Directs the commissioner of health to provide for more comprehensive management and administration of providers of managed long term care

BILL NUMBER:S7600

Title of bill

An act to amend the public health law, in relation to the management and administration of managed long term care plans

Purpose

To clarify service delivery and operational roles, duties and activities, and to facilitate coordination, efficiency and quality, in the delivery of managed care-home care contracted services.

Summary of provisions

Section one amends the public health law to direct the Commissioner of Health to develop a listing of the respective responsibilities for the provision of services by managed long term care plans and home care providers. The delineation of plan-provider responsibilities would include, but not be limited to, responsibilities for: enrollee assessment; supervision of direct care personnel; procurement, maintenance and updating of medical orders; recordkeeping; and reporting.

The listing would provide for clarity of plan-provider responsibility, minimize plan-provider duplication, reconcile any conflicting regulations and program requirements, and otherwise streamline plan-provider duties for program operation and delivery of care. The commissioner would seek the participation and assistance of representatives of the home care workgroup, managed long term care plans, licensed home care services agencies, certified home health agencies, long term home health care programs and statewide associations representative of such plans and providers in the delineation and streamlining of such responsibilities.

The bill requires that the Commissioner issue such delineation no later than sixty days following the effective date of the bill.

The bill also requires the Commissioner, in consultation with the department of financial services, to examine and, within sixty days of the bill's effective day, make recommendations to the legislature regarding the feasibility and appropriateness of creating system-wide efficiencies through establishment of payment practices, including but not limited to: uniform billing codes; timeframes for the provision of written authorization for services and payment; payment assurances for services provided based on verbal authorization; and, requirements for electronic payment.

Section 2 establishes an immediate effective date for the bill.

Justification

This bill is necessary to effectively and efficiently implement the state's major policy changes and system redesign of incorporating Medicaid and Medicaid-Medicare long term care services under manage care plans.

The bill would implement key recommendations of the State's Home and Community Based Services Regulatory Workgroup established by the 2013-14 state budget and continued in the 2014-15 state budget. These recommendations were also substantially based in testimony, input and proposals received from the affected health care sectors.

This bill would address vital concerns and system improvements for the home care providers and health plans faithfully working to implement the state's reform and redesign efforts.

Legislative history

New bill.

Fiscal implications

None.

Effective date

This bill shall take effect immediately.