S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5841
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                                May 2, 2017
                                ___________
 
 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.
              

                                                            LBD02956-02-7

 S. 5841                             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; PROVISIONS OF THE FEDERAL FAIR LABOR STANDARDS  ACT
 FOR EMPLOYEES' OVERTIME AND OTHER MANDATORY BENEFITS; AND AN ADMINISTRA-
 TIVE AND GENERAL COST FACTOR INDEXED ANNUALLY.
   (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 FIFTEENTH, TWO THOUSAND EIGHTEEN.
   (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.
   §  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.