NY State Senate Bill 2023-S9266

Senate Bill S9266

2023-2024 Legislative Session

Relates to certain data required in an annual report on the administration of managed long term care plans

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Current Bill Status - In Senate Committee Health Committee

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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 08, 2024	referred to health

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2023-S9266 (ACTIVE) - Details

See Assembly Version of this Bill:: A10176
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L

2023-S9266 (ACTIVE) - Summary

Requires certain data to be included in reports on the administration of managed long term care plans; changes reporting period to annually.

2023-S9266 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9266

SPONSOR: MAY
 
TITLE OF BILL:

An act to amend the public health law, in relation to data reporting
required on the administration of managed long term care plans

 
PURPOSE OR GENERAL IDEA OF BILL:

To promote greater transparency in the use of public funds by Managed
Long Term Care plans.

 
SUMMARY OF PROVISIONS:

Section 1: Amends the public health law's provisions governing Managed
Long Term Care plans to require greater transparency in the reporting
and sharing of data with the public about the utilization of each plan's
services, associated expenditures and usage rates by members, the types
of complaints and issues received by each plan, and metrics about timely
access to authorized services.

Section 2: sets the effective date.

 
JUSTIFICATION:

This bill would promote transparency concerning how MLTC plans spend
billions in public funds they receive as monthly premiums for each
member each year. MLTC plans already report extensive data to the
Department of Health every year that show how much they spend on each of
the services covered by MLTC plans - from personal care and CDPAP to
dental care, adult day care, and short-term nursing home care, and . how
many members receive each of these services. Plans also report, for each
type of home care, how many members receive the highest number of hours,
the lowest number of hours, and various ranges in between. This bill
would make that data publicly available, to improve accountability and
consumer choice by allowing them to compare plans.

Data would also be made public on how many appeals and complaints
members file challenging plans' denials of services, and the outcomes of
these appeals. This data should both enable better oversight by the
Department of Health and consumer choice.

With the severe shortage of home care workers, MLTC plans often delay
providing home care services they have authorized. Despite the recommen-
dation by the federal Medicaid agency CMS and the NYS Comptroller's
report that thousands of MLTC enrollees went without services, New York
has never instituted measures to track timely access to services. This
bill would adopt measures to track staffing capacity recommended by CMS
and make this data public. Armed with this data, the State as well as
the public can hold plans accountable for failing to provide timely
access.

Additionally, it has been reported that New York lags behind other
states in tracking how plans are performing in "rebalancing" long term
care, meaning how good a job they are doing in shifting long-term care
expenditures from nursing homes to community-based services.  If a plan
refuses to reinstate services for many of its enrollees who are ready
for discharge after a short-term stay in a rehabilitation facility,
those enrollees are "disenrolled" from the MLTC plan and become perma-
nent nursing home residents. This practice has increased since 2020,
when long-term nursing home care was "carved out" of the MLTC benefit.
Adopting some of the recommendations made by CMS, data would be made
public showing the rate of each plan's nursing home admissions, with the
percentage successfully discharged back to the community with MLTC
services reinstated versus the percentage who remained permanently in
the nursing home. Also, measures would track the extent to which each
MLTC plan is willing to enroll new members had been in a nursing home
prior to enrollment, accomplishing the goal of rebalancing long term
care. Tracking this data could become the basis for new quality measures
to reward plans for rebalancing success.

All of this data would he added to the existing reports by the Depart-
ment of Health, which would be increased from bi-annually to annually.
The data would also be available in an interactive format online, allow-
ing for comparisons between plans. This should not be burdensome as the
Department already makes much data available online in interactive
format at https://health.data.ny.gov/. Finally, the data would be avail-
able for each plan on a statewide basis and also separately for each
geographic region in which the plan operates.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPACT:

To be determined.

 
EFFECTIVE DATE:
Immediately.

2023-S9266 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9266
 
                             I N  S E N A T E
 
                                May 8, 2024
                                ___________
 
 Introduced  by  Sen.  MAY  --  read  twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law, in  relation  to  data  reporting
   required on the administration of 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. Subparagraph (ix) of paragraph  (b)  of  subdivision  7  of
 section  4403-f  of  the  public health law, as added by section 56-a of
 part D of chapter 56 of the laws of 2012 and as relettered by section  4
 of  part  B  of  chapter  57  of the laws of 2018, is amended to read as
 follows:
   (ix) (1) The commissioner shall report [biannually]  ANNUALLY  on  the
 implementation  of  this subdivision. The reports shall include, but not
 be limited to:
   (A) satisfaction of enrollees with care coordination/case  management;
 timeliness of care;
   (B)  service  utilization  data including changes in the level, hours,
 frequency, and types of services and providers;
   (C) enrollment data, including auto-assignment rates by plan;
   (D) quality data; and
   (E) continuity of care for participants as they move to  managed  long
 term care, with respect to community based and nursing home populations,
 including  pediatric  nursing  home  populations,  and medically fragile
 children being served by home care agencies  affiliated  with  pediatric
 nursing  homes  and  diagnostic  and treatment centers primarily serving
 medically fragile children.
   (2) THE FOLLOWING DATA SHALL BE INCLUDED  IN  THE  REPORT  UNDER  THIS
 SUBDIVISION AND SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE IN AN INTER-
 ACTIVE  FORMAT. TO THE EXTENT THE DATA SET FORTH IN THIS SUBPARAGRAPH IS
 NOT NOW REPORTED BY PLANS TO THE DEPARTMENT, PLANS SHALL BE REQUIRED  TO
 REPORT THIS DATA THROUGH A REPORTING MECHANISM THAT THE DEPARTMENT SHALL
 DEVELOP BY OCTOBER FIRST, TWO THOUSAND TWENTY-FOUR:
   (A)  STATEWIDE  AND  REGIONAL  SERVICE UTILIZATION DATA FOR EACH PLAN,
 WITH THE NUMBER AND PERCENTAGE OF "MEMBER MONTHS"  AUTHORIZED  FOR  EACH
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD15241-02-4
 S. 9266                             2
 
