§ 365-m. Administration and management of behavioral health services.
1. The commissioners of the office of mental health and the office of
alcoholism and substance abuse services, in consultation with the
commissioner of health, the impacted local governmental units and with
the approval of the division of the budget, shall have responsibility
for jointly designating regional entities to provide administrative and
management services for the purposes of prior approving and coordinating
the provision of behavioral health services, facilitating the continuity
of post-hospitalization behavioral health and the integration of
behavioral health services with other services available under this
title, for recipients of medical assistance who are not enrolled in
managed care, and for such approval, coordination, facilitating
continuity and integration of behavioral health services that are not
provided through managed care programs under this title for individuals
regardless of whether or not such individuals are enrolled in managed
care programs. Such regional entities shall also be responsible for
promoting appropriate care and service utilization while safeguarding
against unnecessary utilization of such care and services and assuring
that payments are consistent with the efficient and economical delivery
of quality care.

2. In exercising this responsibility, the commissioners of the office
of mental health and the office of alcoholism and substance abuse
services are authorized to contract, after consultation with the
commissioner of health and the impacted local governmental units, with
regional behavioral health organizations or other entities. Such
contracts may include responsibility for receipt, review, and
determination of prior authorization requests for behavioral health care
and services under subdivision one of this section, consistent with
criteria established or approved by the commissioners of mental health
and alcoholism and substance abuse services, and authorization of
appropriate care and services based on documented patient medical need.

3. 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 commissioners of the office of mental health and
the office of alcoholism and substance abuse services are authorized to
enter into a contract or contracts under subdivisions one and two of
this section without a competitive bid or request for proposal process,
provided, however, that:

(a) the office of mental health and the office of alcoholism and
substance abuse services shall post on their websites, for a period of
no less than thirty days:

(i) a description of the proposed services to be provided pursuant to
the contractor contracts;

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

(iii) 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

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

(b) all reasonable and responsive submissions that are received from
prospective contractors in timely fashion shall be reviewed by the
commissioners; and

(c) the commissioners of the office of mental health and the office of
alcoholism and substance abuse services, in consultation with the
commissioner of health and the impacted local governmental units, shall
select such contractor or contractors that, in their discretion, have
demonstrated the ability to effectively, efficiently, and economically
integrate behavioral health and health services; have the requisite
expertise and financial resources; have demonstrated that their
directors, sponsors, members, managers, partners or operators have the
requisite character, competence and standing in the community, and are
best suited to serve the purposes of this section. In selecting such
contractor or contractors, the commissioners shall:

(i) ensure that any such contractor or contractors have an adequate
network of providers to meet the behavioral health and health needs of
enrollees, and shall review the adequacy prior to approval of any such
contract or contracts, and upon contract renewal or expansion. To the
extent that the network has been determined to meet standards set forth
in subdivision five of section four thousand four hundred three of the
public health law, such network shall be deemed adequate.

(ii) ensure that such contractor or contractors shall make level of
care and coverage determinations utilizing evidence-based tools or
guidelines designated to address the behavioral health needs of
enrollees.

(iii) ensure sufficient access to behavioral health and health
services for eligible enrollees by establishing and monitoring
penetration rates of any such contractor or contractors.

(iv) establish standards to encourage the use of services, products
and care recommended, ordered or prescribed by a provider to
sufficiently address the behavioral health and health services needs of
enrollees; and monitor the application of such standards to ensure that
they sufficiently address the behavioral health and health services
needs of enrollees.

4. The commissioners of the office of mental health, the office of
alcoholism and substance abuse services and the department of health,
shall have the responsibility for jointly designating on a regional
basis, after consultation with the local social services district and
local governmental unit, as such term is defined in the mental hygiene
law, of a city with a population of over one million persons, and after
consultation of other affected counties, a limited number of special
needs managed care plans under section three hundred sixty-four-j of
this title capable of managing the behavioral and physical health needs
of medical assistance enrollees with significant behavioral health
needs. Initial designations of such plans should be made no later than
April first, two thousand fourteen, provided, however, such designations
shall be contingent upon a determination by such state commissioners
that the entities to be designated have the capacity and financial
ability to provide services in such plans, and that the region has a
sufficient population and service base to support such plans. Once
designated, the commissioner of health shall make arrangements to enroll
such enrollees in such plans and to pay such plans on a capitated or
other basis to manage, coordinate, and pay for behavioral and physical
health medical assistance services for such enrollees. Notwithstanding
any inconsistent provision of section one hundred twelve and one hundred
sixty-three of the state finance law, and section one hundred forty-two
of the economic development law, or any other law to the contrary, the
designations of such plans, and any resulting contracts with such plans
or providers are authorized to be entered into by such state
commissioners without a competitive bid or request for proposal process,
provided however that:

