S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7554
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 25, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend the public health law, in relation to the performance
   standards that must be met by managed long term care plans
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Paragraph (a) of subdivision 6-a of section 4403-f of the
 public health law, as added by section 4 of part I of chapter 57 of  the
 laws of 2023, is amended to read as follows:
   (a) On or before January first, two thousand twenty-four, each managed
 long  term  care  plan  that  has been issued a certificate of authority
 pursuant to this section shall  have  an  active  INSTITUTIONAL  SPECIAL
 NEEDS  PLAN  OR A Medicare Dual Eligible Special Needs Plan in operation
 whose H-contract either has a  current  quality  star  rating  from  the
 Centers  for Medicare and Medicaid Services of three stars or higher, or
 has not been issued a quality star rating from the Centers for  Medicare
 and Medicaid Services, OR A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDER-
 LY  (PACE).    In addition, the managed long term care plan shall suffi-
 ciently demonstrate success in the following performance categories:
   (i) in addition to meeting the requirements of paragraph (j) of subdi-
 vision seven of this section, in order  to  ensure  network  adequacy  a
 commitment  to contracting with an adequate number of licensed home care
 service agencies needed to provide necessary personal care  services  to
 the  greatest  practicable  number  of  enrollees,  and with an adequate
 number of fiscal intermediaries needed  to  provide  necessary  consumer
 directed personal assistance services to the greatest practicable number
 of  enrollees  in  accordance with section three hundred sixty-five-f of
 the social services law;
   (ii) readiness to timely implement and adhere  to  maximum  wait  time
 criteria  for  key  categories of service in accordance with laws, rules

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11574-01-3
 A. 7554                             2
              

 
 and regulations of the department or the Centers for Medicare and  Medi-
 caid Services;
   (iii) commitment to quality improvement;
   (iv)  accessibility  and geographic distribution of network providers,
 taking into account the needs  of  persons  with  disabilities  and  the
 differences between rural, suburban, and urban settings;
   (v)  demonstrated  cultural  and language competencies specific to the
 population of participants;
   (vi) ability to serve enrollees  across  the  continuum  of  care,  as
 demonstrated  by  the  type and number of products the managed long term
 care operates or has applied to operate, including integrated  care  for
 participants  who  are  dually  eligible for Medicaid and Medicare[, and
 those operated under title one-A of article twenty-five of this  chapter
 and section three hundred sixty-nine-gg of the social services law]; and
   (vii) value based care readiness and experience.
   §  2.  This act shall take effect immediately; provided, however, that
 the amendments to 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.