NY State Senate Bill 2015-S379A

Archive: Last 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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 24, 2016	print number 379a
May 24, 2016	amend and recommit to health
Jan 06, 2016	referred to health
Jan 07, 2015	referred to health

Bill Amendments

Original

A (Active)

2015-S379 - Details

See Assembly Version of this Bill:: A414
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§4403-f, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S6583, A3781
2017-2018: S1098, A2358, A5947
2019-2020: A2406, A2797
2021-2022: A6034

2015-S379 - Summary

Relates to prohibiting ownership or control of managed long term care plans by health maintenance organizations or insurers.

2015-S379 - Sponsor Memo

                                 BILL NUMBER:  S379

 TITLE OF BILL :  An act to amend the public health law, in relation
to managed long term care plans not being controlled or owned by
for-profit health maintenance organizations or insurers

 PURPOSE OR GENERAL IDEA OF BILL :

To assure that managed long term care plans are primarily owned by not
for profit providers or service entities, to promote best practices
consistent with the interests of the recipient.

 SUMMARY OF SPECIFIC PROVISIONS :

Amends the definition of "eligible applicant" for certification as a
managed long, term care (MLTC) plan to require eligible insurers and
health maintenance organizations be not-for-profit. An exception would
recognize entities already certified.  The bill clarifies that an
MLTC, or other lawful combinations of long term care providers can
participate in accountable care organizations.

 JUSTIFICATION :

Medicaid long term care (over 120 days) has been reformed to be
delivered by care coordination entities, predominantly through
risk-bearing managed long term care plans. Currently, this transition

is applied to home and community-based services, with institutional
(nursing home) care contemplated to be phased in.

MLTCs have, until now been almost exclusively entities owned by long
term care providers, not by HMOs or insurance companies. When
participation in an MLTC was voluntary, there was little concern that
insurance carriers would enter the field. However, now participation
in an MLTC is mandatory for many and will become mandatory for more
long term care recipients. There is growing interest by for-profit
HMOs and insurance companies in forming MLTCs. With their economic
resources they could easily come to dominate the field. So there is
growing concern that patients may ultimately have no choice but to
enroll in for-profit insurance carrier-owned MLTCs.

The individuals affected by this transition are primarily those with
chronic conditions, many who are elderly or otherwise affected with
life-limiting illness. Care and service decisions for these
individuals should not be measured against profit margins of
shareholders. Other states' experience in this area has proven that
provider-based MLTCs, which most all of New York MLTCs currently are,
deliver both the quality and the savings expected.

 PRIOR LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.

2015-S379 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   379

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

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, in relation to managed long  term
  care  plans not being controlled or owned by for-profit health mainte-
  nance organizations or insurers

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  (b)  of subdivision 1 of section 4403-f of the
public health law, as added by chapter 659  of  the  laws  of  1997,  is
amended to read as follows:
  (b) "Eligible applicant" means an entity controlled or wholly owned by
one  or  more of the following: a hospital as defined in subdivision one
of section twenty-eight hundred one of this chapter; a home care  agency
licensed  or  certified  pursuant to article thirty-six of this chapter;
[an] A NOT-FOR-PROFIT entity that has received a certificate of authori-
ty pursuant to sections forty-four  hundred  three,  forty-four  hundred
three-a or AN INTEGRATED DELIVERY SYSTEM THAT HAS RECEIVED A CERTIFICATE
OF  AUTHORITY  PURSUANT  TO  SECTION  forty-four hundred eight-a of this
article (as added by chapter six hundred  thirty-nine  of  the  laws  of
nineteen  hundred  ninety-six),  or  a NOT-FOR-PROFIT health maintenance
organization authorized under article forty-three of the insurance  law;
or  a  not-for-profit  organization  which has a history of providing or
coordinating health care services and long term  care  services  to  the
elderly  and  disabled;  PROVIDED,  HOWEVER,  THAT  AN  ENTITY  OWNED OR
CONTROLLED BY AN ENTITY THAT HAS RECEIVED  A  CERTIFICATE  OF  AUTHORITY
PURSUANT  TO  SECTION  FORTY-FOUR  HUNDRED  THREE  OR FORTY-FOUR HUNDRED
THREE-A OF THIS ARTICLE AND HAS  RECEIVED  A  CERTIFICATE  OF  AUTHORITY
UNDER  THIS  SECTION  PRIOR  TO THE EFFECTIVE DATE OF THE CHAPTER OF THE
LAWS OF TWO THOUSAND FIFTEEN  WHICH  AMENDED  THIS  PARAGRAPH  SHALL  BE
DEEMED TO BE AN ELIGIBLE APPLICANT.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD02424-01-5

S. 379                              2

  S  2.  This act shall take effect immediately; provided, however, that
the amendments to section 4403-f  of  the  public  health  law  made  by
section  one of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.

