NY State Senate Bill 2023-S7293

Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2024	referred to health
May 19, 2023	referred to health

2023-S7293 (ACTIVE) - Details

See Assembly Version of this Bill:: A7554
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L

2023-S7293 (ACTIVE) - Summary

Relates to the performance standards that must be met by managed long term care plans; enables managed long term care plans operated by organizations that also operate an Institutional Special Needs Plan (ISNP) or a PACE program, but not a Medicare Dual Eligible Special Needs Plan, to continue to meet managed long term care plans performance standards.

2023-S7293 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7293

SPONSOR: RYAN
 
TITLE OF BILL:

An act to amend the public health law, in relation to the performance
standards that must be met by managed long term care plans

 
PURPOSE:

The purpose of this bill is to enable managed long term care (MLTC)
plans that operate a Medicare Advantage Institutional Special Needs Plan
(ISNP)or a Program of All-Inclusive Care for the Elderly (PACE) program,
but not a Medicare Advantage Dual Eligible Special Needs (DSNP), to
continue to meet performance standards. The bill also removes from
performance standards the offering of Child Health Plus and Basic Health
Program products because those ò products are irrelevant to the delivery
of integrated care for dual eligibles.

 
SUMMARY OF PROVISIONS:

Section one of the bill amends subdivision 6-a of section 4403-f of the

Public Health Law to:

*Expand the performance standards imposed on MLTC plans to allow MLTC
plans that operate ISNPs or PACE programs to continue to meet those
standards;

*Remove from MLTC performance standards offering products under the
Child Health Plus and Basic Health ("Essential Plan") programs.

Section two of the bill provides an immediate effective date.

 
JUSTIFICATION:

This legislation would modify the performance standards required of MLTC
plans to enable MLTC plans that operate a PACE program or an ISNP, but
not a DSNP, to continue meet those standards. Under legislation enacted
with the SFY 2023-24 budget, MLTC plans must operate a DSNP by January
1, 2024 in order to meet performance standards. In addition, the
performance standards include offering products under the Child Health
Plus and Basic Health programs.  However, under current law, MLTC plans
that also operate ISNPs or PACE programs would be deemed out of compli-
ance with those standards.

The DSNP performance standard was imposed in order to ensure that MLTC
plans are engaged in providing care management, coordination, and cover-
age that integrates Medicare-covered services and Medicaid-covered
services. ISNPS and PACE programs, like DSNPs, also serve dual eligibles
and integrate Medicare and Medicaid services. In fact, unlike DSNPs,
both ISNPs and PACE programs serve individuals who require a long-term
care services (although ISNPs are named "institutional," they may serve
individuals who live in the community, as long as they require a nursing
home level of care).

Moreover, by defining the performance standard based on the operation of
a DSNP only, the current law imposes a condition that is impossible to
meet for MLTC plans that are not currently operating one. According to
Medicare's schedule for approving new DSNPs, a plan would have had to
submit an application by February 2023 in order to be operational in
January 2024. Thus, at the time the current performance standard was
enacted, plans that had not already submitted an application fora DSNP
would not be able to begin operating a DSNP until January 2025.

Finally, the ability to offer Child Health Plus and Basic Health Plan
products is irrelevant to the MLTC program. There is very little, if
any, overlap between the individuals served by Child Health Plus or the
Essential Plan and MLTC plans. MLTC plans are specialized plans that
serve individuals who are age 18 or over, eligible for Medicaid, typi-
cally eligible for Medicare as well, and require long-term care services
for a period of 120 days or more. By contrast, Basic Health Program
enrollees must be under age 65 and not eligible for Medicaid.  Child
Health Plus Program enrollees must be under age 19 and not eligible for
Medicaid. Neither the Basic Health Program nor the Child Health Plus
Program may enroll the population that would generally be eligible for
MLTC.

 
PRIOR LEGISLATIVE HISTORY:

None.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S7293 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7293
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 19, 2023
                                ___________
 
 Introduced  by  Sen.  RYAN  --  read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law, in relation  to  the  performance
   standards that must be met by 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. Paragraph (a) of subdivision 6-a of section 4403-f  of  the
 public  health law, as added by section 4 of part I of chapter 57 of the
 laws of 2023, is amended to read as follows:
   (a) On or before January first, two thousand twenty-four, each managed
 long term care plan that has been  issued  a  certificate  of  authority
 pursuant  to  this  section  shall  have an active INSTITUTIONAL SPECIAL
 NEEDS PLAN OR A Medicare Dual Eligible Special Needs Plan  in  operation
 whose  H-contract  either  has  a  current  quality star rating from the
 Centers for Medicare and Medicaid Services of three stars or higher,  or
 has  not been issued a quality star rating from the Centers for Medicare
 and Medicaid Services, OR A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDER-
 LY (PACE).  In addition, the managed long term care  plan  shall  suffi-
 ciently demonstrate success in the following performance categories:
   (i) in addition to meeting the requirements of paragraph (j) of subdi-
 vision  seven  of  this  section,  in order to ensure network adequacy a
 commitment to contracting with an adequate number of licensed home  care
 service  agencies  needed to provide necessary personal care services to
 the greatest practicable number  of  enrollees,  and  with  an  adequate
 number  of  fiscal  intermediaries  needed to provide necessary consumer
 directed personal assistance services to the greatest practicable number
 of enrollees in accordance with section three  hundred  sixty-five-f  of
 the social services law;
   (ii)  readiness  to  timely  implement and adhere to maximum wait time
 criteria for key categories of service in accordance  with  laws,  rules
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11574-01-3
 S. 7293                             2

 
 and  regulations of the department or the Centers for Medicare and Medi-
 caid Services;
   (iii) commitment to quality improvement;
   (iv)  accessibility  and geographic distribution of network providers,
 taking into account the needs  of  persons  with  disabilities  and  the
 differences between rural, suburban, and urban settings;
   (v)  demonstrated  cultural  and language competencies specific to the
 population of participants;
   (vi) ability to serve enrollees  across  the  continuum  of  care,  as
 demonstrated  by  the  type and number of products the managed long term
 care operates or has applied to operate, including integrated  care  for
 participants  who  are  dually  eligible for Medicaid and Medicare[, and
 those operated under title one-A of article twenty-five of this  chapter
 and section three hundred sixty-nine-gg of the social services law]; and
   (vii) value based care readiness and experience.
   §  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 repealed therewith.

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Senate Bill S7293

Sponsored By

Current Bill Status - In Senate Committee Health Committee

2023-S7293 (ACTIVE) - Details

2023-S7293 (ACTIVE) - Summary

2023-S7293 (ACTIVE) - Sponsor Memo

2023-S7293 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7293

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Sponsored By

Sean M. Ryan

Current Bill Status - In Senate Committee Health Committee

2023-S7293 (ACTIVE) - Details

2023-S7293 (ACTIVE) - Summary

2023-S7293 (ACTIVE) - Sponsor Memo

2023-S7293 (ACTIVE) - Bill Text download pdf

Comments