUNDRED  THREE-F  OF  THIS
CHAPTER; or a health care practitioner licensed or certified under title
eight  of  the education law or a lawful combination of such health care
practitioners; and may also include, to the  extent  provided  by  regu-
lation  of  the  commissioner,  other  entities  that  provide technical
assistance, information systems  and  services,  care  coordination  and
other services to health care providers and patients participating in an
ACO.
  S  4.  This act shall take effect immediately; provided, however, that
the amendments to section 4403-f  of  the  public  health  law  made  by
sections  one  and  two  of this act shall not affect the repeal of such
section and shall be deemed repealed therewith.

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