S. 7800 2
LEVELS OF CARE WHO WISH TO REMAIN IN THEIR COMMUNITY (SEE, SECTIONS 1894
AND 1934 TO TITLE XVIII OF THE SOCIAL SECURITY ACT; 42 CFR 460), WHICH
ARE LICENSED TO OPERATE UNDER ARTICLE TWENTY-NINE-EE OF THIS CHAPTER.
(B) "MEDICAID ADVANTAGE PLUS PROGRAM" OR "MAP" MEANS A FULLY CAPITATED
STATE DEVELOPED MODEL OF COMPREHENSIVE CARE FOR PERSONS EIGHTEEN YEARS
OF AGE OR OLDER THAT ARE ELIGIBLE FOR MEDICAID AND ALSO ELIGIBLE FOR
MEDICARE, QUALIFYING FOR NURSING HOME LEVELS OF CARE.
(C) "CARE COORDINATION ENTITY" MEANS AN ENTITY THAT HAS OBTAINED
APPROVAL FROM THE COMMISSIONER BASED ON GUIDELINES ESTABLISHED BY THE
DEPARTMENT TO PROMOTE CONTINUITY OF CARE AND COORDINATION OF SERVICES
FOR ALL ENROLLEES. THE ENTITY MAY BE ORGANIZED AS A HEALTH HOME
SPECIALLY CERTIFIED BY THE COMMISSIONER TO SERVE HOME AND COMMUNITY-
BASED SERVICES ELIGIBLE RECIPIENTS, BUT THIS SHALL NOT PRECLUDE OTHER
ORGANIZATIONAL STRUCTURES AS DETERMINED BY THE COMMISSIONER.
2. THE COMMISSIONER SHALL SUBMIT THE APPROPRIATE WAIVERS, INCLUDING
BUT NOT LIMITED TO THOSE AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED
FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT
OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS NECESSARY TO REQUIRE ON
OR AFTER APRIL FIRST, TWO THOUSAND TWENTY-SIX, MEDICAL ASSISTANCE RECIP-
IENTS WHO ARE EIGHTEEN YEARS OF AGE OR OLDER AND WHO REQUIRE LONG TERM
CARE SERVICES, AS SPECIFIED BY THE COMMISSIONER, FOR A CONTINUOUS PERIOD
OF MORE THAN ONE HUNDRED TWENTY DAYS, TO RECEIVE SUCH SERVICES THROUGH
AN AVAILABLE FULLY INTEGRATED PLAN INCLUDING A PACE OR MAP PLAN, OR
THROUGH A FEE-FOR-SERVICE BASED MODEL WITH SERVICES COORDINATED BY A
CARE COORDINATION ENTITY. THE COMMISSIONER SHALL ESTABLISH GUIDELINES ON
THE ESTABLISHMENT AND OPERATION OF CARE COORDINATION ENTITIES. SUCH
GUIDELINES SHALL ADDRESS THE PAYMENT METHODS THAT ENSURE PROVIDER
ACCOUNTABILITY FOR COST EFFECTIVE QUALITY OUTCOMES. COPIES OF SUCH WAIV-
ER APPLICATIONS AND AMENDMENTS THERETO SHALL BE PROVIDED TO THE CHAIRS
OF THE SENATE FINANCE COMMITTEE, THE ASSEMBLY WAYS AND MEANS COMMITTEE
AND THE SENATE AND ASSEMBLY HEALTH COMMITTEES BEFORE THEIR SUBMISSION TO
THE FEDERAL GOVERNMENT.
3. PERSONS THAT ARE DETERMINED ELIGIBLE TO RECEIVE LONG TERM CARE
SERVICES THROUGH PACE OR MAP, OR THROUGH A FEE-FOR-SERVICE BASED MODEL
WITH SERVICES COORDINATED BY A CARE COORDINATION ENTITY ESTABLISHED
PURSUANT TO SUBDIVISION TWO OF THIS SECTION SHALL HAVE AT LEAST THIRTY
DAYS TO SELECT A PACE OR MAP PROVIDER, OR CARE COORDINATION ENTITY AND
SHALL BE PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE. WHERE A
PARTICIPANT HAS NOT SELECTED SUCH A PROVIDER OR CARE COORDINATION ENTI-
TY, THE COMMISSIONER SHALL ASSIGN SUCH PARTICIPANT TO A CARE COORDI-
NATION ENTITY TAKING INTO ACCOUNT CONSISTENCY WITH ANY PRIOR COMMUNITY-
BASED DIRECT CARE WORKERS HAVING RECENTLY SERVED THE RECIPIENT, QUALITY
PERFORMANCE CRITERIA, CAPACITY AND GEOGRAPHIC ACCESSIBILITY.
