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History
- Referred to health
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S6583
Title of bill
An act to amend the public health law, in relation to managed long term care plans not being controlled or owned by for-profit health maintenance organizations or insurers
Purpose or general idea of bill
To assure that managed long term care plans are primarily owned by not for profit providers or service entities, to promote best practices consistent with the interests of the recipient.
Summary of specific provisions
Amends the definition of "eligible applicant" for certification as a managed long, term care (MLTC) plan to require eligible insurers and health maintenance organizations be not-for-profit. An exception would recognize entities already certified.
The bill clarifies that an MLTC, or other lawful combinations of long term care providers can participate in accountable care organizations.
Justification
Medicaid long term care (over 120 days) has been reformed to be delivered by care coordination entities, predominantly through risk-bearing managed long term care plans. Currently, this transition is applied to home and community-based services, with institutional (nursing home) care contemplated to be phased in.
MLTCs have, until now been almost exclusively entities owned by long term care providers, not by HMOs or insurance companies. When participation in an MLTC was voluntary, there was little concern that insurance carriers would enter the field. However, now participation in an MLTC is mandatory for many and will become mandatory for more long term care recipients. There is growing interest by for-profit HMOs and insurance companies in forming MLTCs. With their economic resources they could easily come to dominate the field. So there is growing concern that patients may ultimately have no choice but to enroll in for-profit insurance carrier-owned MLTCs.
The individuals affected by this transition are primarily those with chronic conditions, many who are elderly or otherwise affected with life-limiting illness. Care and service decisions for these individuals should not be measured against profit margins of shareholders. Other states' experience in this area has proven that provider-based MLTCs, which most all of New York MLTCs currently are, deliver both the quality and the savings expected.
Prior legislative history
New bill
Fiscal implications
None
Effective date
Immediately
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.