BILL NUMBER:  S1870

 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 amend 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. 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 will undoubtedly
place some plans in further peril and ultimately consumers in jeopardy

As part of the SFY 2016-17 budget, the date for transitioning the
TBI/NHTDW program participants into managed care was further extended
until at least January 1, 2018. 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 :

S 6814 of 2016: Passed Senate

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
Immediately