S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9538
 
                           I N  A S S E M B L Y
 
                             January 24, 2020
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation to adverse determination notices to Medicaid recipients
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 9 of section 364-j of the social services  law,
 as  amended  by  chapter  433 of the laws of 1997, is amended to read as
 follows:
   9. Managed care providers shall inform participants of such provider's
 grievance procedure and utilization review procedures [required pursuant
 to sections forty-four hundred eight-c  and]  UNDER  ARTICLE  forty-nine
 [hundred]  of  the  public  health law. A managed care provider or local
 social services  district,  as  appropriate,  shall  provide  notice  to
 participants  of  their  respective  rights  to  a  fair hearing and aid
 continuing in accordance with applicable state and federal law.  MANAGED
 CARE PROVIDERS SHALL PROVIDE WRITTEN NOTICE OF THE NAME, ADDRESS,  PHONE
 NUMBER  AND  WEBSITE  OF THE DEPARTMENT OF HEALTH DESIGNATED INDEPENDENT
 CONSUMER ASSISTANCE PROGRAM AND THE INDEPENDENT SUBSTANCE  USE  DISORDER
 AND  MENTAL  HEALTH OMBUDSMAN ESTABLISHED BY SECTION 33.27 OF THE MENTAL
 HYGIENE LAW ON ALL NOTICES OF  ADVERSE  DETERMINATIONS,  GRIEVANCES  AND
 APPEALS.
   §  2.  Paragraph  (b)  of  subdivision  2 and subdivision 7 of section
 4408-a of the public health law, as added by chapter 705 of the laws  of
 1996, are amended to read as follows:
   (b)  The  notice to an enrollee describing the grievance process shall
 explain: (i) the process for filing a grievance with  the  organization;
 (ii) the timeframes within which a grievance determination must be made;
 [and]  (iii)  the  right of an enrollee to designate a representative to
 file a grievance on behalf of the enrollee; AND (IV) NOTICE OF THE NAME,
 ADDRESS, PHONE NUMBER AND WEBSITE OF THE DEPARTMENT DESIGNATED  CONSUMER
 ASSISTANCE PROGRAM AND THE INDEPENDENT SUBSTANCE USE DISORDER AND MENTAL
 HEALTH  OMBUDSMAN ESTABLISHED BY SECTION 33.27 OF THE MENTAL HYGIENE LAW
 ON ALL NOTICES OF ADVERSE DETERMINATIONS, GRIEVANCES AND APPEALS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD14155-02-9

 A. 9538                             2
 
   7. The notice of a  determination  shall  include:  (i)  the  detailed
 reasons for the determination; (ii) in cases where the determination has
 a  clinical  basis,  the clinical rationale for the determination; [and]
 (iii) the procedures for the filing of an appeal of  the  determination,
 including  a  form  for the filing of such an appeal; AND (IV) NOTICE OF
 THE NAME, ADDRESS, PHONE NUMBER AND WEBSITE OF THE DEPARTMENT DESIGNATED
 CONSUMER ASSISTANCE PROGRAM AND THE INDEPENDENT SUBSTANCE  USE  DISORDER
 AND  MENTAL  HEALTH OMBUDSMAN ESTABLISHED BY SECTION 33.27 OF THE MENTAL
 HYGIENE LAW ON ALL NOTICES OF  ADVERSE  DETERMINATIONS,  GRIEVANCES  AND
 APPEALS.
   § 3. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become a law; provided, however, the amendments made to
 subdivision 9 of section 364-j  of  the  social  services  law  made  by
 section one of this act shall not affect the repeal of such section, and
 shall be deemed repealed therewith.