NY State Senate Bill 2023-S4622

Senate Bill S4622

2023-2024 Legislative Session

Provides for automatic enrollment and recertification simplification for Medicaid eligible recipients

download bill text pdf

Current Bill Status - On Floor Calendar

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 12, 2024	advanced to third reading
Feb 07, 2024	2nd report cal.
Feb 06, 2024	1st report cal.383
Jan 03, 2024	referred to health
May 23, 2023	print number 4622b
May 23, 2023	amend and recommit to finance print number 4622a
May 23, 2023	amend and recommit to finance
May 09, 2023	reported and committed to finance
Feb 13, 2023	referred to health

Votes

- Feb 6, 2024 - Health Committee Vote
  S4622
  
  10
  
  Aye
  
  2
  
  Nay
  
  3
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Feb 6, 2024
      
      aye (10)
      
      Brouk
      
      Felder
      
      Hoylman-Sigal
      
      Mannion
      
      May
      
      Myrie
      
      Rivera
      
      Salazar
      
      Thomas
      
      Webb
      
      nay (2)
      
      Gallivan
      
      Stec
      
      aye wr (3)
      
      Ashby
      
      Martins
      
      Rhoads
  May 9, 2023 - Health Committee Vote
  S4622
  
  10
  
  Aye
  
  3
  
  Nay
  
  2
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: May 9, 2023
      
      aye (10)
      
      Brouk
      
      Felder
      
      Hoylman-Sigal
      
      Mannion
      
      May
      
      Myrie
      
      Rivera
      
      Salazar
      
      Thomas
      
      Webb
      
      nay (3)
      
      Gallivan
      
      Rhoads
      
      Stec
      
      aye wr (2)
      
      Ashby
      
      Martins

Bill Amendments

Original

B (Active)

co-Sponsors

2023-S4622 - Details

Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L; amd §366-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S7523
2021-2022: S4965

2023-S4622 - Summary

Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.

2023-S4622 - Sponsor Memo

                                 
BILL NUMBER: S4622

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the social services law, in
relation to automatic enrollment and recertification simplification for
Medicaid eligible recipients

 
PURPOSE:

To shorten and simplify Medicaid long term care eligibility processes.

 
SUMMARY OF PROVISIONS:

Section 1 amends Public Health Law § 4403-f to enable auto-assignment in
a managed long term care plan when a person determined to be eligible
has not chosen a plan within the first 75 days of eligibility, and
extends that eligibility if auto-assignment is not completed within 75
days.

Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid

recertification process less burdensome and error-prone by allowing
attestation of resources that are unchanged or have diminished, and
providing automatic recertification for Managed Long Term Care (MLTC)
enrollees, mainstream managed care members receiving personal care
services, enrollees in the Aged, Blind, and Disabled Category without
excess income and Medicare Savings Program recipients.

Section 4 provides for the effective date.

 
JUSTIFICATION:

People who have successfully applied for Medicaid in order to enroll in
a MLTC plan face many hurdles and delays before they are effectively
enrolled. First, an in-home eligibility assessment by a nurse can take
several weeks to schedule and this assessment is valid for only 75 days.

After that assessment is completed, the Medicaid recipient will schedule
in-home assessments with prospective MTLC plans to determine the level
of care each will provide. It can take several weeks to schedule and
complete those visits. Once the recipient agrees to a plan, the plan
will process enrollment, which is effective either the first of the
following month, or, if it is already after the 18th, effective the
first of the month after the following month. If 75 days have lapsed,
the process restarts at the beginning, resulting in care delays.

Currently, Medicaid recipients complete a mail renewal form, attesting
to their income, once a year in order to continue to receive health care
coverage. This is true even if the recipient is on a fixed income. The
recertification process is so prone to errors that it frequently results
in a discontinuance of eligibility. The recipient may not receive the
discontinuance notice on time or at all, or may not be able to request a
fair hearing within 10 days, which automatically triggers disenrollment.
In 2011, the Medicaid program recognized the problems and initiated a
demonstration program to automate renewals for Aged, Blind and Disabled
Medicaid recipients with fixed incomes. This bill extends the benefits
of that demonstration to the rest of the program.

