BILL NUMBER: S3108

SPONSOR: MANNION
 
TITLE OF BILL:

An act to amend the mental hygiene law, in relation to establishing the
independent developmental disability ombudsman program

 
PURPOSE:

The purpose of this bill is to create the independent developmental
disability ombudsman program.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of this bill would add a new section to the Mental Hygiene Law
to create the independent developmental disabilities ombudsman program.

Subdivision (a) of section 1 would establish the program and indicate it
will be selected by the NYS Office for People with Developmental Disa-
bilities (OPWDD). It also specifies it is intended to assist people with
developmental disabilities (DD) to ensure their access to services and
              

preserve their rights.

Subdivision (b) of section 1 would set out the duties of the program,
including but not limited to:

*establishing a service delivery structure based in New York state that
includes a toll-free telephone hotline, an interactive website, and
availability of in-person, telephone and email access to ombudsman
program staff or volunteers;

*identifying, investigating, referring and resolving complaints made by,
or on behalf of, individuals relative to their access to services
provided by OPWDD or the care coordination provided by their Care Coor-
dination Organization (CCO) or services provided by other providers;

*providing assistance navigating and completing processes, such as
paperwork and documentation to access services, and/or anyone seeking
assistance on their behalf;

*assisting individuals in filing and preparing appeals, and representing
individuals in appeals and hearings, concerning adverse benefit determi-
nations;

*collecting, tracking, and quantifying problems and inquires encountered
by individuals; and,

*educating individuals on their rights and responsibilities with respect
to access to services.

Subdivision (c) of section 1 would require that notice and materials
provided to individuals by OPWDD, CCO, and other providers of services
to include the name, phone number, and web address of the program.

Subdivision (d) of section 1 would establish stipulations, including
that:


*the funds for the program shall be distributed through a procurement
process conducted by OPWDD;

*only domestic, not-for-profit corporations are eligible to submit
proposals for this procurement;

*Entities that currently receive funding from OPWDD to provide services
to people with DD, or to operate CCO, or that bill the Medicaid program
for medical or healthcare services, shall be excluded from consider-
ation; and

*the OPWDD Commissioner will have discretion in the procurement process
and shall exercise a preference in favor of applicants who demonstrate
experience providing advocacy or assistance to people with intellectual
and developmental disabilities, experience operating a call center, and
experience tracking and reporting on case activities while protecting
individual confidentiality.

Section 2 of this bill provides that the effective date shall take
effect on the one hundred eightieth day after it shall have become a
law.

 
JUSTIFICATION:

People with developmental disabilities (DD), their. family members and
their advocates need individual assistance navigating the complex system
of services and care coordination intended to provide for their needs
and choices.

According to anecdotal reports, the Care Coordination Organizations
(CCOs), in place since 2018 to provide essential services previously
provided by the Medicaid Service Coordination (MSC) program, do not
universally operate in ways that allow people and their advocates to
successfully navigate the care coordination system. CCOs are charged
with assessing individual needs and wishes, helping individuals execute
a Life Plan, and ensuring Life Plans are successfully implemented.

People with I/DD deserve an independent avenue for addressing their
concerns. CCOs have internal mechanisms for addressing individual
concerns. In addition, the state has a network of regional offices
administered by the Office for People with Developmental Disabilities
(OPWDD), one function of which is to address individual issues that
arise with the CCOs. Neither the CCOs nor the state regional offices
adequately address people's concerns and are not independent. Such
issues may include (but are not limited to) failure of a care coordina-
tor to be responsive to individuals in their case load, individual
dissatisfaction with how their Life Plan is being implemented, failure
of the CCO to provide adequate training of care coordinators, and more.

This program would provide individual assistance to people with DD,
their family members and advocates; be available statewide; advise and
advocate on individual cases and concerns; and provide accessible educa-
tion on various aspects of state programs and CCO services.

Some advocacy and assistance programs for people with DD do currently
exist, but they are earmarked for specific reasons for specific popu-
lations, and they are not readily available statewide.  Independent
individual assistance services of this type are already available to
people enrolled in Managed Long Term Care (M LTC), Health and Recovery
Plans (HARP), and the Fully-Integrated Duals Advantage program for
people with I/DD (FIDA-IDD).

People need assistance services whether their services are moved to
managed care or not, and there are some people who are enrolled in
managed care on a voluntary basis who would benefit from these services.
Should managed care be implemented, assistance services related to
managed care could be integrated into an already-existing assistance
program.

 
PRIOR LEGISLATIVE HISTORY:

2021-22: S.8326-A (Mannion) - Passed Senate.

 
FISCAL IMPLICATIONS:

The estimated cost of creating this program is approximately $3 million.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law.