NY State Senate Bill 2015-S8072

Senate Bill S8072

2015-2016 Legislative Session

Provides for the payment of actuarially sound and adequate rates for managed care plans and service providers

download bill text pdf

Archive: Last Bill Status - In Assembly Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 15, 2016	referred to ways and means delivered to assembly passed senate ordered to third reading cal.1850
Jun 10, 2016	referred to rules

Votes

- Jun 15, 2016 - Floor Vote
  S8072
  
  62
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 15, 2016
      
      aye (62)
      
      Addabbo Jr.
      
      Akshar
      
      Amedore
      
      Avella
      
      Bonacic
      
      Boyle
      
      Breslin
      
      Carlucci
      
      Comrie
      
      Croci
      
      DeFrancisco
      
      Dilan
      
      Espaillat
      
      Farley
      
      Felder
      
      Flanagan
      
      Funke
      
      Gallivan
      
      Gianaris
      
      Golden
      
      Griffo
      
      Hamilton
      
      Hannon
      
      Hassell-Thompson
      
      Hoylman-Sigal
      
      Kaminsky
      
      Kennedy
      
      Klein
      
      Krueger
      
      LaValle
      
      Lanza
      
      Larkin
      
      Latimer
      
      Little
      
      Marcellino
      
      Marchione
      
      Martins
      
      Montgomery
      
      Murphy
      
      Nozzolio
      
      O'Mara
      
      Ortt
      
      Panepinto
      
      Parker
      
      Peralta
      
      Perkins
      
      Persaud
      
      Ranzenhofer
      
      Ritchie
      
      Rivera
      
      Robach
      
      Sanders Jr.
      
      Savino
      
      Serino
      
      Serrano
      
      Seward
      
      Squadron
      
      Stavisky
      
      Stewart-Cousins
      
      Valesky
      
      Venditto
      
      Young
      
      excused (1)
      
      Diaz
  Jun 15, 2016 - Rules Committee Vote
  S8072
  
  22
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  2
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Rules Committee Vote: Jun 15, 2016
      
      aye (22)
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Dilan
      
      Farley
      
      Flanagan
      
      Gianaris
      
      Hannon
      
      Hassell-Thompson
      
      Krueger
      
      LaValle
      
      Lanza
      
      Little
      
      Marcellino
      
      Montgomery
      
      Nozzolio
      
      Parker
      
      Robach
      
      Seward
      
      Stewart-Cousins
      
      Valesky
      
      aye wr (1)
      
      Perkins
      
      absent (2)
      
      Espaillat
      
      Larkin

2015-S8072 (ACTIVE) - Details

Current Committee:: Assembly Ways And Means
Law Section:: Public Health Law
Laws Affected:: Amd §§4403-f & 3614, add §3614-f, Pub Health L; amd §364-j, Soc Serv L

2015-S8072 (ACTIVE) - Summary

Provides for the payment of actuarially sound and adequate rates for managed care plans and service providers.

2015-S8072 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S8072

 TITLE OF BILL :  An act to amend the public health law and the social
services law, in relation to actuarially sound and adequate rates of
payment for managed care plans and service providers

 PURPOSE :

To ensure adequacy and transparency in implementation of state
reimbursement provisions for minimum wage and associated new and
baseline labor expenses to managed care plans and home care agencies

 SUMMARY OF PROVISIONS :

Amends provisions of the managed long term care law (PHL 4403-f), the
home health agency "Episodic" and fee-for-service reimbursement
law(PHL 3614), and the mainstream managed care law (SSL 364-j), to
specify that the statutory standard adopted with the 2016-17 state
budget providing for "actuarially sound and adequate rates" to "ensure
quality of care and to comply with all applicable laws and
regulations, state and federal" enumerates the labor-related
compensation requirements intended by state (and the budget) to be
included in these rates.