 
LEGISLATIVE HISTORY:

2022: S4965 (Rivera) - Passed Senate

2021: S4965 (Rivera) - Passed Senate

2020: S7523 (Rivera) - Advanced to 3rd Reading

2019: S5485-A (Rivera) - Vetoed

 
FISCAL IMPLICATIONS:

None noted

 
EFFECTIVE DATE:
180 days after enactment.

2023-S4622 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4622
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 13, 2023
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation  to  automatic  enrollment and recertification simplification
   for Medicaid eligible recipients

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (b)  of subdivision 7 of section 4403-f of the
 public health law is amended by adding a new subparagraph (iv)  to  read
 as follows:
   (IV) WHERE A PERSON DETERMINED ELIGIBLE FOR MEDICAID ("MEDICAID RECIP-
 IENT") HAS BEEN DETERMINED BY THE COMMISSIONER OR HIS OR HER DESIGNEE TO
 REQUIRE  COMMUNITY-BASED LONG TERM CARE SERVICES FOR MORE THAN A CONTIN-
 UOUS PERIOD OF ONE HUNDRED TWENTY DAYS, AND THE MEDICAID  RECIPIENT  HAS
 NOT  SELECTED AND ENROLLED IN A MANAGED LONG TERM CARE PLAN PRIOR TO ANY
 EXPIRATION DATE OF SUCH DETERMINATION OF NEED FOR LONG TERM CARE,  AFTER
 BEING  PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE, THE COMMIS-
 SIONER SHALL ASSIGN THE RECIPIENT TO A  MANAGED  LONG  TERM  CARE  PLAN,
 TAKING  INTO  ACCOUNT  CONSISTENCY WITH ANY PRIOR COMMUNITY-BASED DIRECT
 CARE WORKERS HAVING RECENTLY SERVED THE RECIPIENT,  QUALITY  PERFORMANCE
 CRITERIA,  CAPACITY, AND GEOGRAPHIC ACCESSIBILITY.  THE COMMISSIONER MAY
 ASSIGN PARTICIPANTS PURSUANT TO SUCH CRITERIA ON A WEIGHTED  BASIS.    A
 RECIPIENT  ASSIGNED TO A MANAGED LONG TERM CARE PLAN UNDER THIS SUBPARA-
 GRAPH SHALL BE DEEMED TO HAVE BEEN DETERMINED TO BE IN NEED OF LONG TERM
 CARE SERVICES FOR MORE THAN A CONTINUOUS PERIOD OF  ONE  HUNDRED  TWENTY
 DAYS AND ELIGIBLE TO BE ENROLLED IN A MANAGED LONG TERM CARE PLAN.
   §  2.  Paragraph  (b)  of subdivision 2 of section 366-a of the social
 services law, as added by section 51 of part A of chapter 1 of the  laws
 of 2002, is amended to read as follows:
   (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
 sion, an applicant or recipient may attest to the amount of his  or  her
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02420-01-3