2015-S379A (ACTIVE) - Details

See Assembly Version of this Bill:: A414
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§4403-f, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S6583, A3781
2017-2018: S1098, A2358, A5947
2019-2020: A2406, A2797
2021-2022: A6034

2015-S379A (ACTIVE) - Summary

Relates to prohibiting ownership or control of managed long term care plans by health maintenance organizations or insurers.

2015-S379A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S379A

 TITLE OF BILL :

An act to amend the public health law, in relation to managed long
term care plans not being controlled or owned by for-profit health
maintenance organizations or insurers

 PURPOSE :

To assure that managed long term care plans are primarily owned by not
for profit providers or service entities, to promote best practices
consistent with the interests of the recipient.

 SUMMARY OF PROVISIONS :

Amends the definition of "eligible applicant" for certification as a
managed long term care (MLTC) plan to require eligible insurers and
health maintenance organizations be not-for-profit. An exception would
recognize entities already certified.

 JUSTIFICATION :

Medicaid long term care (over 120 days) has been reformed to be
delivered by care coordination entities, predominantly through
risk-bearing managed long term care plans. Currently, this transition

is applied to home and community-based services, with institutional
(nursing home)care contemplated to be phased in.

MLTCs have, until now, been almost exclusively entities owned by long
term care providers, not by HMOs or insurance companies. When
participation in an MLTC was voluntary, there was little concern that
insurance carriers would enter the field. However, now participation
in an MLTC is mandatory for many and will become mandatory for more
long term care recipients. There is growing interest by for-profit
HMOs and insurance companies in forming MLTCs. With their economic
resources they could easily come to dominate the field. So there is
growing concern that patients may ultimately have no choice but to
enroll in for-profit insurance carrier-owned MLTCs.

The individuals affected by this transition are primarily those with
chronic conditions, many who are elderly or otherwise affected with
life-limiting illness. Care and service decisions for these
individuals should not be measured against profit margins of
shareholders. Other states' experience in this area has proven that
provider-based MLTCs, which most all of New York MLTCs currently are,
deliver both the quality and the savings expected.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately

2015-S379A (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 379--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

AN  ACT to amend the public health law, in relation to managed long term
  care plans not being controlled or owned by for-profit health  mainte-
  nance organizations or insurers

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph (b) of subdivision 1 of  section  4403-f  of  the
public  health  law,  as  added  by  chapter 659 of the laws of 1997, is
amended to read as follows:
  (b) "Eligible applicant" means an entity controlled or wholly owned by
one or more of the following: a hospital as defined in  subdivision  one
of  section twenty-eight hundred one of this chapter; a home care agency
licensed or certified pursuant to article thirty-six  of  this  chapter;
[an] A NOT-FOR-PROFIT entity that has received a certificate of authori-
ty  pursuant  to  sections  forty-four hundred three, forty-four hundred
three-a or AN INTEGRATED DELIVERY SYSTEM THAT HAS RECEIVED A CERTIFICATE
OF AUTHORITY PURSUANT TO SECTION  forty-four  hundred  eight-a  of  this
article  (as  added  by  chapter  six hundred thirty-nine of the laws of
nineteen hundred ninety-six), or  a  NOT-FOR-PROFIT  health  maintenance
organization  authorized under article forty-three of the insurance law;
or a not-for-profit organization which has a  history  of  providing  or
coordinating  health  care  services  and long term care services to the
elderly and disabled.   HOWEVER, AN ENTITY OWNED  OR  CONTROLLED  BY  AN
ENTITY  THAT HAS RECEIVED A CERTIFICATE OF AUTHORITY PURSUANT TO SECTION
FORTY-FOUR HUNDRED THREE OR FORTY-FOUR HUNDRED THREE-A OF  THIS  ARTICLE
AND  HAS RECEIVED A CERTIFICATE OF AUTHORITY UNDER THIS SECTION PRIOR TO

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD02424-09-6

S. 379--A                           2

THE EFFECTIVE DATE OF THE CHAPTER OF LAW  WHICH  ENACTED  THIS  SENTENCE
SHALL BE DEEMED TO BE AN ELIGIBLE APPLICANT.
  S  2.  This act shall take effect immediately; provided, however, that
the amendments to section 4403-f  of  the  public  health  law  made  by
section  one of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.

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Senate Bill S379A

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2015-S379 - Details

2015-S379 - Summary

2015-S379 - Sponsor Memo

2015-S379 - Bill Text download pdf

2015-S379A (ACTIVE) - Details

2015-S379A (ACTIVE) - Summary

2015-S379A (ACTIVE) - Sponsor Memo

2015-S379A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S379A

Share this bill

Sponsored By

Gustavo Rivera

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2015-S379 - Details

2015-S379 - Summary

2015-S379 - Sponsor Memo

2015-S379 - Bill Text download pdf

2015-S379A (ACTIVE) - Details

2015-S379A (ACTIVE) - Summary

2015-S379A (ACTIVE) - Sponsor Memo

2015-S379A (ACTIVE) - Bill Text download pdf

Comments