Relates to developmental disability individual support and care coordination organizations (DISCOs)

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 who is eligible for, or receiving Medicaid, and 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 in accordance with the provisions of Public Health Law § 4403-g and Mental Hygiene Law § 13.40.

Section 3 of the bill would amend SSL § 364-j(4)(a)(i) to clarify that a DISCO 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: (1) clarify that Medicaid recipients 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; (2) clarify that recipients eligible to enroll can be limited to one plan in a county if there is federal approval; and (3) 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 5 of the bill would amend SSL§ 364-j(4)(c) to clarify that 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, and that 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.

Section 6 of the bill would: amend SSL § 364-j(4)(e)(iv), (v), (vi) and (vii) to reflect that OPWDD, rather than local social services districts, will provide enrollment counseling for persons enrolling in

developmental disabilities managed care organizations, and to clarify that subsection (v) does not apply to enrollment in a developmental disabilities managed care plan; and 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 with 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)(b) 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 bill would amend MHL § 43.02(c)(ii) to require that regulations including methodologies developed by the Department of Health be adopted by the Department.

Section 19 and 20 of the bill would amend MHL §§ 43.04(2) and 43.04(4) to make conforming changes to language in Section 20.

Section 21 of the bill would amend MHL § 5.07(b)(3) to remove the requirement for an interim report detailing the Commissioner's actions with regard to the creation of the annual plan which addresses the annual statewide 5-year comprehensive plan.

Section 22 of the bill would repeal MHL § 5.07(c). Section 23 of the bill would repeal MHL § 13.06.

Section 24 of the bill would amend MHL § 13.21(a) to clarify the Commissioner of OPWDD's appointing authority.

Section 25 of the bill would amend MHL § 13.33(a) to allow the. Board of Visitors to be appointed solely by the Governor.

Section 26 of this bill would repeal § 33.17 of the Mental Hygiene Law.

Section 27 of the bill would provide for the effective date.

Existing Law: SSL § 364-j generally sets standards for managed care programs for medical assistance recipients. The Mental Hygiene Law 5.07 requires a 5-year statewide comprehensive plan for services for the mentally disabled to be submitted annually. This includes the creation of an interim report on the annual update of the 5-year plan and an annual 3-year capital plan. The Mental Hygiene Law § 13.06 requires the Commissioner to submit an annual plan identifying community residences that will be converted to ICFs. The Mental Hygiene Law § 13.33 requires that members of the Boards of Visitors are appointed by the Governor by and with the advice and consent of the Senate. The Mental Hygiene Law § 33.17 currently requires that any female individual being transported to or from a facility must be accompanied by another female unless she is accompanied by her father, brother, husband or son.

Prior Legislative History: This is 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. In 2012, 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.

MHL § 5.07 requires OPWDD, OASAS and OMH to establish statewide goals and objectives to guide a comprehensive planning, resource allocation and evaluation processes for person with developmental disabilities and formulate a 5-year plan for the provision of services. This plan must be updates annually. This section also requires an interim report of the yearly update to the 5 year plan that is unnecessary in light of the annual reporting requirement. The interim plan along with the 3 year Capital plan that is proposed to be eliminated take up an excessive amount of staff time and resources are superfluous in light of the annual required reports on the 5 year plan.

The MHL § 13.06 requires the Commissioner to submit an Annual Plan identifying community residences that will be converted to ICFs. As part of OPWDD's HCBS Transformation Plan the agency is in the process of moving more and more individuals from ICFs to more community based waiver settings and not in the reverse. As such this section of the MHL is no longer necessary.

The elimination of section § 33.17 of the MHL would allow for greater flexibility and efficiency in the OPWDD system as it provides individuals with a greater opportunity engage in the community. MHL 33.17 was implemented when services were primarily provided by a large institutional care. As services are now primarily provided in small community based settings with individuals needing transportation to a wide variety of activities and appointments, this law not longer fits. The deletion of this section of law would allow the OPWDD system to be more responsive to individual requests and needs without being dependent on same gender staffing.

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

Local Impact: This bill has no anticipated local impact.

Effective Date: The bill would be effective immediately, provided, however, that the amendments to section 364-j of the social services law made by sections one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen and seventeen of this act will not affect the repeal of such section and will be deemed repealed therewith.