 RANGE  OF  HOURS PER MONTH AS REPORTED IN COST REPORTS FILED UNDER PARA-
 GRAPH (A) OF THIS SUBDIVISION, AND USING "MEMBER MONTHS" AS  DEFINED  IN
 THE  COST REPORTS, INCLUDING ALL REQUIRED EXHIBITS.   DATA SHALL INCLUDE
 THE  NUMBER  OF  MEMBER MONTHS FOR WHOM EACH TYPE OF SERVICE WAS AUTHOR-
 IZED, AND THE PERCENTAGE OF EACH PLAN'S TOTAL MEMBER  MONTHS  FOR  WHICH
 MEMBERS  WERE  AUTHORIZED  FOR  EACH OF THE RANGES OF HOURS PER MONTH OF
 EACH SERVICE.  THESE NUMBERS AND PERCENTAGES SHALL BE REPORTED SEPARATE-
 LY FOR EACH OF THE FOLLOWING SERVICES: PERSONAL CARE, CONSUMER  DIRECTED
 PERSONAL  CARE, PRIVATE DUTY NURSING AND HOME HEALTH SERVICES, AND SHALL
 BE REPORTED SEPARATELY FOR EACH REGION OF THE STATE IN  WHICH  THE  PLAN
 OPERATES AND ON A STATEWIDE BASIS;
   (B)  DATA  ON "PER MEMBER PER MONTH" EXPENDITURES BY MANAGED LONG TERM
 CARE PLAN,  AS REPORTED IN COST REPORTS FILED  UNDER  PARAGRAPH  (A)  OF
 THIS  SUBDIVISION,  INCLUDING  BUT NOT LIMITED TO, ADMINISTRATIVE COSTS,
 CASE MANAGEMENT, PERSONAL CARE, CONSUMER  DIRECTED  PERSONAL  ASSISTANCE
 PROGRAMS, HOME HEALTH CARE, PRIVATE DUTY NURSING, ADULT DAY HEALTH CARE,
 SOCIAL ADULT DAY, DENTAL CARE, VISION CARE, AUDIOLOGY, PODIATRY, MEDICAL
 SUPPLIES, DURABLE MEDICAL EQUIPMENT, PERSONAL EMERGENCY RESPONSE SYSTEM,
 HOME-DELIVERED  MEALS,    THE VARIOUS THERAPY AND REHAB SERVICES - PHYS-
 ICAL, OCCUPATIONAL AND SPEECH THERAPY, AND  NURSING  FACILITY  SERVICES.
 THE  REPORTS  SHALL  INCLUDE,  FOR EACH PLAN ON A STATEWIDE AND REGIONAL
 BASIS, A CALCULATION OF THE TOTAL PERCENTAGE OF ALL SERVICE EXPENDITURES
 EXPENDED FOR HOME AND COMMUNITY-BASED LONG TERM CARE  SERVICES  AND  THE
 PERCENTAGE  FOR  INSTITUTIONAL  LONG  TERM  CARE SERVICES, AND THE TOTAL
 NUMBER OF MEMBER MONTHS IN WHICH MEMBERS RECEIVED  HOME  AND  COMMUNITY-
 BASED  LONG  TERM CARE SERVICES AND THE NUMBER OF MEMBER MONTHS IN WHICH
 MEMBERS RECEIVED SOLELY INSTITUTIONAL SERVICES.    THE REPORTS SHALL  BE
 IN  AN  INTERACTIVE  FORMAT THAT ENABLES A COMPARISON BETWEEN PLANS ON A
 STATEWIDE BASIS AND FOR EACH REGION;
   (C) DATA ON PERSONAL CARE AND CONSUMER  DIRECTED  PERSONAL  ASSISTANCE
 PROGRAM  CONTRACTING,  INCLUDING  BUT  NOT  LIMITED  TO,  HOURS  OF CARE
 PROVIDED AND EXPENSES ALLOCATED BY CONTRACTED ENTITY;
   (D) THE TOTAL NUMBER OF COMPLAINTS, GRIEVANCES, PLAN APPEALS, EXTERNAL
 APPEALS, AND FAIR HEARINGS FOR EACH PLAN, BROKEN DOWN BY:
   (I) THE NUMBER AND PERCENTAGE OF CASES DECIDED  WHOLLY  IN  ENROLLEE'S
 FAVOR,  PARTIALLY  IN ENROLLEE'S FAVOR, WHOLLY AGAINST THE ENROLLEE, AND
 THE NUMBER STILL PENDING;
   (II) THE TYPE OF SERVICE INVOLVED IN THE COMPLAINT OR APPEAL; AND
   (III) THE ISSUE OF THE COMPLAINT OR APPEAL, INCLUDING DENIAL OF A  NEW
 SERVICE,  DENIAL  OF  AN  INCREASE IN A SERVICE, REDUCTION OF A SERVICE,
 TERMINATION OF A SERVICE, LATENESS, LACK OF STAFFING, OR OTHER ISSUE;
   (E)  METRICS TO TRACK TIMELY ACCESS TO AUTHORIZED SERVICES,  INCLUDING
 BUT NOT LIMITED TO:
   (I)  THE  NUMBER OF ENROLLEES WHOSE PLANS OF CARE ARE UNSTAFFED OR NOT
 FULLY STAFFED FOR PERIODS OF TIME THAT THE COMMISSIONER SHALL DETERMINE,
 FROM ONE DAY TO MORE THAN SIXTY DAYS, AND THE  TOTAL  NUMBER  OF  MEMBER
 DAYS PER MONTH FOR WHICH PLANS OF CARE ARE NOT FULLY STAFFED; AND
   (II)  THE WAIT TIME FOR PERSONAL CARE, CONSUMER DIRECTED PERSONAL CARE
 UNDER SECTION THREE HUNDRED-SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW,  OR
 PRIVATE DUTY NURSING SERVICES TO BE INITIATED AFTER AUTHORIZATION; AND
   (F)   METRICS TRACKING REBALANCING FROM INSTITUTIONAL CARE TO COMMUNI-
 TY-BASED CARE, INCLUDING:
   (I) FOR EACH PLAN, STATEWIDE AND BY REGION, THE RATE OF  ADMISSION  OF
 ENROLLEES FROM THE COMMUNITY TO NURSING FACILITIES;
   (II)  OF  EACH  PLAN'S  ENROLLEES  ADMITTED TO A NURSING FACILITY, THE
 PERCENTAGE SUCCESSFULLY DISCHARGED TO THE COMMUNITY,  MEANING  REMAINING
 S. 9266                             3

