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A07369 Summary:

Amd 364-j, Soc Serv L
Provides that services to medical assistance recipients suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services shall be provided outside of managed care programs.
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A07369 Actions:

05/18/2023referred to health
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A07369 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
  TITLE OF BILL: An act to amend the social services law, in relation to the provision of services to certain persons suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services   PURPOSE: To prevent waivered Medicaid services provided to persons suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services from being provided to Medicaid recipients through managed care programs.   SUMMARY OF PROVISIONS: Section 1 of the bill amends section 364-j of the social services law to amend paragraph (d-2) preventing service provided pursuant to the Trau- matic Brain Injury and Nursing Home Transition and Diversion (TEI/NHTD) Waiver programs from being provided through Medicaid Managed Care and directing the Commissioner of Health to take any action necessary to continue provisions of these services through waivers. Section 2 of the bill provides for an immediate effective date.   JUSTIFICATION: Individuals who suffer from traumatic brain injury (TBI) and are served by a Medicaid waiver or who have some other disabilities that qualify them for the Nursing Home Transition and Diversion Waiver (NHTD) have varied physical and cognitive disabilities that make them particularly vulnerable to institutionalization. The Federal Medicaid Waivers were established many years ago because the state recognized these vulner- abilities and needs for special services and supports to help individ- uals live in the most integrated setting appropriate. These programs have served as a national model. Given the unique needs of this small population of Medicaid recipients, the legislature introduced legislation in 2015 to delay the move of the TBI/NHTD waivered population into managed care and require that a work group of stakeholders be convened to make recommendations on transition of these services into managed care. The Department of Health ultimate- ly committed to delay the transition until January 2017 and created a work group. In January 2016 the Department shared its draft transition plan with the workgroup and concerns were raised that the draft transition plan did not reflect the workgroup's recommendations nor conversations with the Department. A series of further weekly meetings were scheduled as a result. Of particular concern has been the assessment tool; how existing services fit into managed care; and the process by which plans would qualify individuals and determine approved services, particularly for individuals who may find themselves with a traumatic brain injury or other disability after the move to Medicaid managed care. Managed Long Term Care Plans have also expressed concerns about taking on this population. New York is still in the midst of moving other popu- lations into managed care and those transitions are far from complete or without concerns. Managed Long Term Care Plans, who would enroll TBI/NHTD individuals, are self-reporting that they are already in a fragile state with many of those plans experiencing operating losses. As part of the SFY 2016-17 budget, the date for transitioning the TBI/NHTD program participants into managed care was further extended until at least January 1, 2018. As part of the SFY 2018-19 budget, the date was extended again until January 1, 2022. There are no cost savings associated with moving TBI/NHTD into managed care and given the vast changes the Medicaid program is currently undergoing, as well as the concerns raised by patient advocates, providers, and health plans alike, the State would be best served by placing all its attention on the popu- lations it has already begun moving into managed care. Moving the vulnerable populations served under the TBI/NHTD waiver into managed care would be a tremendous disservice to all involved.   LEGISLATIVE HISTORY: 2016: A9397 Referred to Health; passed Senate 2017: A2442 Reported to W&M; passed Senate 2018: A2442 Referred to W&M / passed Senate 2019: A2798 Reported to W&M / Senate Health 2020: A2798 Reported to Rules / Senate Health 2021/22: A192 (Gottfried)   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None   EFFECTIVE DATE: Immediately.
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A07369 Text:

                STATE OF NEW YORK
                               2023-2024 Regular Sessions
                   IN ASSEMBLY
                                      May 18, 2023
        Introduced by M. of A. McDONALD -- read once and referred to the Commit-
          tee on Health
        AN ACT to amend the social services law, in relation to the provision of
          services to certain persons suffering from traumatic brain injuries or
          qualifying for nursing home diversion and transition services

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1.  Paragraph (d-2) of subdivision 3 of section 364-j  of  the
     2  social services law, as amended by section 1 of part II of chapter 57 of
     3  the laws of 2021, is amended to read as follows:
     4    (d-2)  Services  provided  pursuant  to  waivers,  granted pursuant to
     5  subsection (c) of section 1915 of the federal social  security  act,  to
     6  persons  suffering from traumatic brain injuries or qualifying for nurs-
     7  ing home diversion and transition services, shall  not  be  provided  to
     8  medical  assistance  recipients  through managed care programs [until at
     9  least January first, two thousand twenty-six]  established  pursuant  to
    10  this section; provided, further that the commissioner of health is here-
    11  by  directed  to  take any action required, including but not limited to
    12  filing waivers and waiver  extensions  as  necessary  with  the  federal
    13  government, to continue the provision of such services.
    14    §  2. This act shall take effect immediately, provided that the amend-
    15  ments to section 364-j of the social services law, made by  section  one
    16  of  this  act, shall not affect the repeal of such section, and shall be
    17  deemed repealed therewith.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
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