BILL NUMBER: S8488

SPONSOR: LITTLE
 
TITLE OF BILL:

An act to amend the public health law, in relation to authorizing one or
more demonstration projects that permit a managed long-term care plan to
enroll persons that are permanently placed in a nursing home and to
manage the nursing home benefit in one or more rural areas

 
PURPOSE:

The bill creates a demonstration program that would allow one or more
managed long term care plans that operate in rural counties and that
have demonstrated success in transitioning individuals in need of a
nursing home level of care from the nursing home to the community, to
enroll and manage the care of permanently-placed nursing home residents
for periods longer than three months.

 
SUMMARY OF PROVISIONS:

              

The bill adds sub-paragraph (v-e) to paragraph b of subdivision 7 of
section 4403-f of public health law to authorize the Commissioner of
Health to allow one or more managed long term care plans to enroll Medi-
caid beneficiaries, and retain existing enrollees, who are permanently
placed in a nursing home, on a demonstration basis. Such a demonstration
or demonstrations would operate in one or more rural areas as defined in
section 2951 of public health law.

 
JUSTIFICATION:

Beginning in mid-2018, permanently-placed nursing home residents who
have resided in a nursing home for longer than three consecutive months
are excluded from managed long term care (MLTC) enrollment.  While this
approach may be appropriate for urban areas, in rural areas, the coordi-
nation of services to facilitate the return of an individual with inten-
sive care needs to the community from a nursing home may require addi-
tional time.

This bill will allow those plans and providers most able and interested
in serving members who are permanently placed or are at greatest risk of
permanent placement to continue partnering to do so and will allow
interested individuals to continue to receive coordinated care tailored
to their geographic realities. The bill relies on the definition of
rural area provided in section 2951 of Public Health Law.

It is beneficial for the health care system to allow a managed long term
care plan serving rural communities that has invested time, money,
effort and expertise in developing systems and forging provider partner-
ships to manage the care for individuals in need, or at greatest risk,
of long term nursing home care to continue enrolling and serving such
members. This would maximize the possibility that these members will be
able to return to the community even after a potentially permanent nurs-
ing home placement of more than three months.

Individuals interested in living in the community should have the oppor-
tunity to do so and this measure will serve to broaden that opportunity.
Avoiding or delaying permanent placement for individuals wishing to live

in the community will not only improve the quality of life for these
individuals, it will also serve to save Medicaid dollars.

 
LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.