 S. 4622                             2
 
 accumulated  resources,  unless  such  applicant or recipient is seeking
 medical assistance payment for long term care  services  FOR  THE  FIRST
 TIME.  A  RECIPIENT  WHO HAS ALREADY PROVIDED DOCUMENTATION OF RESOURCES
 MAY ATTEST TO THE AMOUNT OF ACCUMULATED RESOURCES IF IT HAS REMAINED THE
 SAME  OR IS LESS THAN THE AMOUNT ORIGINALLY DOCUMENTED.  For purposes of
 this paragraph, long term care  services  shall  mean  care,  treatment,
 maintenance,  and services described in paragraph (b) of subdivision [1]
 ONE of section three hundred  sixty-seven-f  of  this  title,  with  the
 exception  of  short term rehabilitation, as defined by the commissioner
 of health.
   § 3. Paragraph (d) of subdivision 5 of section  366-a  of  the  social
 services  law,  as  amended by section 12 of part D of chapter 56 of the
 laws of 2013, is relettered paragraph (e) and three new paragraphs  (f),
 (g) and (h) are added to read as follows:
   (F)  NOTWITHSTANDING  PARAGRAPH (B) OF SUBDIVISION TWO OF THIS SECTION
 AND PARAGRAPHS (A), (B), (C) AND (D) OF THIS SUBDIVISION, THE  FOLLOWING
 RECIPIENTS  WILL  BE  RECERTIFIED AUTOMATICALLY, UNLESS THERE HAS BEEN A
 FINDING OF LACK OF ELIGIBILITY FOR MEDICAID:
   (I) ENROLLEES IN MEDICAID MANAGED LONG TERM CARE PLANS AS  DEFINED  IN
 SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW;
   (II)  ENROLLEES  IN  MEDICAID MANAGED CARE PLANS AS DEFINED IN SECTION
 THREE HUNDRED SIXTY-FOUR-J OF  THIS  TITLE  WHO  RECEIVE  PERSONAL  CARE
 SERVICES  PURSUANT  TO PARAGRAPH (E) OF SUBDIVISION TWO OF SECTION THREE
 HUNDRED SIXTY-FIVE-A OF THIS TITLE OR CONSUMER DIRECTED PERSONAL ASSIST-
 ANCE SERVICES PURSUANT TO SECTION THREE  HUNDRED  SIXTY-FIVE-F  OF  THIS
 TITLE;
   (III)  ENROLLEES  RECEIVING  MEDICAID  IN THE AGED, BLIND AND DISABLED
 CATEGORY WHO RECEIVE FIXED INCOME  FROM  THE  SOCIAL  SECURITY  ADMINIS-
 TRATION (SSA); AND
   (IV) MEDICARE SAVINGS PROGRAM (MSP) RECIPIENTS WHO HAVE A FIXED INCOME
 FROM THE SOCIAL SECURITY ADMINISTRATION (SSA).
   (G)  NOTHING  IN PARAGRAPH (E) OF THIS SUBDIVISION SHOULD BE CONSTRUED
 TO ALTER A MEDICAID RECIPIENT'S OBLIGATION TO INFORM THE PUBLIC  WELFARE
 DISTRICT  OF CHANGES IN INCOME OR OTHER FACTORS THAT MIGHT IMPACT ELIGI-
 BILITY PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
   (H) UPON A FINDING OF LACK OF ELIGIBILITY,  RECIPIENTS  IDENTIFIED  IN
 PARAGRAPH (E) OF THIS SUBDIVISION WILL BE ENTITLED TO NOTICE AND HEARING
 RIGHTS AS PROVIDED IN SECTION TWENTY-TWO OF THIS CHAPTER.
   § 4. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become a law; provided that the amendments to paragraph
 (b) of subdivision 7 of section 4403-f of the public health law made  by
 section one of this act shall be subject to the expiration and reversion
 of  such paragraph and shall expire and be deemed repealed therewith and
 provided further that such amendments shall not  affect  the  repeal  of
 such  section  and shall expire and be deemed repealed therewith. Effec-
 tive immediately, the commissioner of health shall make regulations  and
 take  other  actions  reasonably necessary to implement this act on that
 date.

co-Sponsors

2023-S4622A - Details

Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L; amd §366-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S7523
2021-2022: S4965

2023-S4622A - Summary

Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.

2023-S4622A - Sponsor Memo

                                 
BILL NUMBER: S4622A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the social services law, in
relation to automatic enrollment and recertification simplification for
Medicaid eligible recipients

 
PURPOSE:

To shorten and simplify Medicaid long term care eligibility processes.

 
SUMMARY OF PROVISIONS:

Section 1 amends Public Health Law § 4403-f to enable auto-assignment in
a managed long term care plan when a person determined to be eligible
has not chosen a plan within the first 75 days of eligibility, and
extends that eligibility if auto-assignment is not completed within 75
days.

Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid

recertification process less burdensome and error-prone by allowing
attestation of resources that are unchanged or have diminished, and
providing automatic recertification for Managed Long Term Care (MLTC)
enrollees, mainstream managed care members receiving personal care
services, enrollees in the Aged, Blind, and Disabled Category without
excess income and Medicare Savings Program recipients. These provisions
would be subject to federal financial participation.

Section 4 provides for the effective date.

 
JUSTIFICATION:

People who have successfully applied for Medicaid in order to enroll in
a MLTC plan face many hurdles and delays before they are effectively
enrolled. First, an in-home eligibility assessment by a nurse can take
several weeks to schedule and this assessment is valid for only 75 days.

