Relates to the transition of traumatic brain injury waiver and nursing home transition and diversion waiver program services to Medicaid managed care programs

2 Co-sponsors

• Thomas Croci
• William J. Larkin Jr.

BILL NUMBER:S5535

Title of bill

An act to amend the public health law, in relation to the transition of traumatic brain injury waiver and nursing home transition and diversion waiver program services to Medicaid managed care programs

Purpose or general idea of bill

This bill delays the transition of persons receiving services under the traumatic brain injury (TBI) waiver or nursing home transition and diversion (NHTD) waiver into Medicaid managed care and creates a work group to develop recommendations relating to that transition.

Summary of specific provisions

Section 1. Adds a new sub-paragraph (v-a) to paragraph (b) of subsection (7) of section 4403-f of the public health law delaying the transition of TBI and NHTD waiver populations into Medicaid managed care until at least April 1, 2017; provides that the commissioner shall convene a work group to develop recommendations on transitioning these populations and spells out membership and responsibilities of the work group.

Section 2. Effective date - immediate

Justification

Over the past 20 years, the traumatic brain injury (TBI) waiver and nursing home transition and diversion (NHTD) waiver have allowed highly sensitive populations to be cared for by specialized providers in the community, avoiding costly institutionalized care. Patients' families and providers have raised concerns about the scheduled transition of these populations out of the TBI and NHTD programs and into Medicaid managed care. While the State plans to transfer these populations into Medicaid managed care in January 2016 (NHTD) and April 2016 (TBI), many questions remain about these populations' access to appropriate provid- ers and ability to stay in the community under the new system.

The 1999 Supreme Court Olmstead decision ruled that unjustified segre- gation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act.

Consistent with the State's obligations under Olmstead, to ensure that these populations continue receiving community-based services whenever possible and are not inadvertently redirected to nursing home settings, this bill would delay implementation for a year and establish a trans- parent process through which consumers, providers, payers and other stakeholders could provide input in developing an operationally viable transition plan.

Prior legislative history

New bill

Fiscal implications

None

Effective date

Immediate