S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8470
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             December 29, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend  the  public health law, the social services law, the
   elder law and the mental hygiene law, in relation to  long  term  care
   options;  and  to  repeal  certain provisions of the public health law
   relating to managed long term care

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Legislative  intent.   The state, as part of an ambitious
 effort to move all Medicaid recipients to some  form  of  managed  care,
 moved  those in need of home and community-based long term care services
 for over a one hundred twenty day period into  managed  long  term  care
 plans  on  a  mandatory basis over ten years ago. The original intent of
 the MLTC program was that the managed long term care plans would develop
 into fully capitated plans over time. This has not happened.
   Therefore, it is the intent of the legislature to repeal the partially
 capitated managed long term care program and instead, provide  appropri-
 ate  home  and  community-based long term care benefits under a fee-for-
 service arrangement. Fully capitated programs such as the  PACE  program
 shall continue to be an option. This transition shall not be implemented
 until  the  commissioner  of  health is satisfied that all necessary and
 appropriate transition planning has occurred, and federal approvals have
 been obtained.
   § 2. Section 4403-f of the public health law is  REPEALED  and  a  new
 section 4403-f is added to read as follows:
   §  4403-F. LONG TERM CARE OPTIONS. 1.  THE FOLLOWING WORDS OR PHRASES,
 AS USED IN THIS SECTION, SHALL HAVE THE FOLLOWING MEANINGS:
   (A) "PROGRAM OF ALL-INCLUSIVE CARE OF THE ELDERLY" OR "PACE"  MEANS  A
 FULLY  CAPITATED  FEDERALLY  RECOGNIZED  MODEL OF COMPREHENSIVE CARE FOR
 PERSONS FIFTY-FIVE YEARS OF AGE OR OLDER THAT ARE ELIGIBLE FOR  MEDICAID
 AND  MAY  ALSO  BE  ELIGIBLE  FOR  MEDICARE, QUALIFYING FOR NURSING HOME
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13640-07-3
              

 A. 8470                             2
 
 LEVELS OF CARE WHO WISH TO REMAIN IN THEIR COMMUNITY (SEE, SECTIONS 1894
 AND 1934 TO TITLE XVIII OF THE SOCIAL SECURITY ACT; 42 CFR  460),  WHICH
 ARE LICENSED TO OPERATE UNDER ARTICLE TWENTY-NINE-EE OF THIS CHAPTER.
   (B) "MEDICAID ADVANTAGE PLUS PROGRAM" OR "MAP" MEANS A FULLY CAPITATED
 STATE  DEVELOPED  MODEL OF COMPREHENSIVE CARE FOR PERSONS EIGHTEEN YEARS
 OF AGE OR OLDER THAT ARE ELIGIBLE FOR MEDICAID  AND  ALSO  ELIGIBLE  FOR
 MEDICARE, QUALIFYING FOR NURSING HOME LEVELS OF CARE.
   (C)  "CARE  COORDINATION  ENTITY"  MEANS  AN  ENTITY THAT HAS OBTAINED
 APPROVAL FROM THE COMMISSIONER BASED ON GUIDELINES  ESTABLISHED  BY  THE
 DEPARTMENT  TO  PROMOTE  CONTINUITY OF CARE AND COORDINATION OF SERVICES
 FOR ALL ENROLLEES.   THE ENTITY  MAY  BE  ORGANIZED  AS  A  HEALTH  HOME
 SPECIALLY   CERTIFIED  BY THE  COMMISSIONER TO SERVE HOME AND COMMUNITY-
 BASED SERVICES ELIGIBLE RECIPIENTS, BUT THIS SHALL  NOT  PRECLUDE  OTHER
 ORGANIZATIONAL STRUCTURES AS DETERMINED BY THE COMMISSIONER.
   2.  THE  COMMISSIONER  SHALL SUBMIT THE APPROPRIATE WAIVERS, INCLUDING
 BUT NOT LIMITED TO THOSE AUTHORIZED PURSUANT TO SECTIONS ELEVEN  HUNDRED
 FIFTEEN  AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT
 OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS NECESSARY TO  REQUIRE  ON
 OR AFTER APRIL FIRST, TWO THOUSAND TWENTY-SIX, MEDICAL ASSISTANCE RECIP-
 IENTS  WHO  ARE EIGHTEEN YEARS OF AGE OR OLDER AND WHO REQUIRE LONG TERM
 CARE SERVICES, AS SPECIFIED BY THE COMMISSIONER, FOR A CONTINUOUS PERIOD
 OF MORE THAN ONE HUNDRED TWENTY DAYS, TO RECEIVE SUCH  SERVICES  THROUGH
 AN  AVAILABLE  FULLY  INTEGRATED  PLAN  INCLUDING A PACE OR MAP PLAN, OR
 THROUGH A FEE-FOR-SERVICE BASED MODEL WITH  SERVICES  COORDINATED  BY  A
 CARE COORDINATION ENTITY. THE COMMISSIONER SHALL ESTABLISH GUIDELINES ON
 THE  ESTABLISHMENT  AND  OPERATION  OF  CARE COORDINATION ENTITIES. SUCH
 GUIDELINES SHALL  ADDRESS  THE  PAYMENT  METHODS  THAT  ENSURE  PROVIDER
 ACCOUNTABILITY FOR COST EFFECTIVE QUALITY OUTCOMES. COPIES OF SUCH WAIV-
 ER  APPLICATIONS  AND AMENDMENTS THERETO SHALL BE PROVIDED TO THE CHAIRS
 OF THE SENATE FINANCE COMMITTEE, THE ASSEMBLY WAYS AND  MEANS  COMMITTEE
 AND THE SENATE AND ASSEMBLY HEALTH COMMITTEES BEFORE THEIR SUBMISSION TO
 THE FEDERAL GOVERNMENT.