After that assessment is completed, the Medicaid recipient will schedule
in-home assessments with prospective MTLC plans to determine the level
of care each will provide. It can take several weeks to schedule and
complete those visits. Once the recipient agrees to a plan, the plan
will process enrollment, which is effective either the first of the
following month, or, if it is already after the 18th, effective the
first of the month after the following month. If 75 days have lapsed,
the process restarts at the beginning, resulting in care delays.

Currently, Medicaid recipients complete a mail renewal form, attesting
to their income, once a year in order to continue to receive health care
coverage. This is true even if the recipient is on a fixed income. The
recertification process is so prone to errors that it frequently results
in a discontinuance of eligibility. The recipient may not receive the
discontinuance notice on time or at all, or may not be able to request a
fair hearing within 10 days, which automatically triggers disenrollment.
In 2011, the Medicaid program recognized the problems and initiated a
demonstration program to automate renewals for Aged, Blind and Disabled
Medicaid recipients with fixed incomes. This bill extends the benefits
of that demonstration to the rest of the program.
 
LEGISLATIVE HISTORY:

2022: S4965 (Rivera) - Passed Senate

2021: S4965 (Rivera) - Passed Senate

2020: S7523 (Rivera) - Advanced to 3rd Reading

2019: S5485-A (Rivera) - Vetoed

 
FISCAL IMPLICATIONS:

None noted

 
EFFECTIVE DATE:
This act shall take effect 180 days after it becomes law. Sections 2 and
3 will be subjected to federal financial participation, therefore, these
sections will not take effect until the federal center for Medicaid and
Medicare services (CMS) approves in writing to the state commissioner
that the changes do not affect eligibility requirements and federal
participation is not affected.

2023-S4622A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4622--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 13, 2023
                                ___________
 
 Introduced  by  Sens. RIVERA, MAY -- read twice and ordered printed, and
   when printed to be committed to the Committee on  Health  --  reported
   favorably  from  said  committee  and  committed  to  the Committee on
   Finance -- committee discharged, bill amended,  ordered  reprinted  as
   amended and recommitted to said committee

 AN  ACT  to  amend the public health law and the social services law, in
   relation to automatic enrollment  and  recertification  simplification
   for Medicaid eligible recipients
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (b) of subdivision 7 of  section  4403-f  of  the
 public  health  law is amended by adding a new subparagraph (iv) to read
 as follows:
   (IV) WHERE A PERSON DETERMINED ELIGIBLE FOR MEDICAID ("MEDICAID RECIP-
 IENT") HAS BEEN DETERMINED BY THE COMMISSIONER OR HIS OR HER DESIGNEE TO
 REQUIRE COMMUNITY-BASED LONG TERM CARE SERVICES FOR MORE THAN A  CONTIN-
 UOUS  PERIOD  OF ONE HUNDRED TWENTY DAYS, AND THE MEDICAID RECIPIENT HAS
 NOT SELECTED AND ENROLLED IN A MANAGED LONG TERM CARE PLAN PRIOR TO  ANY
 EXPIRATION  DATE OF SUCH DETERMINATION OF NEED FOR LONG TERM CARE, AFTER
 BEING PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE, THE  COMMIS-
 SIONER  SHALL  ASSIGN  THE  RECIPIENT  TO A MANAGED LONG TERM CARE PLAN,
 TAKING INTO ACCOUNT CONSISTENCY WITH ANY  PRIOR  COMMUNITY-BASED  DIRECT
 CARE  WORKERS  HAVING RECENTLY SERVED THE RECIPIENT, QUALITY PERFORMANCE
 CRITERIA, CAPACITY, AND GEOGRAPHIC ACCESSIBILITY.  THE COMMISSIONER  MAY
 ASSIGN  PARTICIPANTS  PURSUANT  TO SUCH CRITERIA ON A WEIGHTED BASIS.  A
 RECIPIENT ASSIGNED TO A MANAGED LONG TERM CARE PLAN UNDER THIS  SUBPARA-
 GRAPH SHALL BE DEEMED TO HAVE BEEN DETERMINED TO BE IN NEED OF LONG TERM
 CARE  SERVICES  FOR  MORE THAN A CONTINUOUS PERIOD OF ONE HUNDRED TWENTY
 DAYS AND ELIGIBLE TO BE ENROLLED IN A MANAGED LONG TERM CARE PLAN.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02420-03-3
 S. 4622--A                          2

