S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10176
 
                           I N  A S S E M B L Y
 
                               May 10, 2024
                                ___________
 
 Introduced by COMMITTEE ON RULES -- (at request of M. of A. Gonzalez-Ro-
   jas, Paulin) -- read once and referred to the Committee on Health
 
 AN  ACT  to  amend  the public health law, in relation to data reporting
   required on the administration of managed long term care plans
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Subparagraph  (ix)  of  paragraph (b) of subdivision 7 of
 section 4403-f of the public health law, as added  by  section  56-a  of
 part  D of chapter 56 of the laws of 2012 and as relettered by section 4
 of part B of chapter 57 of the laws of  2018,  is  amended  to  read  as
 follows:
   (ix)  (1)  The  commissioner shall report [biannually] ANNUALLY on the
 implementation of this subdivision. The reports shall include,  but  not
 be limited to:
   (A)  satisfaction of enrollees with care coordination/case management;
 timeliness of care;
   (B) service utilization data including changes in  the  level,  hours,
 frequency, and types of services and providers;
   (C) enrollment data, including auto-assignment rates by plan;
   (D) quality data; and
   (E)  continuity  of care for participants as they move to managed long
 term care, with respect to community based and nursing home populations,
 including pediatric nursing  home  populations,  and  medically  fragile
 children  being  served  by home care agencies affiliated with pediatric
 nursing homes and diagnostic and  treatment  centers  primarily  serving
 medically fragile children.
   (2)  THE  FOLLOWING  DATA  SHALL  BE INCLUDED IN THE REPORT UNDER THIS
 SUBDIVISION AND SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE IN AN INTER-
 ACTIVE FORMAT. TO THE EXTENT THE DATA SET FORTH IN THIS SUBPARAGRAPH  IS
 NOT  NOW REPORTED BY PLANS TO THE DEPARTMENT, PLANS SHALL BE REQUIRED TO
 REPORT THIS DATA THROUGH A REPORTING MECHANISM THAT THE DEPARTMENT SHALL
 DEVELOP BY OCTOBER FIRST, TWO THOUSAND TWENTY-FOUR:
   (A) STATEWIDE AND REGIONAL SERVICE UTILIZATION  DATA  FOR  EACH  PLAN,
 WITH  THE  NUMBER  AND PERCENTAGE OF "MEMBER MONTHS" AUTHORIZED FOR EACH
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15241-02-4
 A. 10176                            2
 
