Relates to participation in managed long term care plans by certain medical assistance recipients

Section 2: Amends section 2742 of the Public Health Law to create a statewide neurobehavioral resource project subject to appropriation.

Section 3: Amends section 3614-d of the Public Health Law to implement a high needs rate cell for Medicaid claims supplementary to the basic benefit package. Section 4: Directs the Department of Health to study and report to the legislature by December 31, 2017 on the need for and feasibility of repatriation of complex-needs patients placed in out-of-state facilities.

Section 5: Effective date.

Justification

Every year, traumatic brain injury (TBI) results in more than 2,000 deaths, 19,000 hospital admissions, and over 100,000 emergency roomvisits throughout the state. New York's Medicaid program currently provides services to many TBI patients through the TBI and Nursing Home Transition and Diversion (NHTD) Waivers, These programs play a crucial role in supporting TBI patients' ability to stay in environments less restrictive than long-term care facilities. The TBI and NHTD Waiver programs were scheduled for transition into Medicaid Managed Care (MMC) in 2016. However, the legislature, patients, providers, and TBI advocates raised serious concerns about the quality of care in an MMC environment and the Department agreed to an administrative delay until January 2017 and to form a work group on the issue.

Unfortunately, there are still significant concerns about the transition - many raised by the work group itself. It is unclear whether the services present in the TIM and NHTD Waivers particularly service coordination provided to patients at a mandated ratio of no greater than 17 patients per coordinator - will be maintained at an adequate level under MMC. There is also concern that MMC plans will be unwilling to support the current level of care for high-acuity patients and will instead place them into settings requiring less care coordination, such as nursing homes.

In response to these concerns, this bill requires that program services under MMC be at least "substantially comparable" to those spelled out in the current TBI and NHTD Waiver manuals. It also creates a high-needs rate cell under MMC for services supplementary to the basic benefit package that may be necessary for individuals to remain in the most integrated setting appropriate.

Additionally, the bill authorizes a "statewide neurobehavioral resource project" specializing in the evaluation and development of support plans for TBI patients. The statewide neurobehavioral resource project began in 1996 but is no longer active. It employed behavioral specialists to provide technical consultation and training to providers and crisis intervention services. Subject to appropriation, the program could be a valuable tool for ensuring expertise among TBI support staff and coordination with their patients.

Finally, many TBI patients are placed in out-of-state facilities due to lack of appropriate facilities or adequate support programs in New York. This applies to other areas as well, including medically fragile children. Out-of-state placements of any population are disruptive to families, expensive, and difficult to provide quality-of-care oversight. This bill gives the Department until December 31, 2017 to study and report to the legislature on the need for and feasibility of repatriation of complex-needs patients.

Legislative history

New Bill

Fiscal implications

To be determined, for the statewide neurobehavioral resource project and Medicaid high-needs rate cell.

Effective date

Immediately.