These labor requirements, which the amendments ensure are clearly
referenced in the managed care and home care sections include the

provisions of:

*Public Health law 3614-c (home care worker wage parity requirements);
*Labor Law 652.1 (minimum wage payment requirements)
*Workers Compensation Law, article 2, § 10 (workers comp coverage);
*Federal Fair Labor Standards Act for employee overtime and other
mandatory benefits; and
*Other expenses mandated upon plans or providers for employees under
any other provision of law
*Public Health Law 3614.7, 3614.7-a, and 3612 (the statutorily
provided-for administrative and general cost factor for home care
agencies).

The bill further provides that the amount of reimbursement required to
meet the costs of the above statutes is to be specifically identified
as part of the payment rates to managed care plans and to contracted
providers, and that a uniform process be established for the payment
these mandates to providers.

The bill codifies the practice whereby, in setting actuarially sound
and adequate payment rates, the commissioner is required to consider
the analysis and recommendations of an independent actuary, and
directs that the actuary's also be directly provided to the chairs of
the senate and assembly health and fiscal committees.

The commissioner is directed to provide for expeditious adjustment and
increase of managed care premiums to ensure actuarial soundness and
adequacy of rates for timely compliance with the state's labor and
public health laws as amended by the new 2016-17 state budget, and for
expeditious adjustment of rates and payments to providers for timely
compliance with the same.

The commissioner is further directed to provide for the efficient
implementation of the managed care plan and provider reimbursement
provisions, minimizing any new administrative, procedural or
documentation burden on managed care plans or providers.

 JUSTIFICATION :


The adopted 2016-17 state budget provides for historic level increases
in the minimum wage, the cost for which is especially critical in the
long term health care field. The budget also provides new and
carryover funding for other new and baseline mandated labor costs (as
enumerated in the "summary of provisions" section of this memo.

Importantly, Article VII amendments were enacted with the new budget
that require state calculation of adequate and sound rates, enabling
managed care plans and providers "to comply with all applicable laws
and regulations, state and federal."

This legislation ensures accountability and transparency in the
implementation budget provisions funding for the minimum wage law.
First, it enumerates key "state and federal" provisions intended to be
covered in the overarching Article VII provisions adopted with the
budget in order to ensure there is no question as to the coverage of
these essential labor expenses as part of sound and adequate payments
to providers and plans. Second, it ensures that payment adjustments
made to managed care plans and providers to support these increased
expenses are to be visibly itemized, and may not be offset by
reductions elsewhere (that would essentially take back the needed
adjustments and compromise rate soundness and adequacy). Third, it
ensures uniformity, timeliness, efficiency and administrative
simplicity in administration. Fourth, independent actuarial analyses
used to calculate premiums are to be shared with the Legislature.

With the core roles played by managed care plans and home care
agencies in the provision services to seniors, adults and medically
fragile children, with the increased dependence on the viability and
accessibility of community services in virtually all of the state's
major health reforms and cost-containment strategies, with the
significant financial challenges to managed care plans and providers
in servicing these needs, and with state's promise of funding vital
increases for health worker wages, this legislation is critical to
supporting the actual attainment of these important purposes.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

Consistent with the adopted 2016-17 state fiscal plan; legislation
ensures accountability and transparency in the implementation of the
adopted 2016-17 budget.

 EFFECTIVE DATE :
Immediately.

2015-S8072 (ACTIVE) - Bill Text download pdf

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

                                  8072

                            I N  S E N A T E

                              June 10, 2016
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

AN ACT to amend the public health law and the social  services  law,  in
  relation  to  actuarially  sound  and  adequate  rates  of payment for
  managed care plans and service providers