   3.  PERSONS  THAT  ARE  DETERMINED  ELIGIBLE TO RECEIVE LONG TERM CARE
 SERVICES THROUGH PACE OR MAP, OR THROUGH A FEE-FOR-SERVICE  BASED  MODEL
 WITH  SERVICES  COORDINATED  BY  A  CARE COORDINATION ENTITY ESTABLISHED
 PURSUANT TO SUBDIVISION TWO OF THIS SECTION SHALL HAVE  AT LEAST  THIRTY
 DAYS  TO  SELECT A PACE OR MAP PROVIDER, OR CARE COORDINATION ENTITY AND
 SHALL  BE PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE. WHERE  A
 PARTICIPANT  HAS NOT SELECTED SUCH A PROVIDER OR CARE COORDINATION ENTI-
 TY,  THE COMMISSIONER SHALL ASSIGN SUCH PARTICIPANT TO  A  CARE  COORDI-
 NATION  ENTITY TAKING INTO ACCOUNT CONSISTENCY WITH ANY PRIOR COMMUNITY-
 BASED DIRECT CARE WORKERS HAVING RECENTLY SERVED THE RECIPIENT,  QUALITY
 PERFORMANCE CRITERIA, CAPACITY AND GEOGRAPHIC ACCESSIBILITY.
   §  3.  Subdivision  2  of  section 365-a of the social services law is
 amended by adding two new paragraphs (mm) and (nn) to read as follows:
   (MM) THE DEPARTMENT SHALL  PROMULGATE  REGULATIONS  FOR  ALL  MEDICAID
 ENROLLEES RECEIVING SERVICES THROUGH A FEE-FOR-SERVICE MODEL PURSUANT TO
 SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW THAT INCLUDE
 THE ESTABLISHMENT AND OPERATION OF CARE COORDINATION ENTITIES TO PROMOTE
 CONTINUITY  OF  CARE  AND  COORDINATION  OF SERVICES TO ENSURE THAT EACH
 ENROLLEE HAS AN ONGOING SOURCE OF CARE APPROPRIATE  TO  THEIR  NEEDS  AS
 REQUIRED  BY  42  CFR § 438.208. THE REGULATIONS SHALL INCLUDE CONFLICT-
 FREE CASE MANAGEMENT PROTECTIONS TO ENSURE THAT ASSESSMENT  AND  COORDI-
 NATION  OF SERVICES ARE SEPARATE FROM THE DELIVERY OF THOSE SERVICES. IN
 SELECTING PROVIDERS OF CASE MANAGEMENT SERVICES,  THE  DEPARTMENT  SHALL
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 PRIORITIZE  PROVIDERS WITH PROVEN EXPERIENCE SERVING POPULATIONS RECEIV-
 ING HOME AND PERSONAL CARE SERVICES.
   (NN)  THE  DEPARTMENT  SHALL CONDUCT AN EVALUATION OF THE VIABILITY OF
 UTILIZING CARE COORDINATION ENTITIES OPERATING PURSUANT TO THIS  SECTION
 FOR  ASSESSMENTS  OR  REASSESSMENTS REQUIRED FOR DETERMINING AN INDIVID-
 UAL'S NEEDS FOR SERVICES THAT ARE CONTROLLED BY THE INDEPENDENT ASSESSOR
 ESTABLISHED PURSUANT TO SUBDIVISION TEN OF SECTION THREE HUNDRED  SIXTY-
 FIVE-A OF THIS TITLE.
   §  4.  Stakeholder  engagement.  1.  The  commissioner of health shall
 convene an advisory group composed of stakeholder representatives  which
 shall  seek  input from representatives of home and community-based long
 term care services  providers,  including  representative  associations,
 recipients,  the  department of health, local social services districts,
 and the direct care workforce, among others, to:
   (a) further evaluate and promote the transition of persons in  receipt
 of home and community-based long term care services into fee-for-service
 arrangements,  where  appropriate,  and  to  develop guidelines for such
 care; and
   (b) determine a process to transition  providers,  including  but  not
 limited  to  licensed home care services agencies, certified home health
 agencies, and fiscal intermediaries, to a fee-for-service  reimbursement
 system.
   2.  In  implementing  the  transition  to  a fee-for-service model the
 commissioner of health, in consultation with the advisory group,  shall,
 to  the  extent  practicable,  consider and select programs and policies
 that seek to maximize continuity of care and minimize disruption to  the
 provider  labor  workforce,  and  shall  continue  to support providers,
 licensed home care services agencies, and fiscal intermediaries that are
 based on a commitment to quality and value;  provided  that  nothing  in
 this  subdivision  shall supersede or invalidate any contracts or awards
 provided to fiscal intermediaries pursuant to subdivision 4-a of section
 365-f of the social services law, provided that the provisions of subdi-
 vision 4-b of section 365-f of  the  social  services  law  shall  still
 apply,  or  contracts  or awards provided to licensed home care services
 agencies pursuant to section 3605-c of the public health law.
   3. The commissioner of health shall report biannually on the implemen-
 tation of this section. The reports shall include, but  not  be  limited
 to: (a) satisfaction of enrollees with care coordination/case management
 and  timeliness  of care; (b) service utilization data including changes
 in the level, hours, frequency, and types of services and providers; (c)
 enrollment data; (d) quality  data;  and  (e)  continuity  of  care  for
 participants  as  they  move  out of managed long term care and into the
 fee-for-service model. The commissioner shall publish the report on  the
 department's  website  and  provide notice to the temporary president of
 the senate, the speaker of the assembly, the chair of the senate  stand-
 ing committee on health and the chair of the assembly health committee.
