S T A T E O F N E W Y O R K
________________________________________________________________________
7712
I N S E N A T E
May 12, 2016
___________
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 standards and
funding for health homes
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 365-l of the social services law, as added by
section 37 of part H of chapter 59 of the laws of 2011, subdivision 2-a
as added by section 23 of part A of chapter 56 of the laws of 2013,
subdivision 2-b as amended by section 17 and subdivision 9 as amended by
section 28 of part B of chapter 59 of the laws of 2016, subdivision 2-c
as added by section 25 of part B of chapter 57 of the laws of 2015, is
amended to read as follows:
S 365-l. Health homes. 1. Notwithstanding any law, rule or regulation
to the contrary, the commissioner of health is authorized, in consulta-
tion with the commissioners of [the office of] mental health, [office
of] alcoholism and substance abuse services, and [office for people
with] developmental disabilities, to (a) establish, in accordance with
applicable federal law and regulations, standards for the provision of
health home services to Medicaid enrollees with chronic conditions, (b)
establish payment methodologies for health home services based on
factors including but not limited to the complexity of the conditions
providers will be managing, the anticipated amount of patient contact
needed to manage such conditions, and the health care cost savings real-
ized by provision of health home services, (c) establish the criteria
under which a Medicaid enrollee will be designated as being an eligible
individual with chronic conditions for purposes of this program, (d)
assign any Medicaid enrollee designated as an eligible individual with
chronic conditions to a provider of health home services.
1-A. THE DEPARTMENT SHALL REPORT TO THE CHAIRS OF THE HEALTH AND
FISCAL COMMITTEES OF THE LEGISLATURE ON OR BEFORE DECEMBER THIRTY-FIRST,
TWO THOUSAND SIXTEEN AND ANNUALLY THEREAFTER REGARDING ANY HEALTH CARE
COST SAVINGS REALIZED BY PROVISION OF HEALTH HOME SERVICES.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15379-01-6
S. 7712 2
2. In addition to payments made for health home services pursuant to
subdivision one of this section, the commissioner is authorized to pay
additional amounts to providers of health home services that meet proc-
ess or outcome standards specified by the commissioner. SUCH PROCESS OR
OUTCOME STANDARDS SHALL INCLUDE THE CORE SET OF HEALTH CARE QUALITY
MEASURES FOR MEDICAID HEALTH HOME PROGRAMS PURSUANT TO TECHNICAL SPEC-
IFICATIONS AND RESOURCE MANUAL FOR FEDERAL FISCAL YEAR 2013 REPORTING
USED BY THE CENTER FOR MEDICARE AND MEDICAID SERVICES TO ASSESS QUALITY
OUTCOMES AND PERFORMANCE OF HEALTH HOMES. NOTWITHSTANDING THE FOREGOING,
HEALTH HOMES NOT MEETING THE PROCESS OR OUTCOME STANDARDS SHALL BE INEL-
IGIBLE TO RECEIVE PAYMENTS OTHERWISE MADE PURSUANT TO SUBDIVISION ONE OF
THIS SECTION.
2-a. Up to fifteen million dollars in state funding may be used to
fund health home infrastructure development. Such funds shall be used to
develop enhanced systems to support Health Home operations including
assignments, workflow, and transmission of data. Funding will also be
disbursed pursuant to a formula established by the commissioner to be
designated health homes. Such formula may consider prior access to simi-
lar funding opportunities, geographic and demographic factors, including
the population served, and prevalence of qualifying conditions, connec-
tivity to providers, and other criteria as established by the commis-
sioner.
2-b. The commissioner is authorized to make lump sum payments or
adjust rates of payment to providers up to a gross amount of five
million dollars, to establish coordination between the health homes and
the criminal justice system and for the integration of information of
health homes with state and local correctional facilities, to the extent
permitted by law. [Such rate] NOTWITHSTANDING THE FOREGOING, A HEALTH
HOME SHALL ONLY BE ELIGIBLE TO RECEIVE SUCH adjustments [may be made to
health homes] IF THE HEALTH HOME HAS MET THE PROCESS AND OUTCOME STAND-
ARDS PURSUANT TO SUBDIVISION TWO OF THIS SECTION, AND IS participating
in a criminal justice pilot program with the purpose of enrolling incar-
cerated individuals with serious mental illness, two or more chronic
conditions, including substance abuse disorders, or HIV/AIDS, into such
health home. Health homes receiving funds under this subdivision shall
be required to document, AND REPORT TO THE CHAIRS OF THE HEALTH AND
FISCAL COMMITTEES OF THE LEGISLATURE NO LATER THAN DECEMBER
THIRTY-FIRST, TWO THOUSAND SIXTEEN, AND ANNUALLY THEREAFTER, and demon-
strate the effective use of funds distributed herein.