§ 3. Subdivision 2 of section 365-a of the social services law is
amended by adding two new paragraphs (mm) and (nn) to read as follows:
(MM) THE DEPARTMENT SHALL PROMULGATE REGULATIONS FOR ALL MEDICAID
ENROLLEES RECEIVING SERVICES THROUGH A FEE-FOR-SERVICE MODEL PURSUANT TO
SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW THAT INCLUDE
THE ESTABLISHMENT AND OPERATION OF CARE COORDINATION ENTITIES TO PROMOTE
CONTINUITY OF CARE AND COORDINATION OF SERVICES TO ENSURE THAT EACH
ENROLLEE HAS AN ONGOING SOURCE OF CARE APPROPRIATE TO THEIR NEEDS AS
REQUIRED BY 42 CFR § 438.208. THE REGULATIONS SHALL INCLUDE CONFLICT-
FREE CASE MANAGEMENT PROTECTIONS TO ENSURE THAT ASSESSMENT AND COORDI-
NATION OF SERVICES ARE SEPARATE FROM THE DELIVERY OF THOSE SERVICES. IN
SELECTING PROVIDERS OF CASE MANAGEMENT SERVICES, THE DEPARTMENT SHALL
S. 7800 3
PRIORITIZE PROVIDERS WITH PROVEN EXPERIENCE SERVING POPULATIONS RECEIV-
ING HOME AND PERSONAL CARE SERVICES.
(NN) THE DEPARTMENT SHALL CONDUCT AN EVALUATION OF THE VIABILITY OF
UTILIZING CARE COORDINATION ENTITIES OPERATING PURSUANT TO THIS SECTION
FOR ASSESSMENTS OR REASSESSMENTS REQUIRED FOR DETERMINING AN INDIVID-
UAL'S NEEDS FOR SERVICES THAT ARE CONTROLLED BY THE INDEPENDENT ASSESSOR
ESTABLISHED PURSUANT TO SUBDIVISION TEN OF SECTION THREE HUNDRED SIXTY-
FIVE-A OF THIS TITLE.
§ 4. Stakeholder engagement. 1. The commissioner of health shall
convene an advisory group composed of stakeholder representatives which
shall seek input from representatives of home and community-based long
term care services providers, including representative associations,
recipients, the department of health, local social services districts,
and the direct care workforce, among others, to:
(a) further evaluate and promote the transition of persons in receipt
of home and community-based long term care services into fee-for-service
arrangements, where appropriate, and to develop guidelines for such
care; and
(b) determine a process to transition providers, including but not
limited to licensed home care services agencies, certified home health
agencies, and fiscal intermediaries, to a fee-for-service reimbursement
system.
2. In implementing the transition to a fee-for-service model the
commissioner of health, in consultation with the advisory group, shall,
to the extent practicable, consider and select programs and policies
that seek to maximize continuity of care and minimize disruption to the
provider labor workforce, and shall continue to support providers,
licensed home care services agencies, and fiscal intermediaries that are
based on a commitment to quality and value; provided that nothing in
this subdivision shall supersede or invalidate any contracts or awards
provided to fiscal intermediaries pursuant to subdivision 4-a of section
365-f of the social services law, provided that the provisions of subdi-
vision 4-b of section 365-f of the social services law shall still
apply, or contracts or awards provided to licensed home care services
agencies pursuant to section 3605-c of the public health law.
3. The commissioner of health shall report biannually on the implemen-
tation of this section. The reports shall include, but not be limited
to: (a) satisfaction of enrollees with care coordination/case management
and timeliness of care; (b) service utilization data including changes
in the level, hours, frequency, and types of services and providers; (c)
enrollment data; (d) quality data; and (e) continuity of care for
participants as they move out of managed long term care and into the
fee-for-service model. 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 stand-
ing committee on health and the chair of the assembly health committee.
4. The commissioner of health shall seek input from representatives of
home and community-based long term care services providers, recipients,
and the Medicaid managed care advisory review panel, among others, to
assist in the development of guidelines for the establishment and opera-
tion of care coordination entities pursuant to section 4403-f of the
public health law. The guidelines shall be finalized and posted on the
department of health's website no later than November first, two thou-
sand twenty-five.
S. 7800 4
§ 5. Paragraph (o) of subdivision 2 of section 365-a of the social
services law, as added by chapter 659 of the laws of 1997, is amended to
read as follows:
(o) care and services furnished by a [managed long term care plan or
approved managed long term care demonstration pursuant to the provisions
of] PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY section forty-four
hundred three-f of the public health law to eligible individuals [resid-
ing in the geographic area] served by such entity, when such services
are furnished in accordance with an agreement with the department of
health and meet the applicable requirements of federal law and regu-
lation.