   4. The commissioner of health shall seek input from representatives of
 home  and community-based long term care services providers, recipients,
 and the Medicaid managed care advisory review panel,  among  others,  to
 assist in the development of guidelines for the establishment and opera-
 tion  of  care  coordination  entities pursuant to section 4403-f of the
 public health law. The guidelines shall be finalized and posted  on  the
 department  of  health's website no later than November first, two thou-
 sand twenty-five.
 A. 8470                             4
 
   § 5. Paragraph (o) of subdivision 2 of section  365-a  of  the  social
 services law, as added by chapter 659 of the laws of 1997, is amended to
 read as follows:
   (o)  care  and services furnished by a [managed long term care plan or
 approved managed long term care demonstration pursuant to the provisions
 of] PACE OR MAP PLAN AS SUCH TERMS ARE  DEFINED  BY  section  forty-four
 hundred three-f of the public health law to eligible individuals [resid-
 ing  in  the  geographic area] served by such entity, when such services
 are furnished in accordance with an agreement  with  the  department  of
 health  and  meet  the  applicable requirements of federal law and regu-
 lation.
   § 6. Subparagraph (iii) of paragraph (e) of subdivision 2  of  section
 365-a  of  the social services law, as amended by section 36-a of part B
 of chapter 57 of the laws of 2015, is amended to read as follows:
   (iii) the commissioner shall provide assistance to  persons  receiving
 services  under  this  paragraph who are transitioning to receiving care
 from a [managed long term care plan certified pursuant to] PACE  OR  MAP
 PLAN  AS SUCH TERMS ARE DEFINED BY section forty-four hundred three-f of
 the public health law, consistent with subdivision thirty-one of section
 three hundred sixty-four-j of this title;
   § 7. Subdivision 10 of section 365-a of the social  services  law,  as
 amended  by  section  1 of part QQ of chapter 57 of the laws of 2022, is
 amended to read as follows:
   10. The department of health shall establish or procure  the  services
 of  an  independent assessor or assessors no later than October 1, 2022,
 in a manner and schedule as determined by the commissioner of health, to
 take over from local departments  of  social  services[,]  AND  Medicaid
 Managed  Care  providers,  [and  Medicaid  managed long term care plans]
 INCLUDING A MAP PLAN, OR A PACE PLAN IF THE PACE PLAN ELECTS TO  UTILIZE
 THE INDEPENDENT ASSESSOR AS SUCH TERMS ARE DEFINED BY SECTION FORTY-FOUR
 HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, THE performance of assessments
 and  reassessments  required  for  determining  individuals'  needs  for
 personal care services,  including  as  provided  through  the  consumer
 directed  personal  assistance  program,  and other services or programs
 available pursuant to the state's medical assistance program  as  deter-
 mined  by  such  commissioner  for  the purpose of improving efficiency,
 quality, and reliability in assessment [and  to  determine  individuals'
 eligibility  for Medicaid managed long term care plans]. Notwithstanding
 the provisions of section one hundred sixty-three of the  state  finance
 law,  or  sections  one hundred forty-two and one hundred forty-three of
 the  economic  development  law,  or  any  contrary  provision  of  law,
 contracts  may  be  entered or the commissioner may amend and extend the
 terms of a contract awarded prior to the effective date and entered into
 to conduct enrollment broker and conflict-free evaluation  services  for
 the  Medicaid program, if such contract or contract amendment is for the
 purpose of procuring such assessment services from an independent asses-
 sor. Contracts entered into,  amended,  or  extended  pursuant  to  this
 subdivision shall not remain in force beyond September 30, 2025.
   § 8. Paragraph (d) of subdivision 1 and paragraph (h) of subdivision 3
 of  section 218 of the elder law, as amended by section 1 of chapter 259
 of the laws of 2018, are amended to read as follows:
   (d) "Long-term care facilities" shall  mean  residential  health  care
 facilities  as  defined  in  subdivision  three  of section twenty-eight
 hundred one of the public health law; adult care facilities  as  defined
 in  subdivision  twenty-one  of  section two of the social services law,
 including those adult homes and enriched housing  programs  licensed  as
 A. 8470                             5
 
 assisted  living  residences,  pursuant  to  article  forty-six-B of the
 public health law; or any facilities which hold themselves out or adver-
 tise themselves as providing assisted  living  services  and  which  are
 required  to  be  licensed or certified under the social services law or
 the public health law. Within the amounts appropriated therefor,  "long-
 term  care facilities" shall also mean [managed long-term care plans and
 approved managed long-term care or operating demonstrations] A  PACE  OR
 MAP PLAN as SUCH TERMS ARE defined in section forty-four hundred three-f
 of the public health law and the term "resident", "residents", "patient"
 and "patients" shall also include enrollees of such plans.
   (h) Within the amounts appropriated therefor, the state long-term care
 ombudsman  program shall include services specifically designed to serve
 persons enrolled in [managed long-term care plans  or  approved  managed
 long-term  care  or operating demonstrations authorized under] A PACE OR
 MAP PLAN AS SUCH TERMS ARE DEFINED BY section forty-four hundred three-f
 of the  public  health  law,  and  shall  also  review  and  respond  to
 complaints  relating  to  marketing  practices  by such plans and demon-
 strations.