(a) the department of health, the office of mental health and the
office of alcoholism and substance abuse services shall post on their
websites, for a period of not less than thirty days:

(i) a description of the proposed services to be provided by the plans
or systems;

(ii) the criteria for selection of a plan or system;

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

(iv) the manner by which a prospective plan or system may seek such
selection, which may include submission by electronic means;

(b) all reasonable and responsive submissions that are received from
prospective plans or systems in timely fashion shall be reviewed by the
commissioners; and

(c) the commissioners of the office of mental health and the office of
alcoholism and substance abuse services, in consultation with the
commissioner of health, shall select such plans or systems that, in
their discretion, have demonstrated the ability to effectively,
efficiently, and economically manage the behavioral and physical health
needs of medical assistance enrollees with significant behavioral health
needs; have the requisite expertise and financial resources; have
demonstrated that their directors, sponsors, members, managers, partners
or operators have the requisite character, competence and standing in
the community, and are best suited to serve the purposes of this
section. Oversight of such contracts with such plans, providers or
provider systems shall be the joint responsibility of such state
commissioners, and for contracts affecting a city with a population of
over one million persons, also with the city's local social services
district and local governmental unit, as such term is defined in the
mental hygiene law.
In selecting such plans or systems, the commissioners shall:

(i) ensure that any such plans or systems have an adequate network of
providers to meet the behavioral health and health needs of enrollees,
and shall review the adequacy prior to approval of any such plans or
systems, and upon contract renewal or expansion. To the extent that the
network has been determined to meet standards set forth in subdivision
five of section four thousand four hundred three of the public health
law, such network shall be deemed adequate.

(ii) ensure that such plans or systems shall make level of care and
coverage determinations utilizing evidence-based tools or guidelines
designed to address the behavioral health needs of enrollees.

(iii) ensure sufficient access to behavioral health and health
services for eligible enrollees by establishing and monitoring
penetration rates of any such plans or systems.

(iv) establish standards to encourage the use of services, products
and care recommended, ordered or prescribed by a provider to
sufficiently address the behavioral health and health services needs of
enrollees; and monitor the application of such standards to ensure that
they sufficiently address the behavioral health and health services
needs of enrollees.

5. (a) Pursuant to appropriations within the offices of mental health
or addiction services and supports, the department of health shall
reinvest savings realized through the transition of populations covered
by this section from the applicable Medicaid fee-for-service system to a
managed care model, including savings realized through the recovery of
premiums from managed care providers which represent a reduction of
spending on qualifying behavioral health services against established
premium targets for behavioral health services and the medical loss
ratio applicable to special needs managed care plans, for the purpose of
increasing investment in community based behavioral health services,
including residential services certified by the office of addiction
services and supports. The methodologies used to calculate the savings
shall be developed by the commissioner of health and the director of the
budget in consultation with the commissioners of the office of mental
health and the office of addiction services and supports. In no event
shall the full annual value of the reinvestment pursuant to this
subdivision exceed the value of the premiums recovered from managed care
providers which represent a reduction of spending on qualifying
behavioral health services. Within any fiscal year where appropriation
increases are recommended for reinvestment, insofar as managed care
transition savings do not occur as estimated, then spending for such
reinvestment may be reduced in the next year's annual budget
itemization.

(b) Beginning April first, two thousand twenty-two, the department
shall post on its website information about the recovery of premiums
from managed care providers which represent a reduction of spending on
qualifying behavioral health services against established premium
targets for behavioral health services and the medical loss ratio
applicable to special needs managed care plans. Such information shall
include at a minimum: (i) a copy of the department's notification to
each managed care provider that seeks a recovery of such premiums; and
(ii) a list of managed care providers by name that have been subject to
a recovery of such premiums, specifying the amount of premium that has
been recovered from each managed care provider and year. In the initial
posting, the department shall include all premiums recovered to date as
required by this subdivision, by named managed care provider, amount and
year.

(c) The commissioner shall include information regarding the funds
available for reinvestment, including how savings are calculated and how
the reinvestment was utilized pursuant to this section in the annual
report required under section forty-five-c of part A of chapter
fifty-six of the laws of two thousand thirteen.