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

                                  7598

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 20, 2015
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
  Committee on Health

AN ACT to amend the public health law, in relation to the transition  of
  traumatic  brain  injury waiver and nursing home transition and diver-
  sion waiver program services to Medicaid managed care programs

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

  Section  1.  Paragraph  (b)  of subdivision 7 of section 4403-f of the
public health law is amended by adding a new subparagraph (v-a) to  read
as follows:
  (V-A)  NOTWITHSTANDING  SUBPARAGRAPH  (V) OF THIS PARAGRAPH, NO PERSON
RECEIVING SERVICES UNDER THE TRAUMATIC BRAIN INJURY  WAIVER  OR  NURSING
HOME  TRANSITION  AND  DIVERSION  WAIVER  MAY BE REQUIRED TO ENROLL IN A
MANAGED CARE OR MANAGED LONG TERM CARE PROGRAM BEFORE APRIL  FIRST,  TWO
THOUSAND  SEVENTEEN;  AND  PROVIDED  FURTHER THAT THE COMMISSIONER SHALL
CONVENE A WORK GROUP TO DEVELOP RECOMMENDATIONS ON TRANSITION  OF  THESE
WAIVER  SERVICES  TO  MANAGED  CARE.  MEMBERSHIP OF THE WORK GROUP SHALL
INCLUDE PAYERS, CONSUMER REPRESENTATIVES AND PROVIDERS OF SUCH SERVICES,
AND THE CHAIRS OF THE ASSEMBLY AND SENATE HEALTH COMMITTEES. IN DEVELOP-
ING RECOMMENDATIONS ON TRANSITIONING THESE POPULATIONS TO A MANAGED CARE
ENVIRONMENT, THE WORK GROUP SHALL CONSIDER:
  (1) TRACKING OF LEGACY WAIVER POPULATIONS TO ENSURE  CONTINUED  ACCESS
TO COMMUNITY-BASED SERVICES AND IDENTIFY AGGREGATE COSTS OF CARE;
  (2)  ONGOING TRACKING AND IDENTIFICATION OF PEOPLE WITH A DIAGNOSIS OF
A BRAIN INJURY AND SIMILAR POPULATIONS TO ENSURE THAT NECESSARY COMMUNI-
TY-BASED SERVICES WILL BE PROVIDED TO  THESE  POPULATIONS  AND  IDENTIFY
AGGREGATE COSTS OF CARE;
  (3)  HOW CONTINUITY OF SERVICES WILL BE ACCOMPLISHED BEYOND AN INITIAL
TRANSITION PERIOD OF NINETY DAYS;
  (4) ENSURING ACCESS TO A QUALIFIED WORKFORCE, EXPERIENCED WORKING WITH
THESE POPULATIONS;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11174-01-5
              

A. 7598                             2

  (5) DEVELOPMENT OF ACTUARIALLY SOUND CAPITATION  REFLECTING  THE  HIGH
ACUITY OF THESE POPULATIONS; AND
  (6)  DEVELOPMENT  OF  ANNUAL  REPORTING  BY THE COMMISSIONER ON, AMONG
OTHER THINGS, AGGREGATE COSTS OF CARE FOR THESE POPULATIONS AND  WHETHER
THE TRANSITION OF THESE POPULATIONS IN MANAGED CARE HAS INCREASED UTILI-
ZATION OF NURSING HOME OR OTHER INSTITUTIONALIZED CARE.
  THE RECOMMENDATIONS OF SUCH WORK GROUP SHALL BE DUE TO THE COMMISSION-
ER  AND THE LEGISLATURE ON OR BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND
SIXTEEN. TO THE EXTENT THE DEPARTMENT'S FINAL IMPLEMENTATION  PLAN  DOES
NOT  REFLECT  ONE OR MORE RECOMMENDATIONS OF THE WORK GROUP, THE COMMIS-
SIONER SHALL PROVIDE A WRITTEN EXPLANATION FOR SUCH  OMISSION  OR  VARI-
ATION.
  S  2.  This  act shall take effect immediately; provided however, that
the amendments to paragraph (b) of subdivision 7 of  section  4403-f  of
the  public  health law made by section one of this act shall not affect
the repeal of such section and shall be deemed repealed therewith.