BILL NUMBER: S1577A

SPONSOR: RIVERA
 
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 individuals 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 Trau-
matic 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 a 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/MHTD waived 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 ultimate-
ly committed to delay the transition until January 2017 and created a
work-group 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
recommendations nor conversations with the Department. A series of
further weekly meetings were scheduled as a result. Of the particular
concerns have 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 State 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
effect 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 Janu-
ary 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 und er the TBI/NHTD waiv-
er into managed care at this time would be a tremendous disservice to
all involved.

 
LEGISLATIVE HISTORY:

2015-2016: S6814 Hannon/A9397 Gottfried Passed Senate

2017-2018: S1870  Hannon/A2442 Gottfried

2019-2020: S1890A/A2798A Gottfried

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.