S T A T E   O F   N E W   Y O R K
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                                  9288

                          I N  A S S E M B L Y

                            February 11, 2016
                               ___________

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  participation  in
  managed  long  term care plans by medical assistance recipients in the
  traumatic brain injury waiver program and the nursing home  transition
  and diversion waiver program

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

  Section 1. Clauses 2 and 3 of subparagraph (v)  of  paragraph  (b)  of
subdivision  7 of section 4403-f of the public health law, as amended by
section 48 of part A of chapter 56 of the laws of 2013, are amended  and
three  new  subparagraphs  (v-a),  (v-b)  and (v-c) are added to read as
follows:
  (2) a participant in the traumatic brain injury waiver  program  OR  A
PERSON  WHOSE  CIRCUMSTANCES WOULD QUALIFY HIM OR HER FOR THE PROGRAM AS
IT EXISTED ON JANUARY FIRST, TWO THOUSAND FIFTEEN;
  (3) a participant in the nursing home transition and diversion  waiver
program OR A PERSON WHOSE CIRCUMSTANCES WOULD QUALIFY HIM OR HER FOR THE
PROGRAM AS IT EXISTED ON JANUARY FIRST, TWO THOUSAND FIFTEEN;
  (V-A)  FOR  PURPOSES  OF  CLAUSE (2) OF SUBPARAGRAPH (V) OF THIS PARA-
GRAPH, PROGRAM FEATURES  SHALL  BE  SUBSTANTIALLY  COMPARABLE  TO  THOSE
SERVICES  OFFERED  TO  TRAUMATIC  BRAIN INJURY WAIVER PARTICIPANTS AS OF
JANUARY FIRST, TWO THOUSAND FIFTEEN, INCLUDING BUT NOT LIMITED TO:
  (1) FULL-TIME SERVICE COORDINATORS WHO MAY  NOT  EXCEED  CASELOADS  OF
SEVENTEEN  PROGRAM  PATIENTS PER COORDINATOR AND MAY NOT BE EMPLOYEES OF
THE PARTICIPANT'S MANAGED CARE PLAN;
  (2) HOME AND COMMUNITY SUPPORT SERVICES;
  (3) POSITIVE BEHAVIORAL INTERVENTIONS AND CAREGIVER SUPPORT SERVICES;
  (4) COMMUNITY INTEGRATION COUNSELING SERVICES PROVIDED IN AN  INDIVID-
UAL OR GROUP SETTING;
  (5) APPROPRIATELY STRUCTURED DAY PROGRAM SERVICES;
  (6)  INDEPENDENT  LIVING  SKILLS  TRAINING  AND  DEVELOPMENT  SERVICES
PROVIDED IN AN INDIVIDUAL OR GROUP SETTING;
  (7) SUBSTANCE ABUSE PROGRAM SERVICES;

