S T A T E O F N E W Y O R K
________________________________________________________________________
5459
2015-2016 Regular Sessions
I N S E N A T E
May 14, 2015
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to the review of
reimbursement methodologies under contracts or agreements with insur-
ers under the medical assistance program for home and community-based
long term care services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 18 of section 364-j of the social services law,
as amended by chapter 649 of the laws of 1996, paragraph (b) as amended
by chapter 433 of the laws of 1997, paragraph (c) as added by section
40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d)
as added by section 55 of part B of chapter 57 of the laws of 2015, is
amended to read as follows:
18. (a) The department of health may, where not inconsistent with the
rate setting authority of other state agencies and subject to approval
of the director of the division of the budget, develop reimbursement
methodologies and fee schedules for determining the amount of payment to
be made to managed care providers under the managed care program. Such
reimbursement methodologies and fee schedules may include provisions for
payment of managed care fees and capitation arrangements.
(b) The department of health in consultation with organizations
representing managed care providers shall select an independent actuary
to review any such reimbursement rates. Such independent actuary shall
review and make recommendations concerning appropriate actuarial assump-
tions relevant to the establishment of rates including but not limited
to the adequacy of the rates in relation to the population to be served
adjusted for case mix, the scope of services the plans must provide, the
utilization of services and the network of providers necessary to meet
state standards. The independent actuary shall issue a report no later
than December thirty-first, nineteen hundred ninety-eight and annually
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11080-01-5
S. 5459 2
thereafter. Such report shall be provided to the governor, the temporary
president and the minority leader of the senate and the speaker and the
minority leader of the assembly. The department of health shall assess
managed care providers under the managed care program on a per enrollee
basis to cover the cost of such report.
(c) In setting such reimbursement methodologies, the department shall
consider costs borne by the managed care program to ensure actuarially
sound and adequate rates of payment to ensure quality of care.
[(c)] (D) The department of health shall require the independent actu-
ary selected pursuant to paragraph (b) of this subdivision to provide a
complete actuarial memorandum, along with all actuarial assumptions made
and all other data, materials and methodologies used in the development
of rates, to managed care providers thirty days prior to submission of
such rates to the centers for medicare and medicaid services for
approval. Managed care providers may request additional review of the
actuarial soundness of the rate setting process and/or methodology.
[(d)] (E)(I) THE DEPARTMENT OF HEALTH SHALL SELECT AND CONTRACT WITH
AN INDEPENDENT ACTUARY TO STUDY AND REVIEW ADEQUATE REIMBURSEMENT METH-
ODOLOGIES UNDER CONTRACTS OR AGREEMENTS WITH INSURERS UNDER THE MEDICAL
ASSISTANCE PROGRAM FOR HOME AND COMMUNITY-BASED LONG TERM CARE SERVICES
PROVIDED UNDER THIS ARTICLE, BY FISCAL INTERMEDIARIES OPERATING PURSUANT
TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE OR RATES OF PAYMENT
FOR SUCH SERVICES UNDER THE MEDICAL ASSISTANCE PROGRAM TO ENSURE SUCH
CONTRACTS OR RATES SHALL SUPPORT COMPENSATION FOR PERSONS PROVIDING SUCH
HOME CARE AIDE SERVICES AND CONSUMER DIRECTED PERSONAL ASSISTANCE
SERVICES TO ENSURE THE RETENTION OF A QUALIFIED WORKFORCE CAPABLE OF
PROVIDING HIGH QUALITY CARE TO RECIPIENTS OF SUCH SERVICES IN BOTH WAGE
PARITY AND NON-WAGE PARITY REGIONS. SUCH COMPENSATION SHALL AT A MINIMUM
INCLUDE WAGE PARITY COMPENSATION AS REQUIRED UNDER SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THE PUBLIC HEALTH LAW OR SUCH WAGE AS REQUIRED
UNDER ARTICLE NINETEEN OR NINETEEN-A OF THE LABOR LAW AS REQUIRED
TOGETHER WITH THE FOLLOWING COSTS: RECRUITMENT, TRAINING AND RETENTION
OF DIRECT CARE PERSONNEL INCLUDING WAGE; SALARY; MANDATORY CONTRIBUTIONS
PURSUANT TO TITLE 26, SUBTITLE C, CHAPTER 21 OF THE UNITED STATES CODE
(FICA); COSTS ATTRIBUTED TO WORKERS COMPENSATION; COUNTY LIVING WAGE
LAWS AS APPROPRIATE; AND A SUPPLEMENTAL BENEFIT RATE.
(II) THE DEPARTMENT OF HEALTH SHALL REPORT ON THE RESULTS OF THE INDE-
PENDENT ACTUARY FINDINGS UNDER THIS PARAGRAPH TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE
CHAIRS OF THE SENATE HEALTH COMMITTEE AND ASSEMBLY HEALTH COMMITTEE ON
OR BEFORE JANUARY FIRST, TWO THOUSAND SIXTEEN.
(F) The department of health shall annually provide to the temporary
president of the senate and the speaker of the assembly the annual Medi-
caid managed care operating reports submitted to the department from
managed care plans that contract with the state to manage services
provided under the Medicaid program.
S 2. This act shall take effect immediately; provided that the amend-
ments made to section 364-j of the social services law by section one of
this act shall not affect the repeal of such section and shall be deemed
repealed therewith.