§ 6. Subparagraph (iii) of paragraph (e) of subdivision 2 of section
365-a of the social services law, as amended by section 36-a of part B
of chapter 57 of the laws of 2015, is amended to read as follows:
(iii) the commissioner shall provide assistance to persons receiving
services under this paragraph who are transitioning to receiving care
from a [managed long term care plan certified pursuant to] PACE OR MAP
PLAN AS SUCH TERMS ARE DEFINED BY section forty-four hundred three-f of
the public health law, consistent with subdivision thirty-one of section
three hundred sixty-four-j of this title;
§ 7. Subdivision 10 of section 365-a of the social services law, as
amended by section 1 of part QQ of chapter 57 of the laws of 2022, is
amended to read as follows:
10. The department of health shall establish or procure the services
of an independent assessor or assessors no later than October 1, 2022,
in a manner and schedule as determined by the commissioner of health, to
take over from local departments of social services[,] AND Medicaid
Managed Care providers, [and Medicaid managed long term care plans]
INCLUDING A MAP PLAN, OR A PACE PLAN IF THE PACE PLAN ELECTS TO UTILIZE
THE INDEPENDENT ASSESSOR AS SUCH TERMS ARE DEFINED BY SECTION FORTY-FOUR
HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, THE performance of assessments
and reassessments required for determining individuals' needs for
personal care services, including as provided through the consumer
directed personal assistance program, and other services or programs
available pursuant to the state's medical assistance program as deter-
mined by such commissioner for the purpose of improving efficiency,
quality, and reliability in assessment [and to determine individuals'
eligibility for Medicaid managed long term care plans]. Notwithstanding
the provisions of section one hundred sixty-three of the state finance
law, or sections one hundred forty-two and one hundred forty-three of
the economic development law, or any contrary provision of law,
contracts may be entered or the commissioner may amend and extend the
terms of a contract awarded prior to the effective date and entered into
to conduct enrollment broker and conflict-free evaluation services for
the Medicaid program, if such contract or contract amendment is for the
purpose of procuring such assessment services from an independent asses-
sor. Contracts entered into, amended, or extended pursuant to this
subdivision shall not remain in force beyond September 30, 2025.
§ 8. Paragraph (d) of subdivision 1 and paragraph (h) of subdivision 3
of section 218 of the elder law, as amended by section 1 of chapter 259
of the laws of 2018, are amended to read as follows:
(d) "Long-term care facilities" shall mean residential health care
facilities as defined in subdivision three of section twenty-eight
hundred one of the public health law; adult care facilities as defined
in subdivision twenty-one of section two of the social services law,
including those adult homes and enriched housing programs licensed as
S. 7800 5
assisted living residences, pursuant to article forty-six-B of the
public health law; or any facilities which hold themselves out or adver-
tise themselves as providing assisted living services and which are
required to be licensed or certified under the social services law or
the public health law. Within the amounts appropriated therefor, "long-
term care facilities" shall also mean [managed long-term care plans and
approved managed long-term care or operating demonstrations] A PACE OR
MAP PLAN as SUCH TERMS ARE defined in section forty-four hundred three-f
of the public health law and the term "resident", "residents", "patient"
and "patients" shall also include enrollees of such plans.
(h) Within the amounts appropriated therefor, the state long-term care
ombudsman program shall include services specifically designed to serve
persons enrolled in [managed long-term care plans or approved managed
long-term care or operating demonstrations authorized under] A PACE OR
MAP PLAN AS SUCH TERMS ARE DEFINED BY section forty-four hundred three-f
of the public health law, and shall also review and respond to
complaints relating to marketing practices by such plans and demon-
strations.
§ 9. Subdivisions (a), (c), (d), (f), the opening paragraph of subdi-
vision (g) and subdivision (h) of section 13.40 of the mental hygiene
law, subdivisions (a), (d), (f) and the opening paragraph of subdivision
(g) as added by section 72-b of part A of chapter 56 of the laws of
2013, subdivision (c) as amended by section 17 of part Z of chapter 57
of the laws of 2018, and subdivision (h) as added by section 1 of part D
of chapter 58 of the laws of 2014, are amended to read as follows:
(a) The commissioner and the commissioner of health shall jointly
establish a people first waiver program for purposes of developing a
care coordination model that integrates various long-term habilitation
supports and/or health care. The people first waiver program shall
include the use of developmental disability individual support and care
coordination organizations, herein referred to as DISCOs, pursuant to
section forty-four hundred three-g of the public health law, health
maintenance organizations, herein referred to as HMOs, providing
services under subdivision eight of section forty-four hundred three of
the public health law, and [managed] long term care [plans, herein
referred to as MLTCs] OPTIONS, providing OR COORDINATING services under
[subdivisions twelve, thirteen and fourteen of] section forty-four
hundred three-f of the public health law. Services shall be provided as
described in section forty-four hundred three-g of the public health
law, subdivision eight of section forty-four hundred three of the public
health law, and [subdivisions twelve, thirteen and fourteen of] section
forty-four hundred three-f of the public health law.