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

  Section  1.  Subdivision 8 of section 4403-f of the public health law,
as amended by section 21 of part B of chapter 59 of the laws of 2016, is
amended to read as follows:
  8. Payment rates for managed long term care  plan  enrollees  eligible
for  medical  assistance. The commissioner shall establish payment rates
for services provided to enrollees  eligible  under  title  XIX  of  the
federal  social  security  act.  Such  payment rates shall be subject to
approval by the director of the division of the budget and shall reflect
savings to both state and local governments when compared to costs which
would be incurred by such program if enrollees were to receive  compara-
ble health and long term care services on a fee-for-service basis in the
geographic  region  in  which such services are proposed to be provided.
Payment rates shall be risk-adjusted to take into account the character-
istics of enrollees, or proposed enrollees, including, but  not  limited
to:    frailty,  disability  level,  health  and functional status, age,
gender, the nature of services provided to  such  enrollees,  and  other
factors  as  determined  by the commissioner. The risk adjusted premiums
may also be combined with  disincentives  or  requirements  designed  to
mitigate  any incentives to obtain higher payment categories. In setting
such payment rates, the commissioner shall consider costs borne  by  the
managed  care  program to ensure actuarially sound and adequate rates of
payment to MANAGED CARE PLANS, INCLUDING THE COSTS FOR REIMBURSING THEIR
CONTRACTED PROVIDERS, TO ensure quality of care shall  comply  with  all
applicable  laws  and regulations, state and federal, including, BUT NOT
LIMITED TO: regulations as to actuarial soundness for  medicaid  managed
care;  THE  PROVISIONS  OF SECTION THIRTY-SIX HUNDRED FOURTEEN-C OF THIS
CHAPTER; PROVISIONS OF SUBDIVISION ONE OF SECTION SIX HUNDRED  FIFTY-TWO

