S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    700
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  M. of A. GONZALEZ-ROJAS, PAULIN, SIMON, LUPARDO, SIMONE,
   WEPRIN,  ROSENTHAL,  KELLES,  MAMDANI,  DINOWITZ,  SAYEGH,   SHRESTHA,
   FORREST,  REYES,  GALLAGHER, ALVAREZ, GLICK, KIM, EPSTEIN -- 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01012-01-5
 A. 700                              2
 
 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-FIVE:
   (A)  STATEWIDE  AND  REGIONAL  SERVICE UTILIZATION DATA FOR EACH PLAN,
 WITH THE NUMBER AND PERCENTAGE OF "MEMBER MONTHS"  AUTHORIZED  FOR  EACH
 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
 A. 700                              3
 
   (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
 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 repealed 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  and  be  deemed  repealed
 therewith.