§ 13.40 People first waiver program.

(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, providing 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.

(b) Entities providing services pursuant to this section shall provide
health and long term care services as the term is defined in section
forty-four hundred three-g 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 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 pursuant to subdivision
twenty-seven of section three hundred sixty-four-j of the social
services law are operating in such person's county of residence to meet
the needs of persons with developmental disabilities, and that such
entities meet the standards of this section. No person shall be required
to enroll in a DISCO, HMO or MLTC 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, 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 the social services law, shall accept as full
reimbursement the negotiated 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 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.

(e) 1. The commissioner and the commissioner of health shall identify
one or more valid and reliable quality assurance instruments that
include assessments of individual and family satisfaction, provision of
services, and personal outcomes. The instruments shall:

(1) provide nationally validated, benchmarked, consistent, reliable
and measurable data for a comprehensive quality improvement and review
process, and

(2) include outcome-based measures such as health, safety, well-being,
relationships, interactions with people who do not have a disability,
employment, quality of life, integration, choice, service and consumer
satisfaction.

2. Within available appropriations, the instruments identified in this
subdivision may be expanded to collect additional data requested by
other offices, departments or agencies of the state, local or federal
government.

3. The commissioner may contract with an independent agency or
organization for the development of the quality assurance instruments
described in this subdivision.

4. The commissioner shall establish the methodology by which the
quality assurance instruments shall be administered.

5. The commissioner, in consultation with stakeholders, shall annually
review the data collected from the quality assurance instruments
described in this subdivision and shall review recommendations regarding
additional or different criteria for the quality assurance instruments
in order to assess the performance of the state's developmental
disabilities services system and improve services for consumers.

(f) There shall be a joint advisory council chaired by the
commissioner 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 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 disabilities,
family members of, advocates for, and providers of services to people
with developmental disabilities. Three members of the joint advisory
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
developmental 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 subdivision four of section forty-four hundred three of the
public health law, paragraph a-two of subdivision eight of section
forty-four hundred three of the public health law or paragraph a-two of
subdivision 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 developmental 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 advisory council shall have access to any and all
information that may be lawfully disclosed to it and that is necessary
to perform its functions under this section.

(g) 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
subdivision twelve of section forty-four hundred three-f of the public
health law, provided, however, that:

1. the office shall post on its website, for a period of no less than
thirty days:

(1) a description of the proposed services to be provided pursuant to
the contract or contracts;

(2) the criteria for selection of a contractor or contractors;

(3) the period of time during which a prospective contractor may seek
selection, which shall be no less than thirty days after such
information is first posted on the website; and

(4) the manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;

2. all reasonable and responsive submissions that are received from
prospective contractors in a timely fashion shall be reviewed by the
commissioners; and

3. the commissioner and the commissioner of health may jointly select
such contractor or contractors that, in their discretion, have
demonstrated the ability to effectively, efficiently and economically
integrate health and long term care services as defined in section
forty-four hundred three-g of the public health law, and meet the
standards for a certificate of authority in the public health law for
the provision of services operated, funded, certified, authorized or
approved by the office for people with developmental disabilities and
applicable to the type of managed care plan that such contractor
proposes to operate.

* (h) Consistent with and subject to the terms of federal approval,
the commissioner shall establish the managed care for persons with
developmental disabilities advocacy program, hereinafter referred to as
the advocacy program. The activities of the advocacy program shall be
coordinated 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
coordination 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
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 organization
or organizations to provide advocacy services under this subdivision.

* NB Effective upon approval by the federal centers for medicare and
medicaid services of a managed care advocacy program for individuals
with developmental disabilities