BILL NUMBER: S1890

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to the provision of
services to certain persons suffering from traumatic brain injuries or
qualifying for nursing home diversion and transition services

 
PURPOSE:

To prevent waivered Medicaid services provided to persons suffering from
traumatic brain injuries or qualifying for nursing home diversion and
transition services from being provided to Medicaid recipients through
managed care programs.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill amends section 364-j of the social services law to
amend paragraph (d-2) preventing service provided pursuant to the Trau-
matic Brain Injury and Nursing Home Transition and Diversion (TBI/NHTD)
              

Waiver programs from being provided. through Medicaid Managed Care and
directing the Commissioner of Health to take any action necessary to
continue provisions of these services through waivers.

Section 2 of the bill provides for an immediate effective date.

 
JUSTIFICATION:

Individuals who suffer from traumatic brain injury (TBI) and are served
by a Medicaid waiver or who have some other disabilities that qualify
them for the Nursing Home Transition and Diversion Waiver (NHTD) have
varied physical and cognitive disabilities that make them particularly
vulnerable to institutionalization. The Federal Medicaid Waivers were
established many years ago because the state recognized these vulner-
abilities and needs for special services and supports to help individ-
uals live in the least integrated setting. These programs have served as
a national model.

Given the unique needs of this small population. of Medicaid recipients,
the legislature introduced legislation in 2015 to delay the move of the
TBI/MHTD waivered population into managed care and require that a work
group of stakeholders be convened to make recommendations on transition
of these services into managed care.  The Department of Health ultimate-
ly committed to delay the transition until January 2017 and created a
work-group which met many times. in late January, 2016 the Department
shared its draft transition plan with the workgroup and concerns were
raised that the draft transition plan does not reflect the workgroup's
recom- mendations nor conversations with the Department. A series of
further weekly meetings were schedule as a result. Of particular concern
has been the assessment tool, how existing services fit into managed
care and the process by which plans would qualify individuals and deter-
mine approved services, particularly for individuals who may find them-
selves with a. traumatic brain injury or other disability after the move
to Medicaid managed care. .

Even Managed Long Term Care Plans have expressed concerns about taking
on this population. New York is still in the midst of moving other popu-
lations into managed care and those transitions are far from complete or
without concerns. Managed Long Term Care Plans, who would enroll
TBI/NHTD individuals, are self reporting that they are already in a
fragile state with many of those plans experiencing operating losses. In
July 2015, New York moved the nursing home benefit into MLTC and the
affect of that high acuity population being added to MLTC plans is
putting additional pressures on the system Adding yet another high acui-
ty population such as TBI/NHTD to plans will undoubtedly place some
plans in further peril and ultimately consumers in jeopardy

As part of the SFY 2016-17 budget, the date for transitioning the
TBI/NHTDW program participants into managed care was further extended
until at least January 1, 2018. There are no cost savings associated
with moving TBI/NHTD into managed care and given the vast changes the
Medicaid program is currently undergoing, the State would be best served
by placing all its attention on the populations it has already begun
moving into managed care. Moving the vulnerable populations served under
the TBI/NHTD waiver into managed care at this time would be a tremendous
disservice to all involved.

 
LEGISLATIVE HISTORY:

S 6814 of 2016: Passed Senate

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
Immediately