   § 2. Paragraph (b) of subdivision 2 of section  366-a  of  the  social
 services  law, as added by section 51 of part A of chapter 1 of the laws
 of 2002, is amended to read as follows:
   (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
 sion, an applicant or recipient may attest to the amount of his  or  her
 accumulated  resources,  unless  such  applicant or recipient is seeking
 medical assistance payment for long term care  services  FOR  THE  FIRST
 TIME.  A  RECIPIENT  WHO HAS ALREADY PROVIDED DOCUMENTATION OF RESOURCES
 MAY ATTEST TO THE AMOUNT OF ACCUMULATED RESOURCES IF IT HAS REMAINED THE
 SAME OR IS LESS THAN THE AMOUNT ORIGINALLY DOCUMENTED.  For purposes  of
 this  paragraph,  long  term  care  services shall mean care, treatment,
 maintenance, and services described in paragraph (b) of subdivision  [1]
 ONE  of  section  three  hundred  sixty-seven-f  of this title, with the
 exception of short term rehabilitation, as defined by  the  commissioner
 of health.
   §  3.  Paragraph  (d)  of subdivision 5 of section 366-a of the social
 services law, as amended by section 12 of part D of chapter  56  of  the
 laws  of 2013, is relettered paragraph (e) and three new paragraphs (f),
 (g) and (h) are added to read as follows:
   (F) NOTWITHSTANDING PARAGRAPH (B) OF SUBDIVISION TWO OF  THIS  SECTION
 AND  PARAGRAPHS (A), (B), (C) AND (D) OF THIS SUBDIVISION, THE FOLLOWING
 RECIPIENTS WILL BE RECERTIFIED AUTOMATICALLY, UNLESS THERE  HAS  BEEN  A
 FINDING OF LACK OF ELIGIBILITY FOR MEDICAID:
   (I)  ENROLLEES  IN MEDICAID MANAGED LONG TERM CARE PLANS AS DEFINED IN
 SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW;
   (II) ENROLLEES IN MEDICAID MANAGED CARE PLANS AS  DEFINED  IN  SECTION
 THREE  HUNDRED  SIXTY-FOUR-J  OF  THIS  TITLE  WHO RECEIVE PERSONAL CARE
 SERVICES PURSUANT TO PARAGRAPH (E) OF SUBDIVISION TWO OF  SECTION  THREE
 HUNDRED SIXTY-FIVE-A OF THIS TITLE OR CONSUMER DIRECTED PERSONAL ASSIST-
 ANCE  SERVICES  PURSUANT  TO  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS
 TITLE;
   (III) ENROLLEES RECEIVING MEDICAID IN THE  AGED,  BLIND  AND  DISABLED
 CATEGORY  WHO  RECEIVE  FIXED  INCOME  FROM THE SOCIAL SECURITY ADMINIS-
 TRATION (SSA); AND
   (IV) MEDICARE SAVINGS PROGRAM (MSP) RECIPIENTS WHO HAVE A FIXED INCOME
 FROM THE SOCIAL SECURITY ADMINISTRATION (SSA).
   (G) NOTHING IN PARAGRAPH (E) OF THIS SUBDIVISION SHOULD  BE  CONSTRUED
 TO  ALTER A MEDICAID RECIPIENT'S OBLIGATION TO INFORM THE PUBLIC WELFARE
 DISTRICT OF CHANGES IN INCOME OR OTHER FACTORS THAT MIGHT IMPACT  ELIGI-
 BILITY PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
   (H)  UPON  A  FINDING OF LACK OF ELIGIBILITY, RECIPIENTS IDENTIFIED IN
 PARAGRAPH (E) OF THIS SUBDIVISION WILL BE ENTITLED TO NOTICE AND HEARING
 RIGHTS AS PROVIDED IN SECTION TWENTY-TWO OF THIS CHAPTER.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided that the  amendments  to  paragraph
 (b)  of subdivision 7 of section 4403-f of the public health law made by
 section one of this act shall be subject to the expiration and reversion
 of such paragraph and shall expire and be deemed repealed therewith  and
 provided  further  that  such  amendments shall not affect the repeal of
 such section and shall expire and be deemed repealed  therewith.  Effec-
 tive  immediately, the commissioner of health shall make regulations and
 take other actions reasonably necessary to implement this  act  on  that
 date.  Provided,  further, that sections two and three of this act shall
 only take effect when the  federal  center  for  Medicaid  and  Medicare
 services  (CMS)  approves in writing to the state commissioner of health
 that the changes do not affect  eligibility requirements and that feder-
 S. 4622--A                          3
 
