NY State Senate Bill 2013-S6583

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 10, 2014	referred to health

2013-S6583 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§4403-f & 2999-o, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S379
2017-2018: S1098

2013-S6583 (ACTIVE) - Summary

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

2013-S6583 (ACTIVE) - Sponsor Memo

                                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

2013-S6583 (ACTIVE) - Bill Text download pdf

                            
                    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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Senate Bill S6583

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

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2013-S6583 (ACTIVE) - Details

2013-S6583 (ACTIVE) - Summary

2013-S6583 (ACTIVE) - Sponsor Memo

2013-S6583 (ACTIVE) - Bill Text download pdf

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Sponsored By

Gustavo Rivera

Archive: Last Bill Status - In Senate Committee Health Committee

Actions

2013-S6583 (ACTIVE) - Details

2013-S6583 (ACTIVE) - Summary

2013-S6583 (ACTIVE) - Sponsor Memo

2013-S6583 (ACTIVE) - Bill Text download pdf

Comments