 RANGE OF HOURS PER MONTH AS REPORTED IN COST REPORTS FILED  UNDER  PARA-
 GRAPH  (A)  OF THIS SUBDIVISION, AND USING "MEMBER MONTHS" AS DEFINED IN
 THE COST REPORTS, INCLUDING ALL REQUIRED EXHIBITS.   DATA SHALL  INCLUDE
 THE  NUMBER  OF  MEMBER MONTHS FOR WHOM EACH TYPE OF SERVICE WAS AUTHOR-
 IZED, AND THE PERCENTAGE OF EACH PLAN'S TOTAL MEMBER  MONTHS  FOR  WHICH
 MEMBERS  WERE  AUTHORIZED  FOR  EACH OF THE RANGES OF HOURS PER MONTH OF
 EACH SERVICE.  THESE NUMBERS AND PERCENTAGES SHALL BE REPORTED SEPARATE-
 LY FOR EACH OF THE FOLLOWING SERVICES: PERSONAL CARE, CONSUMER  DIRECTED
 PERSONAL  CARE, PRIVATE DUTY NURSING AND HOME HEALTH SERVICES, AND SHALL
 BE REPORTED SEPARATELY FOR EACH REGION OF THE STATE IN  WHICH  THE  PLAN
 OPERATES AND ON A STATEWIDE BASIS;
   (B)  DATA  ON "PER MEMBER PER MONTH" EXPENDITURES BY MANAGED LONG TERM
 CARE PLAN,  AS REPORTED IN COST REPORTS FILED  UNDER  PARAGRAPH  (A)  OF
 THIS  SUBDIVISION,  INCLUDING  BUT NOT LIMITED TO, ADMINISTRATIVE COSTS,
 CASE MANAGEMENT, PERSONAL CARE, CONSUMER  DIRECTED  PERSONAL  ASSISTANCE
 PROGRAMS, HOME HEALTH CARE, PRIVATE DUTY NURSING, ADULT DAY HEALTH CARE,
 SOCIAL ADULT DAY, DENTAL CARE, VISION CARE, AUDIOLOGY, PODIATRY, MEDICAL
 SUPPLIES, DURABLE MEDICAL EQUIPMENT, PERSONAL EMERGENCY RESPONSE SYSTEM,
 HOME-DELIVERED  MEALS,    THE VARIOUS THERAPY AND REHAB SERVICES - PHYS-
 ICAL, OCCUPATIONAL AND SPEECH THERAPY, AND  NURSING  FACILITY  SERVICES.
 THE  REPORTS  SHALL  INCLUDE,  FOR EACH PLAN ON A STATEWIDE AND REGIONAL
 BASIS, A CALCULATION OF THE TOTAL PERCENTAGE OF ALL SERVICE EXPENDITURES
 EXPENDED FOR HOME AND COMMUNITY-BASED LONG TERM CARE  SERVICES  AND  THE
 PERCENTAGE  FOR  INSTITUTIONAL  LONG  TERM  CARE SERVICES, AND THE TOTAL
 NUMBER OF MEMBER MONTHS IN WHICH MEMBERS RECEIVED  HOME  AND  COMMUNITY-
 BASED  LONG  TERM CARE SERVICES AND THE NUMBER OF MEMBER MONTHS IN WHICH
 MEMBERS RECEIVED SOLELY INSTITUTIONAL SERVICES.    THE REPORTS SHALL  BE
 IN  AN  INTERACTIVE  FORMAT THAT ENABLES A COMPARISON BETWEEN PLANS ON A
 STATEWIDE BASIS AND FOR EACH REGION;
   (C) DATA ON PERSONAL CARE AND CONSUMER  DIRECTED  PERSONAL  ASSISTANCE
 PROGRAM  CONTRACTING,  INCLUDING  BUT  NOT  LIMITED  TO,  HOURS  OF CARE
 PROVIDED AND EXPENSES ALLOCATED BY CONTRACTED ENTITY;
   (D) THE TOTAL NUMBER OF COMPLAINTS, GRIEVANCES, PLAN APPEALS, EXTERNAL
 APPEALS, AND FAIR HEARINGS FOR EACH PLAN, BROKEN DOWN BY:
   (I) THE NUMBER AND PERCENTAGE OF CASES DECIDED  WHOLLY  IN  ENROLLEE'S
 FAVOR,  PARTIALLY  IN ENROLLEE'S FAVOR, WHOLLY AGAINST THE ENROLLEE, AND
 THE NUMBER STILL PENDING;
   (II) THE TYPE OF SERVICE INVOLVED IN THE COMPLAINT OR APPEAL; AND
   (III) THE ISSUE OF THE COMPLAINT OR APPEAL, INCLUDING DENIAL OF A  NEW
 SERVICE,  DENIAL  OF  AN  INCREASE IN A SERVICE, REDUCTION OF A SERVICE,
 TERMINATION OF A SERVICE, LATENESS, LACK OF STAFFING, OR OTHER ISSUE;
   (E)  METRICS TO TRACK TIMELY ACCESS TO AUTHORIZED SERVICES,  INCLUDING
 BUT NOT LIMITED TO:
   (I)  THE  NUMBER OF ENROLLEES WHOSE PLANS OF CARE ARE UNSTAFFED OR NOT
 FULLY STAFFED FOR PERIODS OF TIME THAT THE COMMISSIONER SHALL DETERMINE,
 FROM ONE DAY TO MORE THAN SIXTY DAYS, AND THE  TOTAL  NUMBER  OF  MEMBER
 DAYS PER MONTH FOR WHICH PLANS OF CARE ARE NOT FULLY STAFFED; AND
   (II)  THE WAIT TIME FOR PERSONAL CARE, CONSUMER DIRECTED PERSONAL CARE
 UNDER SECTION THREE HUNDRED-SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW,  OR
 PRIVATE DUTY NURSING SERVICES TO BE INITIATED AFTER AUTHORIZATION; AND
   (F)   METRICS TRACKING REBALANCING FROM INSTITUTIONAL CARE TO COMMUNI-
 TY-BASED CARE, INCLUDING:
   (I) FOR EACH PLAN, STATEWIDE AND BY REGION, THE RATE OF  ADMISSION  OF
 ENROLLEES FROM THE COMMUNITY TO NURSING FACILITIES;
   (II)  OF  EACH  PLAN'S  ENROLLEES  ADMITTED TO A NURSING FACILITY, THE
 PERCENTAGE SUCCESSFULLY DISCHARGED TO THE COMMUNITY,  MEANING  REMAINING
 A. 10176                            3