 al financial participation is not affected; provided  that  the  commis-
 sioner  of  health shall notify the legislative bill drafting commission
 upon the occurrence of the enactment of the legislation provided for  in
 sections  two  and  three  of  this act in order that the commission may
 maintain an accurate and timely effective data base of the official text
 of the laws of the state of New York in furtherance of effectuating  the
 provisions  of section 44 of the legislative law and section 70-b of the
 public officers law.

co-Sponsors

2023-S4622B (ACTIVE) - Details

Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L; amd §366-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S7523
2021-2022: S4965

2023-S4622B (ACTIVE) - Summary

Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.

2023-S4622B (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S4622B

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the social services law, in
relation to automatic enrollment and recertification simplification for
Medicaid eligible recipients

 
PURPOSE:

To shorten and simplify Medicaid long term care eligibility processes.

 
SUMMMARY OF PROVISIONS:

Section 1 amends Public Health Law § 4403-f to enable auto-assignment in
a managed long term care plan when a person determined to be eligible
has not chosen a plan within the first 75 days of eligibility, and
extends that eligibility if auto-assignment is not completed within 75
days.

Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid

recertification process less burdensome and error-prone by allowing
attestation of resources that are unchanged or have diminished, and
providing automatic recertification for Managed Long Term Care (MLTC)
enrollees, mainstream managed care members receiving personal care
services, enrollees in the Aged, Blind, and Disabled Category without
excess income and Medicare Savings Program recipients. These provisions
would be subject to federal financial participation.

Section 4 provides for the effective date.

 
JUSTIFICATION:

People who have successfully applied for Medicaid in order to enroll in
a MLTC plan face many hurdles and delays before they are effectively
enrolled. First, an in-home eligibility assessment by a nurse can take
several weeks to schedule and this assessment is valid for only 75 days.

After that assessment is completed, the Medicaid recipient will schedule
in-home assessments with prospective MTLC plans to determine the level
of care each will provide. It can take several weeks to schedule and
complete those visits. Once the recipient agrees to a plan, the plan
will process enrollment, which is effective either the first of the
following month, or, if it is already after the 18th, effective the
first of the month after the following month. If 75 days have lapsed,
the process restarts at the beginning, resulting in care delays.

Currently, Medicaid recipients complete a mail renewal form, attesting
to their income, once a year in order to continue to receive health care
coverage. This is true even if the recipient is on a fixed income. The
recertification process is so prone to errors that it frequently results
in a discontinuance of eligibility. The recipient may not receive the
discontinuance notice on time or at all, or may not be able to request a
fair hearing within 10 days, which automatically triggers disenrollment.
In 2011, the Medicaid program recognized the problems and initiated a
demonstration program to automate renewals for Aged, Blind and Disabled
Medicaid recipients with fixed incomes. This bill extends the benefits
of that demonstration to the rest of the program.
 
LEGISLATIVE HISTORY:

2022: S4965 (Rivera) - Passed Senate

2021: S4965 (Rivera) - Passed Senate

2020: S7523 (Rivera) - Advanced to 3rd Reading

2019: S5485-A (Rivera) - Vetoed

 
FISCAL IMPLICATIONS:

None noted

 
EFFECTIVE DATE:
This act shall take effect 180 days after it becomes law. Sections 2 and
3 will be subjected to federal financial participation, therefore, these
sections will not take effect until the federal center for Medicaid and
Medicare services (CMS) approves in writing to the state commissioner
that the changes do not affect eligibility requirements and federal
participation is not affected.