   § 9. Subdivisions (a), (c), (d), (f), the opening paragraph of  subdi-
 vision  (g)  and  subdivision (h) of section 13.40 of the mental hygiene
 law, subdivisions (a), (d), (f) and the opening paragraph of subdivision
 (g) as added by section 72-b of part A of chapter  56  of  the  laws  of
 2013,  subdivision  (c) as amended by section 17 of part Z of chapter 57
 of the laws of 2018, and subdivision (h) as added by section 1 of part D
 of chapter 58 of the laws of 2014, are amended to read as follows:
   (a) The commissioner and the  commissioner  of  health  shall  jointly
 establish  a  people  first  waiver program for purposes of developing a
 care coordination model that integrates various  long-term  habilitation
 supports  and/or  health  care.  The  people  first waiver program shall
 include the use of developmental disability individual support and  care
 coordination  organizations,  herein  referred to as DISCOs, pursuant to
 section forty-four hundred three-g of  the  public  health  law,  health
 maintenance   organizations,  herein  referred  to  as  HMOs,  providing
 services under subdivision eight of section forty-four hundred three  of
 the  public  health  law,  and  [managed]  long term care [plans, herein
 referred to as MLTCs] OPTIONS, providing OR COORDINATING services  under
 [subdivisions  twelve,  thirteen  and  fourteen  of]  section forty-four
 hundred three-f of the public health law.  Services shall be provided as
 described in section forty-four hundred three-g  of  the  public  health
 law, subdivision eight of section forty-four hundred three of the public
 health  law, and [subdivisions twelve, thirteen and fourteen of] section
 forty-four hundred three-f of the public health law.
   (c) No person with a developmental  disability  who  is  receiving  or
 applying  for  medical  assistance  and who is receiving, or eligible to
 receive, services operated, funded, certified, authorized or approved by
 the office, shall be required to enroll in a DISCO, HMO or  [MLTC]  LONG
 TERM  CARE  OPTION  in  order  to  receive  such  services until program
 features and reimbursement rates are approved by  the  commissioner  and
 the  commissioner of health, and until such commissioners determine that
 a sufficient number of plans that are authorized to coordinate care  for
 individuals  pursuant  to this section or that are authorized to operate
 and to exclusively enroll persons with developmental disabilities pursu-
 ant to subdivision twenty-seven of section three hundred sixty-four-j of
 the social services law are operating in such person's county  of  resi-
 dence  to meet the needs of persons with developmental disabilities, and
 that such entities meet the standards of this section. No  person  shall
 A. 8470                             6
 
 be required to enroll in a DISCO, HMO or [MLTC] LONG TERM CARE OPTION in
 order  to  receive  services  operated, funded, certified, authorized or
 approved by the office until there are at least two  entities  operating
 under  this section in such person's county of residence, unless federal
 approval is secured to require enrollment when there are less  than  two
 such entities operating in such county. Notwithstanding the foregoing or
 any other law to the contrary, any health care provider: (i) enrolled in
 the  Medicaid program and (ii) rendering hospital services, as such term
 is defined in section twenty-eight hundred one of the public health law,
 to an individual with a developmental disability who is  enrolled  in  a
 DISCO, HMO or [MLTC] LONG TERM CARE OPTION, or a prepaid health services
 plan  operating  pursuant  to  section forty-four hundred three-a of the
 public health law, including, but not limited to, an individual  who  is
 enrolled in a plan authorized by section three hundred sixty-four-j [or]
 OF the social services law, shall accept as full reimbursement the nego-
 tiated  rate or, in the event that there is no negotiated rate, the rate
 of payment that the applicable government agency would otherwise pay for
 such rendered hospital services.
   (d) DISCOs, HMOs and [MLTCs] LONG TERM CARE  OPTIONS  operating  under
 this  section  shall  ensure,  to  the greatest extent practicable, that
 their assessment, services, and the grievance and appeals processes  are
 culturally and linguistically competent.
   (f) There shall be a joint advisory council chaired by the commission-
 er  and  the  commissioner of health that shall be charged with advising
 both commissioners in regard to the oversight of DISCOs, HMOs  providing
 services  under subdivision eight of section forty-four hundred three of
 the public health law, and [MLTCs]  LONG  TERM  CARE  OPTIONS  providing
 services  under  [subdivisions twelve, thirteen and fourteen of] section
 forty-four hundred three-f of the public health law. The joint  advisory
 council may be comprised of the members of existing advisory councils or
 similar entities serving the office, provided that it shall be comprised
 of  twelve  members,  including individuals with developmental disabili-
 ties, family members of, advocates for, and  providers  of  services  to
 people with developmental disabilities. Three members of the joint advi-
 sory  council shall also be members of the special advisory review panel
 on medicaid managed care established under section three hundred  sixty-
 four-jj  of  the  social  services law. The joint advisory council shall
 review all managed care options provided to  individuals  with  develop-
 mental  disabilities,  including: the adequacy of habilitation services;
 the record of compliance with person-centered planning,  person-centered
 services  and  community  integration;  the  adequacy  of  rates paid to
 providers in accordance with the provisions of [paragraph one of  subdi-
 vision  four  of]  section forty-four hundred three of the public health
 law, paragraph [a-two] (A-2) of subdivision eight of section  forty-four
 hundred  three  of the public health law or [paragraph a-two of subdivi-
 sion twelve of] section forty-four hundred three-f of the public  health
 law;  and  quality  of life, health, safety and community integration of
 individuals with developmental disabilities enrolled  in  managed  care.
 The commissioner and commissioner of the office for people with develop-
 mental  disabilities or their designees shall attend all meetings of the
 joint advisory council. The joint  advisory  council  shall  report  its
 findings,  recommendations,  and  any  proposed  amendments to pertinent
 sections of the law to the commissioner and the commissioner of  health,
 the  senate majority leader and speaker of the assembly. The joint advi-
 sory council shall have access to any and all information  that  may  be
 A. 8470                             7
 
 lawfully  disclosed to it and that is necessary to perform its functions
 under this section.
