BILL NUMBER: S2867

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:

Provides that services to medical assistance recipients suffering from
traumatic brain injuries or qualifying for nursing home diversion and
transition services shall be provided outside of managed care programs

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill amends paragraph (d-2) of subdivision 3 of section
364-j of the social services law as it relates to medical assistance
recipients suffering from a traumatic brain injury (TBI) or those who
qualify for nursing home diversion and transition services (NHTD). It
prevents services provided pursuant to the TBI/NHTD Waiver programs from
              

being provided through Medicaid Managed Care and directing the Commis-
sioner of Health to take any action necessary to continue provisions of
these services through waivers.

Section 2 provides the 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 services through the Nursing Home Transition and Diver-
sion 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 Waiver 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 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 did not reflect the workgroup recommenda-
tions nor conversations with the Department. A series of further weekly
meetings were scheduled as a result. Of particular concern 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 (MLTC) 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. MLTC Plans that 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, which has resulted in
additional pressures on the system as they serve this high acuity popu-
lation. There are concerns that adding another high acuity population
such as TBI/NHTD to plans would place some plans in further peril and
ultimately put consumers in jeopardy.  For these reasons, the date for
transitioning the TBI/NHTD program participants into managed care was
further extended until January 1, 2018, and then again until August 10,
2022, and most recently until January 1, 2026. After several meetings,
many questions still remain unanswered regarding these issues.

There have been no cost savings associated with proposals to move the
TBI/NHTD population into managed care. Moving the vulnerable populations
served under the TBI/NHTD waiver into managed care would be a tremendous
disservice to all involved.

 
LEGISLATIVE HISTORY:

2015-2016: S6814 Hannon Passed Senate / A9397 Gottfried

2017-2018: S1870 Hannon / A2442 Gottfried

2019-2020: S1890A / A2798A Gottfried

2021-2022: S1577A Passed Senate / A192 Gottfried

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.