2023-S4622B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4622--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 13, 2023
                                ___________
 
 Introduced  by  Sens. RIVERA, MAY -- read twice and ordered printed, and
   when printed to be committed to the Committee on  Health  --  reported
   favorably  from  said  committee  and  committed  to  the Committee on
   Finance -- committee discharged, bill amended,  ordered  reprinted  as
   amended  and  recommitted  to  said committee -- committee discharged,
   bill amended, ordered reprinted as amended  and  recommitted  to  said
   committee
 
 AN  ACT  to  amend the public health law and the social services law, in
   relation to automatic enrollment  and  recertification  simplification
   for Medicaid eligible recipients
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (b) of subdivision 7 of  section  4403-f  of  the
 public  health  law is amended by adding a new subparagraph (iv) to read
 as follows:
   (IV) WHERE A PERSON DETERMINED ELIGIBLE FOR MEDICAID ("MEDICAID RECIP-
 IENT") HAS BEEN DETERMINED BY THE COMMISSIONER OR HIS OR HER DESIGNEE TO
 REQUIRE COMMUNITY-BASED LONG TERM CARE SERVICES FOR MORE THAN A  CONTIN-
 UOUS  PERIOD  OF ONE HUNDRED TWENTY DAYS, AND THE MEDICAID RECIPIENT HAS
 NOT SELECTED AND ENROLLED IN A MANAGED LONG TERM CARE PLAN PRIOR TO  ANY
 EXPIRATION  DATE OF SUCH DETERMINATION OF NEED FOR LONG TERM CARE, AFTER
 BEING PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE, THE  COMMIS-
 SIONER  SHALL  ASSIGN  THE  RECIPIENT  TO A MANAGED LONG TERM CARE PLAN,
 TAKING INTO ACCOUNT CONSISTENCY WITH ANY  PRIOR  COMMUNITY-BASED  DIRECT
 CARE  WORKERS  HAVING RECENTLY SERVED THE RECIPIENT, QUALITY PERFORMANCE
 CRITERIA, CAPACITY, AND GEOGRAPHIC ACCESSIBILITY.  THE COMMISSIONER  MAY
 ASSIGN  PARTICIPANTS  PURSUANT  TO SUCH CRITERIA ON A WEIGHTED BASIS.  A
 RECIPIENT ASSIGNED TO A MANAGED LONG TERM CARE PLAN UNDER THIS  SUBPARA-
 GRAPH SHALL BE DEEMED TO HAVE BEEN DETERMINED TO BE IN NEED OF LONG TERM
 CARE  SERVICES  FOR  MORE THAN A CONTINUOUS PERIOD OF ONE HUNDRED TWENTY
 DAYS AND ELIGIBLE TO BE ENROLLED IN A MANAGED LONG TERM CARE PLAN.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02420-05-3