(c) No person with a developmental disability who is receiving or
applying for medical assistance and who is receiving, or eligible to
receive, services operated, funded, certified, authorized or approved by
the office, shall be required to enroll in a DISCO, HMO or [MLTC] LONG
TERM CARE OPTION in order to receive such services until program
features and reimbursement rates are approved by the commissioner and
the commissioner of health, and until such commissioners determine that
a sufficient number of plans that are authorized to coordinate care for
individuals pursuant to this section or that are authorized to operate
and to exclusively enroll persons with developmental disabilities pursu-
ant to subdivision twenty-seven of section three hundred sixty-four-j of
the social services law are operating in such person's county of resi-
dence to meet the needs of persons with developmental disabilities, and
that such entities meet the standards of this section. No person shall
S. 7800 6
be required to enroll in a DISCO, HMO or [MLTC] LONG TERM CARE OPTION in
order to receive services operated, funded, certified, authorized or
approved by the office until there are at least two entities operating
under this section in such person's county of residence, unless federal
approval is secured to require enrollment when there are less than two
such entities operating in such county. Notwithstanding the foregoing or
any other law to the contrary, any health care provider: (i) enrolled in
the Medicaid program and (ii) rendering hospital services, as such term
is defined in section twenty-eight hundred one of the public health law,
to an individual with a developmental disability who is enrolled in a
DISCO, HMO or [MLTC] LONG TERM CARE OPTION, or a prepaid health services
plan operating pursuant to section forty-four hundred three-a of the
public health law, including, but not limited to, an individual who is
enrolled in a plan authorized by section three hundred sixty-four-j [or]
OF the social services law, shall accept as full reimbursement the nego-
tiated rate or, in the event that there is no negotiated rate, the rate
of payment that the applicable government agency would otherwise pay for
such rendered hospital services.
(d) DISCOs, HMOs and [MLTCs] LONG TERM CARE OPTIONS operating under
this section shall ensure, to the greatest extent practicable, that
their assessment, services, and the grievance and appeals processes are
culturally and linguistically competent.
(f) There shall be a joint advisory council chaired by the commission-
er and the commissioner of health that shall be charged with advising
both commissioners in regard to the oversight of DISCOs, HMOs providing
services under subdivision eight of section forty-four hundred three of
the public health law, and [MLTCs] LONG TERM CARE OPTIONS providing
services under [subdivisions twelve, thirteen and fourteen of] section
forty-four hundred three-f of the public health law. The joint advisory
council may be comprised of the members of existing advisory councils or
similar entities serving the office, provided that it shall be comprised
of twelve members, including individuals with developmental disabili-
ties, family members of, advocates for, and providers of services to
people with developmental disabilities. Three members of the joint advi-
sory council shall also be members of the special advisory review panel
on medicaid managed care established under section three hundred sixty-
four-jj of the social services law. The joint advisory council shall
review all managed care options provided to individuals with develop-
mental disabilities, including: the adequacy of habilitation services;
the record of compliance with person-centered planning, person-centered
services and community integration; the adequacy of rates paid to
providers in accordance with the provisions of [paragraph one of subdi-
vision four of] section forty-four hundred three of the public health
law, paragraph [a-two] (A-2) of subdivision eight of section forty-four
hundred three of the public health law or [paragraph a-two of subdivi-
sion twelve of] section forty-four hundred three-f of the public health
law; and quality of life, health, safety and community integration of
individuals with developmental disabilities enrolled in managed care.
The commissioner and commissioner of the office for people with develop-
mental disabilities or their designees shall attend all meetings of the
joint advisory council. The joint advisory council shall report its
findings, recommendations, and any proposed amendments to pertinent
sections of the law to the commissioner and the commissioner of health,
the senate majority leader and speaker of the assembly. The joint advi-
sory council shall have access to any and all information that may be
S. 7800 7
lawfully disclosed to it and that is necessary to perform its functions
under this section.
Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or section
one hundred forty-two of the economic development law, or any other law
to the contrary, the commissioner and the commissioner of health are
authorized to enter into a contract or contracts under section forty-
four hundred three-g of the public health law, subdivision eight of
section forty-four hundred three of the public health law, and [subdivi-
sion twelve of] section forty-four hundred three-f of the public health
law, provided, however, that:
(h) Consistent with and subject to the terms of federal approval, the
commissioner shall establish the managed care for persons with develop-
mental disabilities advocacy program, hereinafter referred to as the
advocacy program. The activities of the advocacy program shall be coor-
dinated with the independent Medicaid managed care ombuds services
provided to persons with disabilities enrolling in Medicaid managed
care. The advocacy program shall advise individuals of applicable rights
and responsibilities, provide information and assistance to address the
needs of individuals with disabilities, and pursue legal, administrative
and other appropriate remedies or approaches to ensure the protection of
and advocacy for the rights of the enrollees. The advocacy program shall
provide support to eligible individuals with developmental disabilities
enrolling in developmental disability individual support and care coor-
dination organizations pursuant to section forty-four hundred three-g of
the public health law, health maintenance organizations providing
services pursuant to subdivision eight of section forty-four hundred
three of the public health law, [managed long term care plans] LONG TERM
CARE OPTIONS providing services under [subdivisions twelve, thirteen and
fourteen of] section forty-four hundred three-f of the public health
law, and fully integrated dual advantage plans providing services under
subdivision twenty-seven of section three hundred sixty-four-j of the
social services law. The commissioner shall select an independent organ-
ization or organizations to provide advocacy services under this subdi-
vision.
§ 10. Paragraph (c) of subdivision 6 of section 2801-e of the public
health law, as amended by chapter 257 of the laws of 2005, is amended to
read as follows:
(c) The commissioner may, as necessary, waive existing methodologies
for determining public need under this article, article thirty-six of
this chapter and article seven of the social services law[, as well as
enrollment limitations under section forty-four hundred three-f of this
chapter,] to accommodate permanent conversions of beds to other programs
or services on the basis that any such increases in capacity are linked
to commensurate reductions in the number of residential health care
facility beds.
§ 11. The opening paragraph of paragraph (ccc) of subdivision 1 of
section 2807-v of the public health law, as amended by section 12 of
part C of chapter 57 of the laws of 2023, is amended to read as follows:
Funds shall be deposited by the commissioner, within amounts appropri-
ated, and the state comptroller is hereby authorized and directed to
receive for the deposit to the credit of the state special revenue funds
- other, HCRA transfer fund, medical assistance account, or any succes-
sor fund or account, for purposes of funding the state share of
increases in the rates for certified home health agencies, long term
home health care programs, AIDS home care programs, hospice programs and
S. 7800 8
[managed] long term care [plans and approved managed long term care
operating demonstrations as defined in] OPTIONS IN section forty-four
hundred three-f of this chapter for recruitment and retention of health
care workers pursuant to subdivisions nine and ten of section thirty-six
hundred fourteen of this chapter from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
§ 12. Section 2807-x of the public health law is REPEALED.
§ 13. Subdivision 8 of section 3605 of the public health law, as
amended by section 49 of part D of chapter 56 of the laws of 2012, is
amended to read as follows:
8. Agencies licensed pursuant to this section but not certified pursu-
ant to section [three thousand six hundred eight] THIRTY-SIX HUNDRED
EIGHT of this article, shall not be qualified to participate as a home
health agency under the provisions of title XVIII or XIX of the federal
Social Security Act provided, however, an agency which has a contract
with a state agency or its locally designated office or, as specified by
the commissioner, with a managed care organization participating in the
managed care program established pursuant to section three hundred
sixty-four-j of the social services law or with a [managed long term
care plan established pursuant to] PACE OR MAP PLAN AS SUCH TERMS ARE
DEFINED BY section forty-four hundred three-f of this chapter, may
receive reimbursement under title XIX of the federal Social Security
Act.
§ 14. The opening paragraph of subdivision 9 of section 3614 of the
public health law, as amended by section 56 of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
Notwithstanding any law to the contrary, the commissioner shall,
subject to the availability of federal financial participation, adjust
medical assistance rates of payment for certified home health agencies
for such services provided to children under eighteen years of age and
for services provided to a special needs population of medically complex
and fragile children, adolescents and young disabled adults by a CHHA
operating under a pilot program approved by the department, long term
home health care programs, AIDS home care programs established pursuant
to this article, hospice programs established under article forty of
this chapter and for [managed] long term care [plans and approved
managed long term care operating demonstrations as defined in] OPTIONS
UNDER section forty-four hundred three-f of this chapter. Such adjust-
ments shall be for purposes of improving recruitment, training and
retention of home health aides or other personnel with direct patient
care responsibility in the following aggregate amounts for the following
periods:
§ 15. Paragraph (a) of subdivision 10 of section 3614 of the public
health law, as amended by section 57 of part A of chapter 56 of the laws
of 2013, is amended to read as follows:
(a) Such adjustments to rates of payments shall be allocated propor-
tionally based on each certified home health agency, long term home
health care program, AIDS home care and hospice program's home health
aide or other direct care services total annual hours of service
provided to medicaid patients, as reported in each such agency's most
recently available cost report as submitted to the department or for the
purpose of the [managed] long term care [program] OPTION a suitable
proxy developed by the department in consultation with the interested
parties. Payments made pursuant to this section shall not be subject to
subsequent adjustment or reconciliation; provided that such adjustments
S. 7800 9
to rates of payments to certified home health agencies shall only be for
that portion of services provided to children under eighteen years of
age and for services provided to a special needs population of medically
complex and fragile children, adolescents and young disabled adults by a
CHHA operating under a pilot program approved by the department.