   Notwithstanding  any  inconsistent  provision  of sections one hundred
 twelve and one hundred sixty-three of the state finance law, or  section
 one  hundred forty-two of the economic development law, or any other law
 to the contrary, the commissioner and the  commissioner  of  health  are
 authorized  to  enter  into a contract or contracts under section forty-
 four hundred three-g of the public  health  law,  subdivision  eight  of
 section forty-four hundred three of the public health law, and [subdivi-
 sion  twelve of] section forty-four hundred three-f of the public health
 law, provided, however, that:
   (h) Consistent with and subject to the terms of federal approval,  the
 commissioner  shall establish the managed care for persons with develop-
 mental disabilities advocacy program, hereinafter  referred  to  as  the
 advocacy  program. The activities of the advocacy program shall be coor-
 dinated with the  independent  Medicaid  managed  care  ombuds  services
 provided  to  persons  with  disabilities  enrolling in Medicaid managed
 care. The advocacy program shall advise individuals of applicable rights
 and responsibilities, provide information and assistance to address  the
 needs of individuals with disabilities, and pursue legal, administrative
 and other appropriate remedies or approaches to ensure the protection of
 and advocacy for the rights of the enrollees. The advocacy program shall
 provide  support to eligible individuals with developmental disabilities
 enrolling in developmental disability individual support and care  coor-
 dination organizations pursuant to section forty-four hundred three-g of
 the  public  health  law,  health  maintenance  organizations  providing
 services pursuant to subdivision eight  of  section  forty-four  hundred
 three of the public health law, [managed long term care plans] LONG TERM
 CARE OPTIONS providing services under [subdivisions twelve, thirteen and
 fourteen  of]  section  forty-four  hundred three-f of the public health
 law, and fully integrated dual advantage plans providing services  under
 subdivision  twenty-seven  of  section three hundred sixty-four-j of the
 social services law. The commissioner shall select an independent organ-
 ization or organizations to provide advocacy services under this  subdi-
 vision.
   §  10.  Paragraph (c) of subdivision 6 of section 2801-e of the public
 health law, as amended by chapter 257 of the laws of 2005, is amended to
 read as follows:
   (c) The commissioner may, as necessary, waive  existing  methodologies
 for  determining  public  need under this article, article thirty-six of
 this chapter and article seven of the social services law[, as  well  as
 enrollment  limitations under section forty-four hundred three-f of this
 chapter,] to accommodate permanent conversions of beds to other programs
 or services on the basis that any such increases in capacity are  linked
 to  commensurate  reductions  in  the  number of residential health care
 facility beds.
   § 11. The opening paragraph of paragraph (ccc)  of  subdivision  1  of
 section  2807-v  of  the  public health law, as amended by section 12 of
 part C of chapter 57 of the laws of 2023, is amended to read as follows:
   Funds shall be deposited by the commissioner, within amounts appropri-
 ated, and the state comptroller is hereby  authorized  and  directed  to
 receive for the deposit to the credit of the state special revenue funds
 -  other, HCRA transfer fund, medical assistance account, or any succes-
 sor fund or  account,  for  purposes  of  funding  the  state  share  of
 increases  in  the  rates  for certified home health agencies, long term
 home health care programs, AIDS home care programs, hospice programs and
 A. 8470                             8
 
 [managed] long term care [plans and  approved  managed  long  term  care
 operating  demonstrations  as  defined in] OPTIONS IN section forty-four
 hundred three-f of this chapter for recruitment and retention of  health
 care workers pursuant to subdivisions nine and ten of section thirty-six
 hundred  fourteen of this chapter from the tobacco control and insurance
 initiatives pool established for the following periods in the  following
 amounts:
   § 12. Section 2807-x of the public health law is REPEALED.
   §  13.  Subdivision  8  of  section  3605 of the public health law, as
 amended by section 49 of part D of chapter 56 of the laws  of  2012,  is
 amended to read as follows:
   8. Agencies licensed pursuant to this section but not certified pursu-
 ant  to  section  [three  thousand six hundred eight] THIRTY-SIX HUNDRED
 EIGHT of this article, shall not be qualified to participate as  a  home
 health  agency under the provisions of title XVIII or XIX of the federal
 Social Security Act provided, however, an agency which  has  a  contract
 with a state agency or its locally designated office or, as specified by
 the  commissioner, with a managed care organization participating in the
 managed care program  established  pursuant  to  section  three  hundred
 sixty-four-j  of  the  social  services law or with a [managed long term
 care plan established pursuant to] PACE OR MAP PLAN AS  SUCH  TERMS  ARE
 DEFINED  BY  section  forty-four  hundred  three-f  of this chapter, may
 receive reimbursement under title XIX of  the  federal  Social  Security
 Act.
   §  14.  The  opening paragraph of subdivision 9 of section 3614 of the
 public health law, as amended by section 56 of part A of chapter  56  of
 the laws of 2013, is amended to read as follows:
   Notwithstanding  any  law  to  the  contrary,  the commissioner shall,
 subject to the availability of federal financial  participation,  adjust
 medical  assistance  rates of payment for certified home health agencies
 for such services provided to children under eighteen years of  age  and
 for services provided to a special needs population of medically complex
 and  fragile  children,  adolescents and young disabled adults by a CHHA
 operating under a pilot program approved by the  department,  long  term
 home  health care programs, AIDS home care programs established pursuant
 to this article, hospice programs established  under  article  forty  of
 this  chapter  and  for  [managed]  long  term  care [plans and approved
 managed long term care operating demonstrations as defined  in]  OPTIONS
 UNDER  section  forty-four hundred three-f of this chapter. Such adjust-
 ments shall be for  purposes  of  improving  recruitment,  training  and
 retention  of  home  health aides or other personnel with direct patient
 care responsibility in the following aggregate amounts for the following
 periods:
   § 15. Paragraph (a) of subdivision 10 of section 3614  of  the  public
 health law, as amended by section 57 of part A of chapter 56 of the laws
 of 2013, is amended to read as follows:
   (a)  Such  adjustments to rates of payments shall be allocated propor-
 tionally based on each certified home  health  agency,  long  term  home
 health  care  program,  AIDS home care and hospice program's home health
 aide or other  direct  care  services  total  annual  hours  of  service
 provided  to  medicaid  patients, as reported in each such agency's most
 recently available cost report as submitted to the department or for the
 purpose of the [managed] long term  care  [program]  OPTION  a  suitable
 proxy  developed  by  the department in consultation with the interested
 parties. Payments made pursuant to this section shall not be subject  to
 subsequent  adjustment or reconciliation; provided that such adjustments
 A. 8470                             9
 
 to rates of payments to certified home health agencies shall only be for
 that portion of services provided to children under  eighteen  years  of
 age and for services provided to a special needs population of medically
 complex and fragile children, adolescents and young disabled adults by a
 CHHA operating under a pilot program approved by the department.