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

                                                           LBD15742-03-6

S. 8072                             2

OF THE LABOR LAW; PROVISIONS OF SECTION TEN OF THE WORKERS' COMPENSATION
LAW;  PROVISIONS  OF  THE  FEDERAL FAIR LABOR STANDARDS ACT FOR EMPLOYEE
OVERTIME AND OTHER MANDATORY BENEFITS; AND OTHER EXPENSES MANDATED  UPON
PLANS  OR  PROVIDERS  FOR  EMPLOYEES  UNDER  THIS  CHAPTER  OR ANY OTHER
PROVISION OF LAW, PLUS AN ADMINISTRATIVE AND GENERAL COST FACTOR THAT IS
NO LESS THAN ALLOWED PURSUANT TO SUBDIVISION SIX OF SECTION THREE  THOU-
SAND  SIX  HUNDRED  TWELVE  OF  THIS ARTICLE OR PURSUANT TO SUBDIVISIONS
SEVEN OR SEVEN-A OF SECTION THREE THOUSAND SIX HUNDRED FOURTEEN OF  THIS
ARTICLE, AS APPLICABLE. THE AMOUNT OF REIMBURSEMENT REQUIRED TO MEET THE
COSTS  OF  THE  AFOREMENTIONED  LABOR, ADMINISTRATIVE AND OTHER MANDATED
EXPENSES SHALL BE SPECIFICALLY  IDENTIFIED  AS  PART  OF  THE  RATES  OF
PAYMENT  TO  MANAGED  CARE  PLANS AND TO CONTRACTED PROVIDERS; PROVIDED,
HOWEVER, NO REIMBURSEMENT  CHANGES  PURSUANT  TO  THIS  PARAGRAPH  SHALL
PROVIDE  A  DIMINUTION  OF  THE CURRENT RATE OF PAYMENT TO LICENSED HOME
CARE AGENCIES.
  THE COMMISSIONER SHALL ALSO TAKE NECESSARY  STEPS  TO  ENSURE  THAT  A
UNIFORM PROCESS IS ESTABLISHED FOR THE PAYMENT OF SUCH MANDATED COSTS OR
BENEFITS TO PROVIDERS.
  IN  SETTING  ACTUARIALLY SOUND AND ADEQUATE PAYMENT RATES, THE COMMIS-
SIONER SHALL CONSIDER THE ANALYSIS AND RECOMMENDATIONS OF AN INDEPENDENT
ACTUARY, WHICH SHALL ALSO PROVIDE ITS ANALYSIS DIRECTLY TO THE CHAIRS OF
THE SENATE AND ASSEMBLY COMMITTEES ON HEALTH, THE CHAIR  OF  THE  SENATE
FINANCE  COMMITTEE  AND  THE CHAIR OF THE ASSEMBLY COMMITTEE ON WAYS AND
MEANS.
  S 2. Paragraph (a) of subdivision 13 of section  3614  of  the  public
health law, as amended by section 22 of part D of chapter 57 of the laws
of 2015, is amended to read as follows:
  (a)  Notwithstanding  any  inconsistent provision of law or regulation
and subject to the  availability  of  federal  financial  participation,
effective  April  first, two thousand twelve through March thirty-first,
two thousand nineteen, payments  by  government  agencies  for  services
provided  by  certified  home  health agencies, except for such services
provided to children under eighteen years  of  age  and  other  discreet
groups as may be determined by the commissioner pursuant to regulations,
shall  be  based  on episodic payments. In establishing such payments, a
statewide base price shall be established for each sixty day episode  of
care  and  adjusted  by  a  regional wage index factor and an individual
patient case mix index. Such episodic payments may be  further  adjusted
for  low utilization cases and to reflect a percentage limitation of the
cost for high-utilization cases that exceed outlier thresholds  of  such
payments. EPISODIC PAYMENTS SHALL BE FURTHER ADJUSTED TO ENSURE ADEQUACY
FOR  COMPLIANCE  WITH  ALL  APPLICABLE  LAWS  AND REGULATIONS, STATE AND
FEDERAL, INCLUDING: THE PROVISIONS OF SECTION THIRTY-SIX  HUNDRED  FOUR-
TEEN-C  OF  THIS  CHAPTER;  PROVISIONS OF SUBDIVISION ONE OF SECTION SIX
HUNDRED FIFTY-TWO OF THE LABOR LAW; PROVISIONS OF THE FEDERAL FAIR LABOR
STANDARDS ACT FOR EMPLOYEE OVERTIME AND OTHER  MANDATORY  BENEFITS;  AND
OTHER EXPENSES MANDATED UPON PLANS OR PROVIDERS FOR EMPLOYEES UNDER THIS
CHAPTER OR ANY OTHER PROVISION OF LAW; PLUS AN ADMINISTRATIVE AND GENER-
AL  COST  FACTOR  THAT  IS  NO LESS THAN ALLOWED PURSUANT TO SUBDIVISION
SEVEN OF THIS SECTION.  THE AMOUNT OF REIMBURSEMENT REQUIRED TO MEET THE
COSTS OF THE AFOREMENTIONED LABOR,  ADMINISTRATIVE  AND  OTHER  MANDATED
EXPENSES  SHALL  BE  SPECIFICALLY  IDENTIFIED  AS  PART  OF THE RATES OF
PAYMENT PROVIDED PURSUANT TO THIS SECTION. THE REIMBURSEMENT TO  PROVID-
ERS  PURSUANT  TO  THIS  SUBDIVISION SHALL BE IN ADDITION TO THE CURRENT
RATE  OF  PAYMENT  FOR  ADMINISTRATIVE  AND  OTHER  MANDATED   EXPENSES;
PROVIDED,  HOWEVER,  NO REIMBURSEMENT CHANGES PURSUANT TO THIS PARAGRAPH