§ 16. Paragraph (b) of subdivision 2 of section 4409 of the public
health law, as added by section 5 of part NN of chapter 57 of the laws
of 2023, is amended to read as follows:
(b) The department is authorized to address to any health maintenance
organization, and [managed long term care plan with a certificate of
authority pursuant to] A PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY
section forty-four hundred three-f of this article, or officers thereof,
any inquiry in relation to its contracts with providers and other enti-
ties providing covered services to the health maintenance
organization's, or [managed long term care plan's] PACE OR MAP PLANS'
enrollees, including but not limited to the rates of payment and payment
terms and conditions therein. Every entity or person so addressed shall
reply in writing to such inquiry promptly and truthfully, and such reply
shall be, if required by the department, signed by such individual, or
by such officer or officers of a corporation, as the department shall
designate, and affirmed by them as true under penalty of perjury. Fail-
ure to comply with the requirements of this section shall be subject to
civil penalties under section twelve of this chapter. Each day after the
deadline established by the department for reply until such time that
the provider submits a good faith response shall be considered a sepa-
rate and subsequent violation. In accordance with the process outlined
in this paragraph, employers shall provide any documents or materials in
the employer's possession, custody, or control that are requested by the
department as needed to support or verify the employer's reply.
§ 17. Subparagraph (i) of paragraph (e) of subdivision 3 of section
364-j of the social services law, as amended by section 38 of part A of
chapter 56 of the laws of 2013, is amended to read as follows:
(i) an individual dually eligible for medical assistance and benefits
under the federal Medicare program; provided, however, nothing herein
shall: (a) require an individual enrolled in a [managed] long term care
[plan] OPTION, pursuant to section forty-four hundred three-f of the
public health law, to disenroll from such program; or (b) make enroll-
ment in a Medicare managed care plan a condition of the individual's
participation in the managed care program pursuant to this section, or
affect the individual's entitlement to payment of applicable Medicare
managed care or [fee for service] FEE-FOR-SERVICE coinsurance and deduc-
tibles by the individual's managed care provider.
§ 18. Paragraphs (b) and (c) of subdivision 27 of section 364-j of
the social services law, as added by section 72 of part A of chapter 56
of the laws of 2013, are amended to read as follows:
(b) The FIDA program shall provide targeted populations of
[medicare/medicaid] MEDICARE/MEDICAID dually eligible persons with
comprehensive health services that include the full range of [medicare]
MEDICARE and [medicaid] MEDICAID covered services, including but not
limited to primary and acute care, prescription drugs, behavioral health
services, care coordination services, and long-term supports and
services, as well as other services, through managed care providers, as
defined in subdivision one of this section[, including managed long term
care plans, certified pursuant to section forty-four hundred three-f of
the public health law].
S. 7800 10
(c) Under the FIDA program established pursuant to this subdivision,
up to three managed [long term] care plans may be authorized to exclu-
sively enroll individuals with developmental disabilities, as such term
is defined in section 1.03 of the mental hygiene law. The commissioner
of health may waive any of the department's regulations as such commis-
sioner, in consultation with the commissioner of the office for people
with developmental disabilities, deems necessary to allow such managed
[long term] care plans to provide or arrange for service for individuals
with developmental disabilities that are adequate and appropriate to
meet the needs of such individuals and that will ensure their health and
safety. The commissioner of the office for people with developmental
disabilities may waive any of the office for people with developmental
disabilities' regulations as such commissioner, in consultation with the
commissioner of health, deems necessary to allow such managed [long
term] care plans to provide or arrange for services for individuals with
developmental disabilities that are adequate and appropriate to meet the
needs of such individuals and that will ensure their health and safety.
§ 19. Subdivision 31 of section 364-j of the social services law, as
added by section 36-b of part B of chapter 57 of the laws of 2015, is
amended to read as follows:
31. [(a)] The commissioner shall require managed care providers under
this section, [managed long-term care plans] A PACE OR MAP PLAN AS SUCH
TERMS ARE DEFINED under section forty-four hundred three-f OF the public
health law and other appropriate long-term service programs to adopt
expedited procedures for approving personal care services for a medical
assistance recipient who requires immediate personal care or consumer
directed personal assistance services pursuant to paragraph (e) of
subdivision two of section three hundred sixty-five-a of this title or
section three hundred sixty-five-f of this title, respectively, or other
long-term care, and provide such care or services as appropriate, pend-
ing approval by such provider or program.
