Relates to developmental disabilities managed care plan; repealer

This bill would: (1) amend the Social Services Law (SSL) to make conforming programmatic changes for the Office for People With Developmental Disabilities (OPWDD) implementation of a managed care waiver; and (2) amend the Mental Hygiene Law (MHL) to authorize a streamlined contracting process for implementation of certain portions of the OPWDD managed care waiver.

Summary of Provisions:

Section 1 of the bill would add a new definition to SSL § 364-j (1) to define a "developmental disabilities managed care plan" as a managed care plan that has received a certificate of authority under Public Health Law § 4403-g.

Section 2 of the bill would amend SSL § 364-j (3)(a) to modify the requirement that everyone receiving or eligible for Medicaid who lives in a social services district that implemented the state's managed care program must participate in the managed care program ,authorized by § 364-j, to provide that participation in a developmental disabilities managed care plan is governed by the provisions of Public Health Law § 4403-g and Mental Hygiene Law

§ 13.40. This clarifies that persons eligible to enroll in a developmental disabilities managed care plan are only required to do so if the conditions for mandatory enrollment in Public Health Law 4403-g are met.

Section 3 of the bill would amend SSL § 364-j(4)(a)(i) to clarify that a developmental disabilities managed care plan is only required to arrange for primary care if it is authorized to cover such services by its certificate of authority.

Section 4 of the bill would amend SSL§ 364-j(4)(b) to clarify that: (1) recipients eligible to enroll can be limited to one plan in a county if there is federal approval; and (2) a developmental disabilities managed care plan is only required to arrange for primary care if it is authorized to cover such services by its certificate of authority.

Section 5 of the bill would amend SSL§ 364-j(4)(c) to clarify that: (1) the requirement that enrollees in managed care plans select a primary care practitioner from those designated by the plan does not apply to developmental disabilities managed care plans not authorized to arrange for primary care; (2) the right of enrollees to at least three primary care practitioners does not apply to developmental disabilities managed care plans not authorized to arrange for primary care; and (3) a developmental disabilities managed care plan not

authorized to arrange for primary care is not required to select a primary care provider for an enrollee who does not make such a selection.

Section 6 of the bill would: (1) amend SSL § 364-j(4)(e)(iv), (v) and (vi) to reflect that OPWDD, rather than local social services districts, will provide enrollment counseling for persons enrolling in developmental disabilities managed care plans, and to clarify that subsection (v) does not apply to enrollment in a developmental disabilities managed care plan; and (2) amend SSL § 364-j(4)(e)(vii) to allow OPWDD a role in approving marketing materials for developmental disabilities managed care plans.

Section 7 of the bill would add a new subparagraph (vi) to paragraph (f) of SSL § 364-j(4) to exempt persons enrolling in developmental disabilities managed care plans from the provisions of such paragraph (f).

Section 8 of the bill would amend SSL § 364-j(4)(g) to allow persons to enroll in a developmental disabilities managed care plan at any time and to change developmental disabilities managed care plans at any time without cause.

Section 9 of the bill would amend SSL § 364-j(4)(h) to exempt enrollees in developmental disabilities managed care plans from the restrictions on changing providers of Medical services.

Section 10 of the bill would amend SSL § 364-j(4)(i) to prohibit developmental disabilities managed care plans from involuntarily disenrolling a person without prior approval of the commissioner of developmental disabilities and without complying with standards of the commissioners of health and developmental disabilities.

Sections 11, 12 and 13 of the bill would amend various subdivisions of SSL § 364-j (4) to exempt developmental disabilities managed care plans from the requirements to cover early periodic screening diagnostic and treatment services, prenatal services and chemical dependence treatment services if such plans are not authorized to cover such services.

Section 14 of the bill would amend SSL § 364-j(5)(g) to prohibit the commissioner of health from delegating tasks to the local districts with respect to developmental disabilities managed care plans.

Section 15 of the bill would amend SSL § 364-j(6) to allow OPWDD to approve marketing materials for developmental disabilities managed care plans.

Section 16 of the bill would amend SSL § 364-j(8)(f)(ii) to exempt developmental disabilities managed care plans not authorized to cover primary care services from the requirement to allow enrollees to select from at least three primary care providers.

Section 17 of the bill would amend SSL§ 364-j(27)(f) to correct a grammatical error.

Section 18 of the will would amend MHL § 13.40(g) to authorize a streamlined contracting process with appropriate notice for the award of start up funds for developmental disabilities individual support and care coordination care organizations.

Section 19 of the of the bill would amend MHL§ 13.40 to add a new subdivision (h) allowing the commissioners of health and developmental disabilities to use a streamlined contracting process for contracts for services related to quality assessment, quality improvement, assessments of enrollees, enrollment counseling and enrollment processing, outside advocacy and information technology as needed to oversee and develop, operate and oversee a managed care system under the people first waiver program.

Section 20 of the bill would repeal MHL § 41.39 (a) through (m) and 41.36 (o), which are no longer necessary with the transfer of rate setting responsibilities to the Department of Health.

Section 21 of the bill would amend MHL § 41.36(n) to provide for the use of person-first language.

Section 22 of the bill would amend MHL § 43.02(a) to allow the Department of Health to certify Medicaid rates or fees for services where it revises methodologies as a condition of federal approval for the People First Waiver Program, and to require that such methodologies take into account the policies and goals of OPWDD.

Section 23 of the bill would amend MHL § 43.02(c) to require that regulations including methodologies developed by the Department of Health be adopted by the Department.

Section 24 of the bill would provide for an immediate effective date.

Existing Law:

SSL § 364-j generally sets standards for managed care programs for medical assistance recipients. MI-1L § 13.40 governs the People First Waiver Program, the managed care program for individuals with developmental disabilities currently being negotiated by the State and federal governments.

Prior Legislative History:

This is a new bill.

Statement in Support:

OPWDD and the federal Centers for Medicare & Medicaid Services (CMS) continue negotiations to implement the People First Waiver, a managed care program for individuals with developmental disabilities which will be overseen by OPWDD. Last year, legislation was enacted authorizing the People First Waiver and reflecting negotiations with CMS to date. This bill represents additional programmatic modifications based on ongoing federal requirements, and authorizes OPWDD to add additional functions necessary for implementing the Waiver to the streamlined contracting and notice processes enacted last year.

Budget Implications:

This bill will facilitate the implementation of the People First Waiver Program and will allow the savings associated with such program to occur.

Local Impact:

This bill has no anticipated local impact.

Effective Date:

This bill would provide for an immediate effective date.