2-c. The commissioner is authorized to make grants up to a gross
amount of one million dollars for certified application counselors and
assistors to facilitate the enrollment of persons in high risk popu-
lations, including but not limited to persons with mental health and/or
substance abuse conditions that have been recently discharged or are
pending release from state and local correctional facilities. Funds
allocated for certified application counselors and assistors shall be
expended through a request for proposal process AND A REPORT TO THE
CHAIRS OF THE HEALTH AND FISCAL COMMITTEES OF THE LEGISLATURE INCLUDING,
BUT NOT LIMITED TO, THE NUMBER OF AWARDS MADE, THE GEOGRAPHIC DISTRIB-
UTION OF SUCH AWARDS AND HOW SUCH FUNDS WERE EXPENDED. SUCH REPORT SHALL
BE PROVIDED NO LATER THAN DECEMBER THIRTY-FIRST, TWO THOUSAND SIXTEEN,
AND ANNUALLY THEREAFTER.
3. [Until such time as the commissioner obtains necessary waivers
and/or approvals of the federal social security act,] Medicaid enrollees
assigned to providers of health home services will be allowed to opt out
of such services AT ANY TIME. In addition, upon enrollment, an enrollee
S. 7712 3
shall be offered an option of at least two providers of health home
services, to the extent practicable.
4. Payments authorized pursuant to this section will be made with
state funds only, to the extent that such funds are appropriated there-
fore, until such time as federal financial participation in the costs of
such services is available.
5. The commissioner is authorized to submit amendments to the state
plan for medical assistance and/or submit one or more applications for
waivers of the federal social security act, to obtain federal financial
participation in the costs of health home services provided pursuant to
this section, and as provided in subdivision three of this section.
6. Notwithstanding any limitations imposed [by section three hundred
sixty-four-l of this title] on entities participating in demonstration
projects [established pursuant to such section], the commissioner is
authorized to allow such entities which meet the requirements of this
section to provide health home services, IF SUCH ENTITIES MEET PROCESS
OR OUTCOME STANDARDS PURSUANT TO SUBDIVISION TWO OF THIS SECTION.
7. Notwithstanding any law, rule, or regulation to the contrary, the
commissioners of [the department of] health, [the office of] mental
health, [the office for people with] developmental disabilities, and
[the office of] alcoholism and substance abuse services are authorized
to jointly establish a single set of operating and reporting require-
ments and a single set of construction and survey requirements for enti-
ties that:
(a) can demonstrate experience in the delivery of health, and mental
health and/or alcohol and substance abuse services and/or services to
persons with developmental disabilities, and the capacity to offer inte-
grated delivery of such services in each location approved by the
commissioner; and
(b) meet the standards established pursuant to [subdivision] SUBDIVI-
SIONS one AND TWO of this section for providing and receiving payment
for health home services; provided, however, that an entity meeting the
standards established pursuant to subdivision one of this section shall
not be required to be an integrated service provider pursuant to this
subdivision.
In establishing a single set of operating and reporting requirements,
INCLUDING STANDARDS DESCRIBED IN SUBDIVISION TWO OF THIS SECTION, and a
single set of construction and survey requirements for entities
described in this subdivision, the commissioners of [the department of]
health, [the office of] mental health, [the office for people with]
developmental disabilities, and [the office of] alcoholism and substance
abuse services are authorized to waive any regulatory requirements as
are necessary to avoid duplication of requirements and to allow the
integrated delivery of services in a rational and efficient manner. THE
DEPARTMENT SHALL ISSUE A REPORT TO THE CHAIRS OF THE HEALTH AND FISCAL
COMMITTEES OF THE LEGISLATURE, NO LATER THAN DECEMBER THIRTY-FIRST, TWO
THOUSAND SIXTEEN AND ANNUALLY THEREAFTER, ON ANY REGULATORY REQUIREMENTS
THAT HAVE BEEN WAIVED AND THE IMPACT OF SUCH WAIVED REQUIREMENTS.