§ 20. Paragraphs (a) and (c) of subdivision 32 of section 364-j of the
social services law, as amended by section 1 of part KKK of chapter 56
of the laws of 2020, are amended to read as follows:
(a) The commissioner, or for the purposes of subparagraph (iv) of
paragraph (c) of this subdivision, the Medicaid inspector general in
consultation with the commissioner, may, in his or her discretion, apply
penalties to managed care organizations subject to this section and
article forty-four of the public health law, including [managed long
term care plans] A PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, for untimely or
inaccurate submission of encounter data; provided however, no penalty
shall be assessed if the managed care organization OR A PACE OR MAP PLAN
submits, in good faith, timely and accurate data and a material amount
of such data is not successfully received by the department as a result
of department system failures or technical issues that are beyond the
control of the managed care organization.
(c) (i) Penalties assessed pursuant to this subdivision against a
managed care organization other than a [managed long term care plan
certified pursuant to] PACE OR MAP PLAN AS SUCH TERMS ARE DEFINED BY
section forty-four hundred three-f of the public health law shall be as
follows:
(A) for encounter data submitted or resubmitted past the deadlines set
forth in the model contract, the Medicaid capitated premiums shall be
reduced by one-third percent; [and]
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(B) for incomplete or inaccurate encounter data, evaluated at a cate-
gory of service level, that fails to conform to department developed
benchmarks for completeness and accuracy, the Medicaid capitated premi-
ums shall be reduced by one and one-third percent; and
(C) for submitted data that results in a rejection rate in excess of
ten percent of department developed volume benchmarks, the Medicaid
capitated premiums shall be reduced by one-third percent.
(ii) Penalties assessed pursuant to this [subdivisions] SUBDIVISION
against a [managed] long term care [plan] OPTION certified pursuant to
section forty-four hundred three-f of the public health law shall be as
follows:
(A) for encounter data submitted or resubmitted past the deadlines set
forth in the model contract, the Medicaid capitated premiums shall be
reduced by one-quarter percent;
(B) for incomplete or inaccurate encounter data, evaluated at a cate-
gory of service level, that fails to conform to department developed
benchmarks for completeness and accuracy, the Medicaid capitated premi-
ums shall be reduced by one percent; and
(C) for submitted data that results in a rejection rate in excess of
ten percent of department developed volume benchmarks, the Medicaid
capitated premiums shall be reduced by one-quarter percent.
(iii) For incomplete or inaccurate encounter data, identified in the
course of an audit, investigation or review by the Medicaid inspector
general, the Medicaid capitated premiums shall be reduced by an addi-
tional one percent.
§ 21. Paragraph (x) of subdivision (b) of section 364-jj of the social
services law, as amended by section 39 of part C of chapter 60 of the
laws of 2014, is amended to read as follows:
(x) in accordance with the recommendations of the joint advisory coun-
cil established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental disabilities with
respect to the oversight of DISCOs and of health maintenance organiza-
tions and [managed] long term care [plans] OPTIONS providing services
authorized, funded, approved or certified by the office for people with
developmental disabilities, and review all managed care options provided
to persons with developmental disabilities, including: the adequacy of
support for habilitation services; the record of compliance with
requirements for person-centered planning, person-centered services and
community integration; the adequacy of rates paid to providers in
accordance with the provisions of [paragraph 1 of] subdivision four of
section forty-four hundred three of the public health law, paragraph
(a-2) of subdivision eight of section forty-four hundred three of the
public health law or [paragraph (a-2) of subdivision twelve of] section
forty-four hundred three-f of the public health law; and the quality of
life, health, safety and community integration of persons with develop-
mental disabilities enrolled in managed care; and
§ 22. Subdivision 6 of section 365-f of the social services law, as
added by section 50 of part D of chapter 56 of the laws of 2012, is
amended to read as follows:
6. Notwithstanding any inconsistent provision of this section or any
other contrary provision of law, managed care programs established
pursuant to section three hundred sixty-four-j of this title and
[managed] long term care [plans] OPTIONS and other care coordination
models established pursuant to section [four thousand four] FORTY-FOUR
hundred three-f of the public health law shall offer consumer directed
personal assistance programs to enrollees.
