S T A T E O F N E W Y O R K
________________________________________________________________________
7456
2015-2016 Regular Sessions
I N A S S E M B L Y
May 12, 2015
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the public health law and part A of chapter 56 of the
laws of 2013 relating to establishing the home and community-based
care work group, in relation to regulatory alignment of home care
services delivered under contract with managed care plans
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 57-c of part A of chapter 56 of the laws of 2013,
relating to establishing the home and community-based care work group,
as amended by section 27-h of part C of chapter 60 of the laws of 2014,
is amended to read as follows:
S 57-c. Home and community based care workgroup. The commissioner of
health shall convene a home and community based care workgroup to exam-
ine and make recommendations on issues which include, but are not limit-
ed to:
a. State and federal regulatory requirements and related policy guide-
lines (including the applicability of the federal conditions of partic-
ipation);
b. Efficient home and community based care delivery, including tele-
health and hospice services;
c. Alignment of functions between managed care entities and home and
community based providers; and
d. Best practice for clean claims and related dispute resolution.
The workgroup shall be 11 members. The members of the workgroup shall
[including] INCLUDE providers, plans and representatives of consumers
and direct caregivers with relevant expertise.
The commissioner of health, or his or her designee shall chair the
workgroup and department of health and other executive agencies and
offices shall provide relevant data and other information as is neces-
sary for the group to perform its duties.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10838-01-5
A. 7456 2
The commissioner of health shall convene this workgroup by May 15,
2014 and the group shall issue periodic reports with recommendations by
March 1, 2014, September 1, 2014 and February 28, 2015.
THE COMMISSIONER SHALL CONSIDER THE RECOMMENDATIONS OF THE WORKGROUP,
AND SHALL BE AUTHORIZED TO TAKE SUCH STEPS AS NECESSARY TO EXPEDITIOUSLY
IMPLEMENT SUCH RECOMMENDATIONS, INCLUDING BY WAIVER AUTHORITY PROVIDED
UNDER SECTIONS 3623 AND 4403-F OF THE PUBLIC HEALTH LAW, AND SUBSEQUENT-
LY, AND TO THE EXTENT NECESSARY, BY ADOPTION OF CONFORMING REGULATORY
CHANGES ON AN EMERGENCY BASIS.
S 2. The public health law is amended by adding a new section 3623 to
read as follows:
S 3623. REGULATORY ALIGNMENT OF HOME CARE SERVICES DELIVERED UNDER
CONTRACT WITH MANAGED CARE PLANS. NOTWITHSTANDING ANY PROVISION OF LAW
TO THE CONTRARY, THE COMMISSIONER IS AUTHORIZED TO WAIVE RULES AND REGU-
LATIONS OF THE DEPARTMENT FOR SERVICES PROVIDED UNDER THIS ARTICLE
THROUGH CONTRACTS WITH PAYORS UNDER SECTION FORTY-FOUR HUNDRED THREE-F
OF THIS CHAPTER OR SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL
SERVICES LAW, WHERE SUCH WAIVERS ARE NECESSARY TO ELIMINATE DUPLICATION
AND TO PROMOTE EFFICIENCY, COORDINATION AND CLARITY IN THE PROCEDURES
FOR THE DELIVERY OF SUCH SERVICES, AND WHEN THE HEALTH, SAFETY AND
GENERAL WELFARE OF PATIENTS WILL NOT BE IMPAIRED AS A RESULT OF SUCH
WAIVER.
S 3. Subparagraph (i) of paragraph (a) of subdivision 7 of section
4403-f of the public health law, as amended by section 41-b of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
(i) The commissioner shall promulgate regulations to implement this
section and to ensure the quality, appropriateness and cost-effective-
ness of the services provided by managed long term care plans. The
commissioner may waive rules and regulations of the department, includ-
ing but not limited to, those pertaining to duplicative requirements
concerning record keeping, boards of directors, staffing and reporting,
when such waiver will promote the efficient delivery of appropriate,
quality, cost-effective services, OR WHEN SUCH WAIVERS ARE NECESSARY TO
COORDINATE WITH THE COMMISSIONER'S WAIVERS ISSUED UNDER SECTION THIRTY-
SIX HUNDRED TWENTY-THREE OF THIS CHAPTER, and when the health, safety
and general welfare of enrollees will not be impaired as a result of
such waiver. In order to achieve managed long term care plan system
efficiencies and coordination and to promote the objectives of high
quality, integrated and cost effective care, the commissioner may estab-
lish a single coordinated surveillance process, allow for a comprehen-
sive quality improvement and review process to meet component quality
requirements, and require a uniform cost report. The commissioner shall
require managed long term care plans to utilize quality improvement
measures, based on health outcomes data, for internal quality assessment
processes and may utilize such measures as part of the single coordi-
nated surveillance process.
S 4. This act shall take effect immediately; provided that the amend-
ments to section 4403-f of the public health law, made by section three
of this act shall not affect the repeal of such section and shall be
deemed repealed therewith.