Creates the managed care for persons with developmental disabilities advocacy program

2 Co-sponsors

• Mark Grisanti
• Cecilia Tkaczyk

BILL NUMBER:S4885A

Title of bill

An act to amend the mental hygiene law, in relation to the creation of the managed care for persons with developmental disabilities advocacy program

Purpose or general idea of bill

The purpose of this bill is to establish the Managed Case for Persons with Developmental Disabilities Advocacy Program for purposes of assisting persons receiving services from the Office of People with Developmental Disabilities (OPWDD) to navigate the managed care system.

Summary of specific provisions

Section 1 of the bill creates the Managed Case for Persons with Developmental Disabilities Advocacy Program. The advocacy program shall advise individuals of applicable rights and responsibilities, provide information, referrals and technical assistance to address the needs of the individual, and pursue legal, administrative and other appropriate remedies or approaches to ensure the protection of and advocacy for the rights of the enrollees.

Section 2. Clarifies that the bill does not intend to transfer to the advocacy program any current duties, including Medicaid Service Coordination, of state employees employed by OPWDD.

Section 3 of the bill is the effective date.

Justification

The 2013-14 state budget authorizes the State to enroll individuals receiving OPWDD services to risk bearing Medicaid managed care plans starting in 2014. This is a significant change to the OPWDD system which has historically been a fee for service system.

Currently, OPWDD recipients receive care coordination from an independent third party, known as the Medicaid Service Coordination (MSC) program. As OPWDD services transition to managed care, many functions of this program will be assumed by managed care companies. Managed care companies cannot reasonably assume certain advocacy functions of the MSC program because the managed care company will often have a financial interest in denying certain services. For this reason, many stakeholders have expressed the need for additional outside advocates to be available to assist enrollees.

This bill ensures that persons receiving OPWDD services continue to receive independent advocacy after being enrolled in a managed care plan by creating a Managed Care for Persons with Developmental Disabilities Advocacy Program. The program will advise individuals of applicable rights and responsibilities, including, but not limited to, the right to treatment, person centered care, care in the most integrated setting, and the right to contest decisions made by a managed care company; ' provide information, referrals and technical 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. This program will help ensure that enrollees continue to receive adequate care and that they have adequate input in their plan of care.

Prior legislative history

New bill.

Fiscal impact

To be determined.

Effective date

This act shall take effect immediately.