 IN  THE COMMUNITY FOR SIXTY DAYS OR MORE, AND THE PERCENTAGE DISENROLLED
 FROM THE PLAN PURSUANT TO CLAUSE THIRTEEN OF SUBPARAGRAPH (V)  OF  PARA-
 GRAPH (B) OF THIS SUBDIVISION  AND THE PERCENTAGE DISENROLLED BECAUSE OF
 DEATH OR FOR OTHER REASONS, CATEGORIZED BY LENGTH OF NURSING HOME STAY;
   (III)  THE  RATE  OF ENROLLMENT OF NEW ENROLLEES WHO, PRIOR TO ENROLL-
 MENT, WERE IN A NURSING HOME, BY LENGTH OF NURSING HOME STAY;
   (IV) THE RATE OF RE-ENROLLMENT OF ENROLLEES WHO HAD  BEEN  DISENROLLED
 FROM THE PLAN WITHIN THE PRIOR SIX MONTHS BECAUSE OF A LONG-TERM NURSING
 HOME STAY (UNDER CLAUSE THIRTEEN OF SUBPARAGRAPH (V) OF PARAGRAPH (B) OF
 THIS SUBDIVISION).
   (3)  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 standing  committee  on
 health,  the  chair  of  the  assembly health committee and the Medicaid
 Managed Care Advisory Review Panel upon availability of the report.  The
 initial  report  shall  be  provided  by  September  first, two thousand
 twelve. The reports shall be made available by each February first,  and
 September  first  thereafter.  Such  reports shall be formatted to allow
 comparisons between plans.
   (4) THE COMMISSIONER SHALL MAKE THE FINAL AUDITED VERSIONS OF ALL PAST
 ANNUAL MANAGED LONG TERM CARE COST REPORTS  AVAILABLE  FOR  DOWNLOAD  IN
 FULL IN CSV FORMAT ON THE DEPARTMENT'S WEBSITE, AND SHALL MAKE THE FINAL
 AUDITED  VERSIONS  OF ALL FUTURE ANNUAL COST REPORTS AVAILABLE FOR DOWN-
 LOAD WITHIN THIRTY DAYS OF COMPLETION OF THE FINAL AUDITED REPORT.
   § 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 to repeal therewith; and provided, further, 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 not affect
 the expiration of such paragraph and shall expire therewith.

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Senate Bill S9266

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Sponsored By

Rachel May