 IN  THE COMMUNITY FOR SIXTY DAYS OR MORE, AND THE PERCENTAGE DISENROLLED
 FROM THE PLAN PURSUANT TO CLAUSE THIRTEEN OF SUBPARAGRAPH (V)  OF  PARA-
 GRAPH (B) OF THIS SUBDIVISION  AND THE PERCENTAGE DISENROLLED BECAUSE OF
 DEATH OR FOR OTHER REASONS, CATEGORIZED BY LENGTH OF NURSING HOME STAY;
   (III)  THE  RATE  OF ENROLLMENT OF NEW ENROLLEES WHO, PRIOR TO ENROLL-
 MENT, WERE IN A NURSING HOME, BY LENGTH OF NURSING HOME STAY;
   (IV) THE RATE OF RE-ENROLLMENT OF ENROLLEES WHO HAD  BEEN  DISENROLLED
 FROM THE PLAN WITHIN THE PRIOR SIX MONTHS BECAUSE OF A LONG-TERM NURSING
 HOME STAY (UNDER CLAUSE THIRTEEN OF SUBPARAGRAPH (V) OF PARAGRAPH (B) OF
 THIS SUBDIVISION).
   (3)  The  commissioner  shall  publish  the report on the department's
 website and provide notice to the temporary president of the senate, the
 speaker of the assembly, the chair of the senate standing  committee  on
 health,  the  chair  of  the  assembly health committee and the Medicaid
 Managed Care Advisory Review Panel upon availability of the report.  The
 initial  report  shall  be  provided  by  September  first, two thousand
 twelve. The reports shall be made available by each February first,  and
 September  first  thereafter.  Such  reports shall be formatted to allow
 comparisons between plans.
   (4) THE COMMISSIONER SHALL MAKE THE FINAL AUDITED VERSIONS OF ALL PAST
 ANNUAL MANAGED LONG TERM CARE COST REPORTS  AVAILABLE  FOR  DOWNLOAD  IN
 FULL IN CSV FORMAT ON THE DEPARTMENT'S WEBSITE, AND SHALL MAKE THE FINAL
 AUDITED  VERSIONS  OF ALL FUTURE ANNUAL COST REPORTS AVAILABLE FOR DOWN-
 LOAD WITHIN THIRTY DAYS OF COMPLETION OF THE FINAL AUDITED REPORT.
   § 2. This act shall take effect immediately; provided,  however,  that
 the  amendments  to  section  4403-f  of  the public health law, made by
 section one  of this act shall not affect the repeal of  such    section
 and    shall  be deemed to repeal therewith; and provided, further, that
 the amendments to paragraph (b) of subdivision 7 of  section  4403-f  of
 the  public  health law made by section one of this act shall not affect
 the expiration of such paragraph and shall expire therewith.