S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    985
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation to adverse determination notices to Medicaid recipients
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 9 of section 364-j of the social services  law,
 as  amended  by  a  chapter  of  the  laws of 2020 amending the   social
 services law and the public health law relating to adverse determination
 notices to Medicaid recipients, as proposed in legislative bills numbers
 S.7241 and A.9538, is amended to read as follows:
   9. Managed care providers shall inform participants of such provider's
 grievance procedure and  utilization  review  procedures  under  SECTION
 FORTY-FOUR  HUNDRED  EIGHT-A AND article forty-nine of the public health
 law. A managed care provider  or  local  social  services  district,  as
 appropriate,  shall  provide  notice to participants of their respective
 rights to a fair hearing and aid continuing in accordance with  applica-
 ble  state and federal law.  Managed care providers shall provide [writ-
 ten] notice of the name,  address,  phone  number  and  website  of  the
 department  of health designated independent consumer assistance program
 and the independent substance use disorder and mental  health  ombudsman
 established  by  section 33.27 of the mental hygiene law [on all] WITHIN
 notices of adverse [determinations,]  grievances  and  appeals  DETERMI-
 NATIONS.
   §  2.    Paragraph  (b)  of subdivision 2 and subdivision 7 of section
 4408-a of the public health law, as amended by a chapter of the laws  of
 2020  amending the  social services law and the public health law relat-
 ing to adverse determination notices to Medicaid recipients, as proposed
 in legislative bills numbers S.7241 and A.9538, are amended to  read  as
 follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07169-01-1
              

 A. 985                              2
 
   (b)  The  notice to an enrollee describing the grievance process shall
 explain: (i) the process for filing a grievance with  the  organization;
 (ii) the timeframes within which a grievance determination must be made;
   (iii) the right of an enrollee to designate a representative to file a
 grievance  on  behalf  of  the  enrollee;  and  (iv) notice of the name,
 address, phone number and website of the department designated  consumer
 assistance program and the independent substance use disorder and mental
 health  ombudsman established by section 33.27 of the mental hygiene law
 [on all] WITHIN notices  of  adverse  [determinations,]  grievances  and
 appeals DETERMINATIONS.
   7.  The  notice  of  a  determination  shall include: (i) the detailed
 reasons for the determination; (ii) in cases where the determination has
 a clinical basis, the clinical rationale for  the  determination;  (iii)
 the procedures for the filing of an appeal of the determination, includ-
 ing  a  form  for  the  filing of such an appeal; and (iv) notice of the
 name, address, phone number and website  of  the  department  designated
 consumer  assistance  program and the independent substance use disorder
 and mental health ombudsman established by section 33.27 of  the  mental
 hygiene  law [on all] WITHIN notices of adverse [determinations,] griev-
 ances and appeals DETERMINATIONS.
   § 3. This act shall take effect on the  same  date  and  in  the  same
 manner  as  a  chapter of the laws of 2020 amending the  social services
 law and the public health law relating to adverse determination  notices
 to  Medicaid recipients, as proposed in legislative bills numbers S.7241
 and A.9538, takes effect; provided, however, the amendments to  subdivi-
 sion  9  of  section 364-j   of   the   social   services law   made  by
 section one of this act shall not affect the repeal of such section, and
 shall be deemed repealed therewith.