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

                                                           LBD14048-01-6

A. 9288                             2

  (8) ENVIRONMENTAL MODIFICATIONS SERVICES;
  (9) ASSISTIVE TECHNOLOGY SERVICES;
  (10)   TRANSPORTATION  SUPPLEMENTS  FOR  NON-MEDICAL  ACTIVITIES  THAT
SUPPORT LIVING IN THE COMMUNITY;
  (11) COMMUNITY TRANSITIONAL SERVICES;
  (12) RESPITE CARE; AND
  (13) HOUSING SUBSIDIES SUBJECT TO APPROPRIATION.
  THE COMMISSIONER MAY APPLY FOR FEDERAL FINANCIAL PARTICIPATION.
  (V-B) FOR PURPOSES OF CLAUSE (3) OF SUBPARAGRAPH  (V)  OF  THIS  PARA-
GRAPH,  PROGRAM  FEATURES  SHALL  BE  SUBSTANTIALLY  COMPARABLE TO THOSE
SERVICES OFFERED TO NURSING HOME TRANSITION AND DIVERSION WAIVER PARTIC-
IPANTS AS OF JANUARY FIRST, TWO  THOUSAND  FIFTEEN,  INCLUDING  BUT  NOT
LIMITED TO:
  (1)  THOSE  SERVICES IDENTIFIED IN SUBPARAGRAPH (V-A) OF THIS SUBPARA-
GRAPH; AND
  (2) HOME DELIVERED AND CONGREGATE MEALS.
  (V-C) ANY MANAGED LONG TERM CARE PROGRAM OR  OTHER  CARE  COORDINATION
MODEL  PROVIDING SERVICES UNDER CLAUSE (2) OR (3) OF SUBPARAGRAPH (V) OF
THIS PARAGRAPH SHALL HAVE AN ADEQUATE NETWORK OF PROVIDERS TO  MEET  THE
NEEDS  OF  ENROLLEES  AND  PROVIDE SERVICES UNDER THIS SUBDIVISION. THEY
SHALL ALSO ENSURE THAT PROVIDERS OF SERVICES TO INDIVIDUALS  WITH  BRAIN
INJURY HAVE APPROPRIATE AND ADEQUATE TRAINING AND COMPETENCY TO MEET THE
NEEDS OF THIS POPULATION AND PROVIDE A STANDARD OF CARE THAT IS AT LEAST
SUBSTANTIALLY COMPARABLE TO THE 2008 TRAUMATIC BRAIN INJURY WAIVER MANU-
AL  OR  2009  NURSING  HOME  TRANSITION  AND DIVERSION WAIVER MANUAL, AS
APPROPRIATE TO THE NEEDS OF THE INDIVIDUAL.
  S 2. Subdivisions 9 and 10 of section 2742 of the public  health  law,
as added by chapter 196 of the laws of 1994 are amended and a new subdi-
vision 11 is added to read as follows:
  9.  to develop training programs for persons providing discharge plans
and case management; [and]
  10. to develop standards for licensing or certifying  residential  and
non-residential  services for persons with traumatic brain injury to the
extent that such services are not otherwise subject to the  jurisdiction
of another state agency[.]; AND
  11. TO ESTABLISH A STATEWIDE NEUROBEHAVIORAL RESOURCE PROJECT SPECIAL-
IZING  IN THE EVALUATION AND DEVELOPMENT OF BEHAVIORAL SUPPORT PLANS FOR
INDIVIDUALS WITH TRAUMATIC BRAIN INJURIES WHOSE BEHAVIORS PRESENT OBSTA-
CLES TO LIVING SAFELY IN THE COMMUNITY. THE PROJECT WILL PROVIDE TECHNI-
CAL CONSULTATION AND TRAINING TO PROVIDERS AND CRISIS  INTERVENTION  AND
BEHAVIORAL  ASSESSMENT  SERVICES  FOR  THE INDIVIDUAL WITH BRAIN INJURY,
SUBJECT TO APPROPRIATION.
  S 3. Section 3614-d of the public health law, as added by  section  49
of  part  B  of  chapter  57  of the laws of 2015, is amended to read as
follows:
  S 3614-d. Universal  standards  for  coding  of  payment  for  medical
assistance  claims  for long term care. (A) Claims for payment submitted
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 the social services  law,  and  by
residential  health  care facilities operating pursuant to article twen-
ty-eight of this chapter shall have standard billing codes. Such  insur-
ers  shall include but not be limited to Medicaid managed care plans and
managed long term care plans. Such payments shall be based on  universal
billing  codes  approved  by  the  department or a nationally accredited

A. 9288                             3

organization as approved by  the  department;  provided,  however,  such
coding  shall  be  consistent  with  any  codes developed as part of the
uniform assessment system for long term care established by the  depart-
ment.
  (B)  THE  DEPARTMENT SHALL IMPLEMENT A HIGH NEEDS RATE CELL FOR CODING
OF PAYMENT FOR MEDICAL ASSISTANCE CLAIMS RELATING TO SERVICES AND  BENE-
FITS  THAT  ARE SUPPLEMENTARY TO THE BASIC BENEFIT PACKAGE AND NECESSARY
IN ORDER THAT THE INDIVIDUAL MAY REMAIN IN THE MOST  INTEGRATED  SETTING
APPROPRIATE.
  S  4.  The department of health shall study and report to the legisla-
ture by December 31, 2017 on the need for and feasibility  of  repatria-
tion of complex-needs patients placed in out-of-state facilities.
  S  5. This act shall take effect immediately; provided that the amend-
ments 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 expira-
tion and reversion of such paragraph and shall be deemed to expire ther-
ewith; and provided further that such amendments to  section  4403-f  of
the  public  health  law shall not affect the repeal of such section and
shall be deemed repealed therewith.