S. 8072                             3

SHALL PROVIDE A DIMINUTION OF THE CURRENT RATE OF  PAYMENT  TO  LICENSED
HOME CARE AGENCIES.
  S  3. Section 3614 of the public health law is amended by adding a new
subdivision 7-b to read as follows:
  7-B. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR  REGU-
LATION,  THE  COMMISSIONER  SHALL  ADJUST  MEDICAL  ASSISTANCE  RATES OF
PAYMENT FOR SERVICES PROVIDED BY LONG  TERM  HOME  HEALTH  CARE  PROGRAM
PROVIDERS TO ENSURE ADEQUACY FOR COMPLIANCE WITH ALL APPLICABLE LAWS AND
REGULATIONS,  STATE  AND  FEDERAL,  INCLUDING: THE PROVISIONS OF SECTION
THIRTY-SIX HUNDRED FOURTEEN-C OF THIS CHAPTER; PROVISIONS OF SUBDIVISION
ONE OF SECTION SIX HUNDRED FIFTY-TWO OF THE  LABOR  LAW;  PROVISIONS  OF
SECTION  TEN OF THE WORKERS' COMPENSATION LAW; PROVISIONS OF THE FEDERAL
FAIR LABOR STANDARDS ACT FOR EMPLOYEE OVERTIME AND OTHER MANDATORY BENE-
FITS, AND OTHER EXPENSES MANDATED UPON PLANS OR PROVIDERS FOR  EMPLOYEES
UNDER THIS CHAPTER OR ANY OTHER PROVISION OF LAW; PLUS AN ADMINISTRATIVE
AND  GENERAL COST FACTOR THAT IS NO LESS THAN ALLOWED PURSUANT TO SUBDI-
VISION SEVEN-A OF THIS SECTION.  THE AMOUNT OF REIMBURSEMENT REQUIRED TO
MEET THE COSTS OF THE AFOREMENTIONED  LABOR,  ADMINISTRATIVE  AND  OTHER
MANDATED  EXPENSES SHALL BE SPECIFICALLY IDENTIFIED AS PART OF THE RATES
OF PAYMENT PROVIDED PURSUANT TO THIS  SECTION.    THE  REIMBURSEMENT  TO
PROVIDERS PURSUANT TO THIS SUBDIVISION SHALL NOT PROVIDE A DIMINUTION OF
THE CURRENT RATE OF PAYMENT TO PROVIDERS.
  S  4.  The public health law is amended by adding a new section 3614-f
to read as follows:
  S 3614-F. REIMBURSEMENT OF MANDATORY  WAGE  AND  BENEFIT  COMPENSATION
EXPENSES.  THE SPECIFICALLY IDENTIFIED FUNDING PROVIDED TO THE CERTIFIED
HOME  HEALTH  AGENCY  PURSUANT  TO  SUBDIVISION  THIRTEEN   OF   SECTION
THIRTY-SIX  HUNDRED  FOURTEEN  OF  THIS  ARTICLE,  LONG TERM HOME HEALTH
PROGRAM PURSUANT TO SUBDIVISION SEVEN-B OF  SECTION  THIRTY-SIX  HUNDRED
FOURTEEN  OF  THIS  ARTICLE OR MANAGED CARE PLAN PURSUANT TO SUBDIVISION
EIGHT OF SECTION FORTY-FOUR HUNDRED THREE-F OF  THIS  CHAPTER,  FOR  THE
SATISFACTION OF THE PROVIDER REIMBURSEMENT REQUIREMENTS OF SECTION THIR-
TY-SIX HUNDRED FOURTEEN-C OF THIS CHAPTER, PROVISIONS OF SUBDIVISION ONE
OF SECTION SIX HUNDRED FIFTY-TWO OF THE LABOR LAW, PROVISIONS OF SECTION
TEN  OF  THE  WORKERS'  COMPENSATION LAW, PROVISIONS OF THE FEDERAL FAIR
LABOR STANDARDS ACT FOR EMPLOYEE OVERTIME AND OTHER MANDATORY  BENEFITS;
AND OTHER EXPENSES MANDATED UPON PLANS AND PROVIDERS FOR EMPLOYEES UNDER
THIS  CHAPTER  OR  ANY OTHER PROVISION OF LAW, AND AN ADMINISTRATIVE AND
GENERAL COST FACTOR THAT IS NO LESS THAN ALLOWED PURSUANT TO SUBDIVISION
SIX OF SECTION THIRTY-SIX HUNDRED TWELVE OF THIS ARTICLE, SHALL BE  USED
BY SUCH ENTITY IN REIMBURSING A LICENSED HOME CARE AGENCY FOR SUCH AGEN-
CY'S  COMPLIANCE  WITH  THE  AFOREMENTIONED PAYMENT AND BENEFIT REQUIRE-
MENTS. THE REIMBURSEMENT TO PROVIDERS PURSUANT TO THIS SECTION SHALL NOT
PROVIDE A DIMINUTION OF THE CURRENT RATE OF  PAYMENT  TO  LICENSED  HOME
CARE AGENCIES.
  S  5.  Paragraph  (c) of subdivision 18 of section 364-j of the social
services law, as added by section 40-c of part B of chapter  57  of  the
laws of 2015, is amended to read as follows:
  (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, AND TO
COMPLY WITH ALL APPLICABLE LAWS  AND  REGULATIONS,  STATE  AND  FEDERAL,
INCLUDING,  BUT NOT LIMITED TO REGULATIONS AS TO ACTUARIAL SOUNDNESS FOR
MEDICAID MANAGED CARE; THE  PROVISIONS  OF  SECTION  THIRTY-SIX  HUNDRED
FOURTEEN-C OF THIS CHAPTER; PROVISIONS OF SUBDIVISION ONE OF SECTION SIX
HUNDRED  FIFTY-TWO  OF  THE  LABOR LAW; PROVISIONS OF SECTION TEN OF THE

