BILL NUMBER:  S6814

 TITLE OF BILL :

An act to amend the social services law, in relation to the provision
of services to certain persons suffering from traumatic brain injuries
or qualifying for nursing home diversion and transition services

 PURPOSE :

To prevent waivered Medicaid services provided to persons suffering
from traumatic brain injuries or qualifying for nursing home diversion
and transition services from being provided to Medicaid recipients
through managed care programs.

 SUMMARY OF PROVISIONS :

Section 1 of the bill amends section 364-j of the social services law
to add a new paragraph (d-2) preventing service provided pursuant to
the Traumatic Brain Injury and Nursing Home Transition and Diversion
(TBI/NHTD) Waiver programs from being provided through Medicaid
Managed Care and directing the Commissioner of Health to take any
action necessary to continue provisions of these services through
waivers.

Section 2 of the bill provides for an immediate effective date.
              

 JUSTIFICATION :

Individuals who suffer from traumatic brain injury (TBI) and are
served by a Medicaid waiver or who have some other disabilities that
qualify them for the Nursing Home Transition and Diversion Waiver
(NHTD) have varied physical and cognitive disabilities that make them
particularly vulnerable to institutionalization. The Federal Medicaid
Waivers were established many years ago because the state recognized
these vulnerabilities and needs for special services and supports to
help individuals live in the least integrated setting. These programs
have served as a national model.

Given the unique needs of this small population of Medicaid
recipients, the legislature introduced legislation in 2015 to delay
the move of the TBI/NHTD waivered population into managed care and
require that a work group of stakeholders be convened to make
recommendations on transition of these services into managed care.
The Department of Health ultimately committed to delay the transition
until January 2017 and created a workgroup which met many times. In
late January 2016 the Department shared its draft transition plan with
the workgroup and concerns were raised that the draft transition plan
does not reflect the workgroup's recommendations nor conversations
with the Department. A series of further weekly meetings were schedule
as a result. Of particular concern has been the assessment tool, how
existing services fit into managed care and the process by which plans
would qualify individuals and determine approved services,
particularly for individuals who may find themselves with a traumatic
brain injury or other disability after the move to Medicaid managed
care.

Even Managed Long Term Care Plans have expressed concerns about taking
on this population. New York is still in the midst of moving other
populations into managed care and those transitions are far from
complete or without concerns. Most recently, the behavioral health
component was carved into managed care, yet the model contracts upon
which plans and providers operate, have yet to be approved by CMS.
Similarly, there are few details about the State's plan to implement
the Community First Choice Option, which also awaits CMS approval,
upon which TBI/NHTD waiver transition seems to hinge. Managed Long
Term Care Plans, who would enroll TBI/NHTD individuals, are self
reporting that they are already in a fragile state with many of those
plans experiencing operating losses. In July 2015, New York moved the
nursing home benefit into MLTC and the affect of that high acuity
population being added to MLTC plans is putting additional pressures
on the system Adding yet another high acuity population such as
TBI/NHTD to plans which haven't even had a year to absorb the last
transition will undoubtedly place some plans in further peril and
ultimately consumers in jeopardy.

There are no cost savings associated with moving TBI/NHTD into managed
care and given the vast changes the Medicaid program is currently
undergoing, the State would be best served by placing all its
attention on the populations it has already begun moving into managed
care. Moving the vulnerable populations served under the TBI/NHTD
waiver into managed care at this time would be a tremendous disservice
to all involved.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
Immediately