   §  16.  Paragraph  (b)  of subdivision 2 of section 4409 of the public
 health law, as added by section 5 of part NN of chapter 57 of  the  laws
 of 2023, is amended to read as follows:
   (b)  The department is authorized to address to any health maintenance
 organization, and [managed long term care plan  with  a  certificate  of
 authority  pursuant  to] A PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY
 section forty-four hundred three-f of this article, or officers thereof,
 any inquiry in relation to its contracts with providers and other  enti-
 ties    providing   covered   services   to   the   health   maintenance
 organization's, or [managed long term care plan's] PACE  OR  MAP  PLANS'
 enrollees, including but not limited to the rates of payment and payment
 terms  and conditions therein. Every entity or person so addressed shall
 reply in writing to such inquiry promptly and truthfully, and such reply
 shall be, if required by the department, signed by such  individual,  or
 by  such  officer  or officers of a corporation, as the department shall
 designate, and affirmed by them as true under penalty of perjury.  Fail-
 ure to comply with the requirements of this section shall be subject  to
 civil penalties under section twelve of this chapter. Each day after the
 deadline  established  by  the department for reply until such time that
 the provider submits a good faith response shall be considered  a  sepa-
 rate  and  subsequent violation. In accordance with the process outlined
 in this paragraph, employers shall provide any documents or materials in
 the employer's possession, custody, or control that are requested by the
 department as needed to support or verify the employer's reply.
   § 17. Subparagraph (i) of paragraph (e) of subdivision  3  of  section
 364-j  of the social services law, as amended by section 38 of part A of
 chapter 56 of the laws of 2013, is amended to read as follows:
   (i) an individual dually eligible for medical assistance and  benefits
 under  the  federal  Medicare program; provided, however, nothing herein
 shall: (a) require an individual enrolled in a [managed] long term  care
 [plan]  OPTION,  pursuant  to  section forty-four hundred three-f of the
 public health law, to disenroll from such program; or (b)  make  enroll-
 ment  in  a  Medicare  managed care plan a condition of the individual's
 participation in the managed care program pursuant to this  section,  or
 affect  the  individual's  entitlement to payment of applicable Medicare
 managed care or [fee for service] FEE-FOR-SERVICE coinsurance and deduc-
 tibles by the individual's managed care provider.
   § 18.  Paragraphs (b) and (c) of subdivision 27 of  section  364-j  of
 the  social services law, as added by section 72 of part A of chapter 56
 of the laws of 2013, are amended to read as follows:
   (b)  The  FIDA  program  shall   provide   targeted   populations   of
 [medicare/medicaid]   MEDICARE/MEDICAID  dually  eligible  persons  with
 comprehensive health services that include the full range of  [medicare]
 MEDICARE  and  [medicaid]  MEDICAID  covered services, including but not
 limited to primary and acute care, prescription drugs, behavioral health
 services,  care  coordination  services,  and  long-term  supports   and
 services,  as well as other services, through managed care providers, as
 defined in subdivision one of this section[, including managed long term
 care plans, certified pursuant to section forty-four hundred three-f  of
 the public health law].
 A. 8470                            10
 
   (c)  Under  the FIDA program established pursuant to this subdivision,
 up to three managed [long term] care plans may be authorized  to  exclu-
 sively  enroll individuals with developmental disabilities, as such term
 is defined in section 1.03 of the mental hygiene law.  The  commissioner
 of  health may waive any of the department's regulations as such commis-
 sioner, in consultation with the commissioner of the office  for  people
 with  developmental  disabilities, deems necessary to allow such managed
 [long term] care plans to provide or arrange for service for individuals
 with developmental disabilities that are  adequate  and  appropriate  to
 meet the needs of such individuals and that will ensure their health and
 safety.  The  commissioner  of  the office for people with developmental
 disabilities may waive any of the office for people  with  developmental
 disabilities' regulations as such commissioner, in consultation with the
 commissioner  of  health,  deems  necessary  to allow such managed [long
 term] care plans to provide or arrange for services for individuals with
 developmental disabilities that are adequate and appropriate to meet the
 needs of such individuals and that will ensure their health and safety.
   § 19.  Subdivision 31 of section 364-j of the social services law,  as
 added  by  section  36-b of part B of chapter 57 of the laws of 2015, is
 amended to read as follows:
   31. [(a)] The commissioner shall require managed care providers  under
 this section, [managed long-term care plans]  A PACE OR MAP PLAN AS SUCH
 TERMS ARE DEFINED under section forty-four hundred three-f OF the public
 health  law  and  other  appropriate long-term service programs to adopt
 expedited procedures for approving personal care services for a  medical
 assistance  recipient  who  requires immediate personal care or consumer
 directed personal assistance  services  pursuant  to  paragraph  (e)  of
 subdivision  two  of section three hundred sixty-five-a of this title or
 section three hundred sixty-five-f of this title, respectively, or other
 long-term care, and provide such care or services as appropriate,  pend-
 ing approval by such provider or program.