S. 8072                             4

WORKERS' COMPENSATION LAW; PROVISIONS OF THE FEDERAL FAIR  LABOR  STAND-
ARDS  ACT  FOR EMPLOYEE OVERTIME AND OTHER MANDATORY BENEFITS; AND OTHER
EXPENSES MANDATED UPON PLANS OR PROVIDERS FOR EMPLOYEES UNDER THIS CHAP-
TER  OR  ANY  OTHER PROVISION OF LAW, PLUS AN ADMINISTRATIVE AND GENERAL
COST FACTOR THAT IS NO LESS THAN ALLOWED PURSUANT TO SUBDIVISION SIX  OF
SECTION  THIRTY-SIX HUNDRED TWELVE OF THIS ARTICLE OR PURSUANT TO SUBDI-
VISION SEVEN OR SEVEN-A OF SECTION THIRTY-SIX HUNDRED FOURTEEN  OF  THIS
ARTICLE,  AS  APPLICABLE.   THE AMOUNT OF REIMBURSEMENT REQUIRED TO MEET
THE COSTS OF THE AFOREMENTIONED LABOR, ADMINISTRATIVE AND OTHER MANDATED
EXPENSES SHALL BE SPECIFICALLY  IDENTIFIED  AS  PART  OF  THE  RATES  OF
PAYMENT  PROVIDED  PURSUANT TO THIS SECTION. THE COMMISSIONER SHALL TAKE
NECESSARY STEPS TO ENSURE THAT A UNIFORM PROCESS IS ESTABLISHED FOR  THE
PAYMENT FOR SUCH MANDATED COSTS OR BENEFITS TO PROVIDERS. THE REIMBURSE-
MENT TO PROVIDERS PURSUANT TO THIS SUBDIVISION SHALL NOT PROVIDE A DIMI-
NUTION OF THE CURRENT RATE OF PAYMENT TO LICENSED HOME CARE AGENCIES.
  S  6. The commissioner of health shall provide for expeditious adjust-
ment and increase of managed care organization premiums to ensure  actu-
arial  soundness  and  adequacy  of rates for timely compliance with the
amendments to subdivision 8 of section 4403-f of the public  health  law
made  by  section one of this act and the amendments to paragraph (c) of
subdivision 18 of section 364-j of  the  social  services  law  made  by
section five of this act.
  The  commissioner  shall  provide  for  such increases in managed care
organization rates, including: (i) developing a uniform process for  the
payment  of  such  increases  to  providers; and (ii) ensuring the expe-
ditious and duly adjusted rates paid to contracted providers  to  ensure
timely  compliance  with  the  amendments made by sections one, four and
five of this act.
  Furthermore, the commissioner shall provide for the  efficient  imple-
mentation  of this act, minimizing any new administrative, procedural or
documentation burden on managed care plans or providers.
  S 7. This act shall take effect immediately; provided,  however,  that
the  amendments  to subdivision 8 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; and provided, further,
that the amendments to paragraph (c) of subdivision 18 of section  364-j
of  the  social  services law made by section five of this act shall not
affect the repeal of such section and shall be  deemed  repealed  there-
with.

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