S. 7800 12
§ 23. Paragraph (a) of subdivision 4 of section 365-h of the social
services law, as amended by section 2 of part LL of chapter 56 of the
laws of 2020, is amended to read as follows:
(a) The commissioner of health is authorized to assume responsibility
from a local social services official for the provision and reimburse-
ment of transportation costs under this section. If the commissioner
elects to assume such responsibility, the commissioner shall notify the
local social services official in writing as to the election, the date
upon which the election shall be effective and such information as to
transition of responsibilities as the commissioner deems prudent. The
commissioner is authorized to contract with a transportation manager or
managers to manage transportation services in any local social services
district, other than transportation services provided or arranged for
enrollees of [managed long term care plans issued certificates of
authority under] A PACE OR MAP PLAN AS DEFINED BY section forty-four
hundred three-f of the public health law. Any transportation manager or
managers selected by the commissioner to manage transportation services
shall have proven experience in coordinating transportation services in
a geographic and demographic area similar to the area in New York state
within which the contractor would manage the provision of services under
this section. Such a contract or contracts may include responsibility
for: review, approval and processing of transportation orders; manage-
ment of the appropriate level of transportation based on documented
patient medical need; and development of new technologies leading to
efficient transportation services. If the commissioner elects to assume
such responsibility from a local social services district, the commis-
sioner shall examine and, if appropriate, adopt quality assurance meas-
ures that may include, but are not limited to, global positioning track-
ing system reporting requirements and service verification mechanisms.
Any and all reimbursement rates developed by transportation managers
under this subdivision shall be subject to the review and approval of
the commissioner.
§ 24. Subparagraph (vi) of paragraph (b) of subdivision 4 of section
365-h of the social services law, as added by section 2 of part LL of
chapter 56 of the laws of 2020, is amended to read as follows:
(vi) Responsibility for transportation services provided or arranged
for enrollees of [managed] long term care [plans issued certificates of
authority] OPTIONS under section forty-four hundred three-f of the
public health law, not including a program designated as a Program of
All-Inclusive Care for the Elderly (PACE) as authorized by Federal
Public law 1053-33, subtitle I of title IV of the Balanced Budget Act of
1997, and, at the commissioner's discretion, other plans that integrate
benefits for dually eligible Medicare and Medicaid beneficiaries based
on a demonstration by the plan that inclusion of transportation within
the benefit package will result in cost efficiencies and quality
improvement, shall be transferred to a transportation management broker
that has a contract with the commissioner in accordance with this para-
graph. Providers of adult day health care may elect to, but shall not be
required to, use the services of the transportation management broker.
§ 25. Subdivision 14 of section 366 of the social services law, as
amended by section 1 of part NN of chapter 57 of the laws of 2021, is
amended to read as follows:
14. The commissioner of health may make any available amendments to
the state plan for medical assistance submitted pursuant to section
three hundred sixty-three-a of this title, or, if an amendment is not
possible, develop and submit an application for any waiver or approval
S. 7800 13
under the federal social security act that may be necessary to disregard
or exempt an amount of income, for the purpose of assisting with housing
costs, for individuals receiving coverage of nursing facility services
under this title, other than short-term rehabilitation services, and for
individuals in receipt of medical assistance while in an adult home, as
defined in subdivision twenty-five of section two of this chapter, who:
are (i) discharged to the community; and (ii) if eligible, enrolled or
required to enroll and have initiated the process of enrolling in a
[plan certified] LONG TERM CARE OPTION pursuant to section forty-four
hundred three-f of the public health law; and (iii) do not meet the
criteria to be considered an "institutionalized spouse" for purposes of
section three hundred sixty-six-c of this title.
§ 26. This act shall take effect immediately; provided, however, that:
(i) sections two, five, six, seven, eight, nine, ten, eleven, twelve,
thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen,
twenty, twenty-one, twenty-two, twenty-three, twenty-four and twenty-
five of this act shall take effect April 1, 2026.
(ii) the amendments to paragraph (o) of subdivision 2 of section 365-a
of the social services law made by section five of this act shall not
affect the expiration and/or repeal of such paragraph and shall be
deemed to expire therewith;
(iii) the amendments to paragraph (h) of subdivision 3 of section 218
of the elder law made by section eight of this act shall be subject to
the repeal of such paragraph and shall expire and be deemed repealed
therewith;
(iv) the amendments to subparagraph (i) of paragraph (e) of subdivi-
sion 3, paragraphs (b) and (c) of subdivision 27, subdivision 31 and
paragraphs (a) and (c) of subdivision 32 of section 364-j of the social
services law made by sections seventeen, eighteen, nineteen and twenty
of this act shall be subject to the repeal of such section and shall
expire and be deemed repealed therewith;
(v) the amendments to paragraph (x) of subdivision (b) of section
364-jj of the social services law made by section twenty-one of this act
shall be subject to the expiration of such section and shall expire and
be deemed repealed therewith; and
(vi) the amendments to section 365-h of the social services law made
by sections twenty-three and twenty-four of this act shall be subject to
the expiration of such section and shall expire and be deemed repealed
therewith.
Effective immediately, the commissioner of health shall promulgate any
rules and regulations and take steps, including requiring the submission
of reports or surveys, submission and receipt of state plans, and neces-
sary federal waivers, as may be necessary for the timely implementation
of this act on such effective date.
