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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7369
SPONSOR: McDonald 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.
STATE OF NEW YORK
________________________________________________________________________
7369
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.
LBD01800-01-3