   § 20. Paragraphs (a) and (c) of subdivision 32 of section 364-j of the
 social  services  law, as amended by section 1 of part KKK of chapter 56
 of the laws of 2020, are amended to read as follows:
   (a) The commissioner, or for the  purposes  of  subparagraph  (iv)  of
 paragraph  (c)  of  this  subdivision, the Medicaid inspector general in
 consultation with the commissioner, may, in his or her discretion, apply
 penalties to managed care organizations  subject  to  this  section  and
 article  forty-four  of  the  public health law, including [managed long
 term care plans] A PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY SECTION
 FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH  LAW,  for  untimely  or
 inaccurate  submission  of  encounter data; provided however, no penalty
 shall be assessed if the managed care organization OR A PACE OR MAP PLAN
 submits, in good faith, timely and accurate data and a  material  amount
 of  such data is not successfully received by the department as a result
 of department system failures or technical issues that  are  beyond  the
 control of the managed care organization.
   (c)  (i)  Penalties  assessed  pursuant  to this subdivision against a
 managed care organization other than a  [managed  long  term  care  plan
 certified  pursuant  to]  PACE  OR MAP PLAN AS SUCH TERMS ARE DEFINED BY
 section forty-four hundred three-f of the public health law shall be  as
 follows:
   (A) for encounter data submitted or resubmitted past the deadlines set
 forth  in  the  model contract, the Medicaid capitated premiums shall be
 reduced by one-third percent; [and]
 A. 8470                            11
 
   (B) for incomplete or inaccurate encounter data, evaluated at a  cate-
 gory  of  service  level,  that fails to conform to department developed
 benchmarks for completeness and accuracy, the Medicaid capitated  premi-
 ums shall be reduced by one and one-third percent; and
   (C)  for  submitted data that results in a rejection rate in excess of
 ten percent of department  developed  volume  benchmarks,  the  Medicaid
 capitated premiums shall be reduced by one-third percent.
   (ii)  Penalties  assessed  pursuant to this [subdivisions] SUBDIVISION
 against a [managed] long term care [plan] OPTION certified  pursuant  to
 section  forty-four hundred three-f of the public health law shall be as
 follows:
   (A) for encounter data submitted or resubmitted past the deadlines set
 forth in the model contract, the Medicaid capitated  premiums  shall  be
 reduced by one-quarter percent;
   (B)  for incomplete or inaccurate encounter data, evaluated at a cate-
 gory of service level, that fails to  conform  to  department  developed
 benchmarks  for completeness and accuracy, the Medicaid capitated premi-
 ums shall be reduced by one percent; and
   (C) for submitted data that results in a rejection rate in  excess  of
 ten  percent  of  department  developed  volume benchmarks, the Medicaid
 capitated premiums shall be reduced by one-quarter percent.
   (iii) For incomplete or inaccurate encounter data, identified  in  the
 course  of  an  audit, investigation or review by the Medicaid inspector
 general, the Medicaid capitated premiums shall be reduced  by  an  addi-
 tional one percent.
   § 21. Paragraph (x) of subdivision (b) of section 364-jj of the social
 services  law,  as  amended by section 39 of part C of chapter 60 of the
 laws of 2014, is amended to read as follows:
   (x) in accordance with the recommendations of the joint advisory coun-
 cil established pursuant to section 13.40 of  the  mental  hygiene  law,
 advise  the  commissioners of health and developmental disabilities with
 respect to the oversight of DISCOs and of health  maintenance  organiza-
 tions  and  [managed]  long term care [plans] OPTIONS providing services
 authorized, funded, approved or certified by the office for people  with
 developmental disabilities, and review all managed care options provided
 to  persons  with developmental disabilities, including: the adequacy of
 support  for  habilitation  services;  the  record  of  compliance  with
 requirements  for person-centered planning, person-centered services and
 community integration; the  adequacy  of  rates  paid  to  providers  in
 accordance  with  the provisions of [paragraph 1 of] subdivision four of
 section forty-four hundred three of the  public  health  law,  paragraph
 (a-2)  of  subdivision  eight of section forty-four hundred three of the
 public health law or [paragraph (a-2) of subdivision twelve of]  section
 forty-four  hundred three-f of the public health law; and the quality of
 life, health, safety and community integration of persons with  develop-
 mental disabilities enrolled in managed care; and
   §  22.  Subdivision  6 of section 365-f of the social services law, as
 added by section 50 of part D of chapter 56 of  the  laws  of  2012,  is
 amended to read as follows:
   6.  Notwithstanding  any inconsistent provision of this section or any
 other contrary provision  of  law,  managed  care  programs  established
 pursuant  to  section  three  hundred  sixty-four-j  of  this  title and
 [managed] long term care [plans] OPTIONS  and  other  care  coordination
 models  established  pursuant to section [four thousand four] FORTY-FOUR
 hundred three-f of the public health law shall offer  consumer  directed
 personal assistance programs to enrollees.