 S. 4622--B                          2
 
   § 2. Paragraph (b) of subdivision 2 of section  366-a  of  the  social
 services  law, as added by section 51 of part A of chapter 1 of the laws
 of 2002, is amended to read as follows:
   (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
 sion, an applicant or recipient may attest to the amount of his  or  her
 accumulated  resources,  unless  such  applicant or recipient is seeking
 medical assistance payment for long term care  services  FOR  THE  FIRST
 TIME.  A  RECIPIENT  WHO HAS ALREADY PROVIDED DOCUMENTATION OF RESOURCES
 MAY ATTEST TO THE AMOUNT OF ACCUMULATED RESOURCES IF IT HAS REMAINED THE
 SAME OR IS LESS THAN THE AMOUNT ORIGINALLY DOCUMENTED.  For purposes  of
 this  paragraph,  long  term  care  services shall mean care, treatment,
 maintenance, and services described in paragraph (b) of subdivision  [1]
 ONE  of  section  three  hundred  sixty-seven-f  of this title, with the
 exception of short term rehabilitation, as defined by  the  commissioner
 of health.
   §  3.  Paragraph  (d)  of subdivision 5 of section 366-a of the social
 services law, as amended by section 12 of part D of chapter  56  of  the
 laws  of 2013, is relettered paragraph (e) and three new paragraphs (f),
 (g) and (h) are added to read as follows:
   (F) NOTWITHSTANDING PARAGRAPH (B) OF SUBDIVISION TWO OF  THIS  SECTION
 AND  PARAGRAPHS (A), (B), (C) AND (D) OF THIS SUBDIVISION, THE FOLLOWING
 RECIPIENTS WILL BE RECERTIFIED AUTOMATICALLY, UNLESS THERE  HAS  BEEN  A
 FINDING OF LACK OF ELIGIBILITY FOR MEDICAID:
   (I)  ENROLLEES  IN MEDICAID MANAGED LONG TERM CARE PLANS AS DEFINED IN
 SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW;
   (II) ENROLLEES IN MEDICAID MANAGED CARE PLANS AS  DEFINED  IN  SECTION
 THREE  HUNDRED  SIXTY-FOUR-J  OF  THIS  TITLE  WHO RECEIVE PERSONAL CARE
 SERVICES PURSUANT TO PARAGRAPH (E) OF SUBDIVISION TWO OF  SECTION  THREE
 HUNDRED SIXTY-FIVE-A OF THIS TITLE OR CONSUMER DIRECTED PERSONAL ASSIST-
 ANCE  SERVICES  PURSUANT  TO  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS
 TITLE;
   (III) ENROLLEES RECEIVING MEDICAID IN THE  AGED,  BLIND  AND  DISABLED
 CATEGORY  WHO  RECEIVE  FIXED  INCOME  FROM THE SOCIAL SECURITY ADMINIS-
 TRATION (SSA); AND
   (IV) MEDICARE SAVINGS PROGRAM (MSP) RECIPIENTS WHO HAVE A FIXED INCOME
 FROM THE SOCIAL SECURITY ADMINISTRATION (SSA).
   (G) NOTHING IN PARAGRAPH (E) OF THIS SUBDIVISION SHOULD  BE  CONSTRUED
 TO  ALTER A MEDICAID RECIPIENT'S OBLIGATION TO INFORM THE PUBLIC WELFARE
 DISTRICT OF CHANGES IN INCOME OR OTHER FACTORS THAT MIGHT IMPACT  ELIGI-
 BILITY PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
   (H)  UPON  A  FINDING OF LACK OF ELIGIBILITY, RECIPIENTS IDENTIFIED IN
 PARAGRAPH (E) OF THIS SUBDIVISION WILL BE ENTITLED TO NOTICE AND HEARING
 RIGHTS AS PROVIDED IN SECTION TWENTY-TWO OF THIS CHAPTER.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided that the  amendments  to  paragraph
 (b)  of subdivision 7 of section 4403-f of the public health law made by
 section one of this act shall be subject to the expiration and reversion
 of such paragraph and shall expire and be deemed repealed therewith  and
 provided  further  that  such  amendments shall not affect the repeal of
 such section and shall expire and be deemed repealed  therewith.  Effec-
 tive  immediately, the commissioner of health shall make regulations and
 take other actions reasonably necessary to implement this  act  on  that
 date.  Provided,  further, that sections two and three of this act shall
 only take effect when the  federal  center  for  Medicaid  and  Medicare
 services  (CMS)  approves in writing to the state commissioner of health
 that the changes do not affect federal financial participation; provided
 S. 4622--B                          3
 
 that the commissioner of health shall notify the legislative bill draft-
 ing commission upon the occurrence of the enactment of  the  legislation
 provided  for  in  sections  two and three of this act in order that the
 commission  may  maintain  an accurate and timely effective data base of
 the official text of the laws of the state of New York in furtherance of
 effectuating the provisions of section 44 of  the  legislative  law  and
 section 70-b of the public officers law.

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Senate Bill S4622

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Sponsored By

Gustavo Rivera

Current Bill Status - On Floor Calendar

Bill Amendments

co-Sponsors

Rachel May

2023-S4622 - Details

2023-S4622 - Summary

2023-S4622 - Sponsor Memo

2023-S4622 - Bill Text download pdf

co-Sponsors

Rachel May

2023-S4622A - Details

2023-S4622A - Summary

2023-S4622A - Sponsor Memo

2023-S4622A - Bill Text download pdf

co-Sponsors

Rachel May

2023-S4622B (ACTIVE) - Details

2023-S4622B (ACTIVE) - Summary

2023-S4622B (ACTIVE) - Sponsor Memo

2023-S4622B (ACTIVE) - Bill Text download pdf

Comments