8. (a) The commissioner of health is authorized to contract with one
or more entities to assist the state in implementing the provisions of
this section. Such entity or entities shall be the same entity or enti-
ties chosen to assist in the implementation of the multipayor patient
centered medical home program pursuant to section twenty-nine hundred
fifty-nine-a of the public health law. Responsibilities of the contrac-
tor shall include but not be limited to: developing recommendations with
respect to program policy, reimbursement, system requirements, reporting
S. 7712 4
requirements, evaluation protocols, and provider and patient enrollment;
providing technical assistance to potential medical home and health home
providers; data collection; data sharing; program evaluation, and prepa-
ration of reports. ANY RECOMMENDATIONS ISSUED BY SUCH ENTITY OR ENTITIES
SHALL INCLUDE AND BE CONSISTENT WITH THE PROCESS OR OUTCOME STANDARDS
DESCRIBED IN SUBDIVISION TWO OF THIS SECTION.
(b) Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or section
one hundred forty-two of the economic development law, or any other law,
the commissioner of health is authorized to enter into a contract or
contracts under paragraph (a) of this subdivision without a competitive
bid or request for proposal process, provided, however, that:
(i) The department of health shall post on its website, for a period
of no less than thirty days:
(1) A description of the proposed services to be provided pursuant to
the contract or contracts;
(2) The criteria for selection of a contractor or contractors;
(3) The period of time during which a prospective contractor may seek
selection, which shall be no less than thirty days after such informa-
tion is first posted on the website; and
(4) The manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;
(ii) All reasonable and responsive submissions that are received from
prospective contractors in timely fashion shall be reviewed by the
commissioner of health; and
(iii) The commissioner of health shall select such contractor or
contractors that, in his or her discretion, are best suited to serve the
purposes of this section.
9. The contract entered into by the commissioner of health prior to
January first, two thousand thirteen pursuant to subdivision eight of
this section may be amended or modified without the need for a compet-
itive bid or request for proposal process, and without regard to the
provisions of sections one hundred twelve and one hundred sixty-three of
the state finance law, section one hundred forty-two of the economic
development law, or any other provision of law, excepting the responsi-
ble vendor requirements of the state finance law, including, but not
limited to, sections one hundred sixty-three and one hundred thirty-
nine-k of the state finance law, to allow the purchase of additional
personnel and services, subject to available funding, for the limited
purpose of assisting the department of health with implementing the
Balancing Incentive Program, the Fully Integrated Duals Advantage
Program, the Vital Access Provider Program, the Medicaid waiver amend-
ment associated with the public hospital transformation, the addition of
behavioral health services as a managed care plan benefit, the delivery
system reform incentive payment plan, activities to facilitate the tran-
sition of vulnerable populations to managed care and/or any workgroups
required to be established by the chapter of the laws of two thousand
thirteen that added this subdivision. The department is authorized to
extend such contract for a period of one year, without a competitive bid
or request for proposal process, upon determination that the existing
contractor is qualified to continue to provide such services; provided,
however, that the department of health shall submit a request for appli-
cations for such contract during the time period specified in this
subdivision and may terminate the contract identified herein prior to
expiration of the extension authorized by this subdivision.
S. 7712 5
10. ALL HEALTH HOME CONTRACTS AUTHORIZED AND CERTIFIED PURSUANT TO
SUBDIVISIONS EIGHT AND NINE OF THIS SECTION SHALL BE REVIEWED AND RECER-
TIFIED EVERY TWO YEARS FOLLOWING INITIAL AUTHORIZATION, AND ANY HEALTH
HOME NOT MEETING THE STANDARDS SET FORTH IN THIS SECTION SHALL BE INELI-
GIBLE FOR RECERTIFICATION.
S 2. This act shall take effect immediately.