 A. 8470                            12
 
   §  23.  Paragraph  (a) of subdivision 4 of section 365-h of the social
 services law, as amended by section 2 of part LL of chapter  56  of  the
 laws of 2020, is amended to read as follows:
   (a)  The commissioner of health is authorized to assume responsibility
 from a local social services official for the provision  and  reimburse-
 ment  of  transportation  costs  under this section. If the commissioner
 elects to assume such responsibility, the commissioner shall notify  the
 local  social  services official in writing as to the election, the date
 upon which the election shall be effective and such  information  as  to
 transition  of  responsibilities  as the commissioner deems prudent. The
 commissioner is authorized to contract with a transportation manager  or
 managers  to manage transportation services in any local social services
 district, other than transportation services provided  or  arranged  for
 enrollees  of  [managed  long  term  care  plans  issued certificates of
 authority under] A PACE OR MAP PLAN AS  DEFINED  BY  section  forty-four
 hundred  three-f of the public health law. Any transportation manager or
 managers selected by the commissioner to manage transportation  services
 shall  have proven experience in coordinating transportation services in
 a geographic and demographic area similar to the area in New York  state
 within which the contractor would manage the provision of services under
 this  section.  Such  a contract or contracts may include responsibility
 for: review, approval and processing of transportation  orders;  manage-
 ment  of  the  appropriate  level  of transportation based on documented
 patient medical need; and development of  new  technologies  leading  to
 efficient  transportation services. If the commissioner elects to assume
 such responsibility from a local social services district,  the  commis-
 sioner  shall examine and, if appropriate, adopt quality assurance meas-
 ures that may include, but are not limited to, global positioning track-
 ing system reporting requirements and service  verification  mechanisms.
 Any  and  all  reimbursement  rates developed by transportation managers
 under this subdivision shall be subject to the review  and  approval  of
 the commissioner.
   §  24.  Subparagraph (vi) of paragraph (b) of subdivision 4 of section
 365-h of the social services law, as added by section 2 of  part  LL  of
 chapter 56 of the laws of 2020, is amended to read as follows:
   (vi)  Responsibility  for transportation services provided or arranged
 for enrollees of [managed] long term care [plans issued certificates  of
 authority]  OPTIONS  under  section  forty-four  hundred  three-f of the
 public health law, not including a program designated as  a  Program  of
 All-Inclusive  Care  for  the  Elderly  (PACE)  as authorized by Federal
 Public law 1053-33, subtitle I of title IV of the Balanced Budget Act of
 1997, and, at the commissioner's discretion, other plans that  integrate
 benefits  for  dually eligible Medicare and Medicaid beneficiaries based
 on a demonstration by the plan that inclusion of  transportation  within
 the  benefit  package  will  result  in  cost  efficiencies  and quality
 improvement, shall be transferred to a transportation management  broker
 that  has a contract with the commissioner in accordance with this para-
 graph. Providers of adult day health care may elect to, but shall not be
 required to, use the services of the transportation management broker.
   § 25. Subdivision 14 of section 366 of the  social  services  law,  as
 amended  by  section  1 of part NN of chapter 57 of the laws of 2021, is
 amended to read as follows:
   14. The commissioner of health may make any  available  amendments  to
 the  state  plan  for  medical  assistance submitted pursuant to section
 three hundred sixty-three-a of this title, or, if an  amendment  is  not
 possible,  develop  and submit an application for any waiver or approval
 A. 8470                            13
 
 under the federal social security act that may be necessary to disregard
 or exempt an amount of income, for the purpose of assisting with housing
 costs, for individuals receiving coverage of nursing  facility  services
 under this title, other than short-term rehabilitation services, and for
 individuals  in receipt of medical assistance while in an adult home, as
 defined in subdivision twenty-five of section two of this chapter,  who:
 are  (i)  discharged to the community; and (ii) if eligible, enrolled or
 required to enroll and have initiated the  process  of  enrolling  in  a
 [plan  certified]  LONG  TERM CARE OPTION pursuant to section forty-four
 hundred three-f of the public health law; and  (iii)  do  not  meet  the
 criteria  to be considered an "institutionalized spouse" for purposes of
 section three hundred sixty-six-c of this title.
   § 26. This act shall take effect immediately; provided, however, that:
   (i) sections two, five, six, seven, eight, nine, ten, eleven,  twelve,
 thirteen,  fourteen,  fifteen,  sixteen,  seventeen, eighteen, nineteen,
 twenty, twenty-one, twenty-two, twenty-three,  twenty-four  and  twenty-
 five of this act shall take effect April 1, 2026.
   (ii) the amendments to paragraph (o) of subdivision 2 of section 365-a
 of  the  social  services law made by section five of this act shall not
 affect the expiration and/or repeal  of  such  paragraph  and  shall  be
 deemed to expire therewith;
   (iii)  the amendments to paragraph (h) of subdivision 3 of section 218
 of the elder law made by section eight of this act shall be  subject  to
 the  repeal  of  such  paragraph and shall expire and be deemed repealed
 therewith;
   (iv) the amendments to subparagraph (i) of paragraph (e)  of  subdivi-
 sion  3,  paragraphs  (b)  and (c) of subdivision 27, subdivision 31 and
 paragraphs (a) and (c) of subdivision 32 of section 364-j of the  social
 services  law  made by sections seventeen, eighteen, nineteen and twenty
 of this act shall be subject to the repeal of  such  section  and  shall
 expire and be deemed repealed therewith;
   (v)  the  amendments  to  paragraph  (x) of subdivision (b) of section
 364-jj of the social services law made by section twenty-one of this act
 shall be subject to the expiration of such section and shall expire  and
 be deemed repealed therewith; and
   (vi) the amendments to section 365-h  of  the social services law made
 by sections twenty-three and twenty-four of this act shall be subject to
 the  expiration  of such section and shall expire and be deemed repealed
 therewith.
   Effective immediately, the commissioner of health shall promulgate any
 rules and regulations and take steps, including requiring the submission
 of reports or surveys, submission and receipt of state plans, and neces-
 sary federal waivers, as may be necessary for the timely  implementation
 of this act on such effective date.