What's happening
This bill restricts managed long term care plans to not-for-profit ownership, barring for-profit insurers, with exceptions for certain grandfathered entities.
Why it matters
Shifts managed long term care plans toward not-for-profit ownership. , aiming to prioritize patient care and community health over shareholder profits, which could affect the quality and focus of services for vulnerable populations like the elderly and disabled.
Grandfathers in certain existing for-profit entities. that already operate under the law, reducing disruption for current enrollees but signaling a clear policy shift for future market entrants.
May reduce market competition by excluding for-profit insurers. , possibly impacting innovation and administrative efficiency, but intended to align the sector more closely with public health goals rather than profit maximization.
Could influence the financial sustainability and administrative practices. of managed long term care plans, as not-for-profits often operate with different cost structures, potentially affecting premiums, provider networks, and service availability.
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Who cares
Headline styles
Ban For-Profit LTC Plans
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Print number 1098a
- Amend and recommit to health
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Ban For-Profit Long-Term Care
Assembly Floor Calendar · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1098--A
2017-2018 Regular Sessions
IN SENATE
January 6, 2017
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the public health law, in relation to managed long term care plans not being controlled or owned by for-profit health maintenance organizations or insurers
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (b) of subdivision 1 of section 4403-f of the public health law, as added by chapter 659 of the laws of 1997, is amended to read as follows:
(b) "Eligible applicant" means an entity controlled or wholly owned by one or more of the following: a hospital as defined in subdivision one of section twenty-eight hundred one of this chapter; a home care agency licensed or certified pursuant to article thirty-six of this chapter; [an] a not-for-profit entity that has received a certificate of authority pursuant to sections forty-four hundred three, forty-four hundred three-a or an integrated delivery system that has received a certificate of authority pursuant to section forty-four hundred eight-a of this article (as added by chapter six hundred thirty-nine of the laws of nineteen hundred ninety-six), or a not-for-profit health maintenance organization authorized under article forty-three of the insurance law; or a not-for-profit organization which has a history of providing or coordinating health care services and long term care services to the elderly and disabled. However, an entity owned or controlled by an entity that has received a certificate of authority pursuant to section forty-four hundred three or forty-four hundred three-a of this article and has received a certificate of authority under this section prior to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00870-04-8
S. 1098--A 2
the effective date of the chapter of the laws of two thousand eighteen which enacted this sentence shall be deemed to be an eligible applicant.
§ 2. This act shall take effect immediately; provided, however, that the amendments to section 4403-f of the public health law made by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to managed long term care plans not being controlled or owned by for-profit health maintenance organizations or insurers
Purpose
To assure that managed long term care plans are primarily owned by not for profit providers or service entities, to promote best practices consistent with the interests of the recipient.
Summary of provisions
Amends the definition of "eligible applicant" for certification as a managed long term care (MLTC) plan to require eligible insurers and health maintenance organizations be not-for-profit. An exception would recognize entities already certified.
Justification
Medicaid long term care (over 120 days) has been reformed to be deliv- ered by care coordination entities, predominantly through risk-bearing managed long term care plans. Currently, this transition is applied to home and community-based services, with institutional (nursing home)care contemplated, to be phased in.
MLTCs have, until now, been almost exclusively entities owned by long term care providers, not by HMOs or insurance companies. When partic- ipation in an MLTC was voluntary, there was little concern that insur- ance carriers would enter the field. However, now participation in an MLTC is mandatory for many and will become mandatory for more long term care recipients. There is growing interest by for-profit HMOs and insur- ance companies in forming MLTCs. With their economic resources they could easily come to dominate the field. So there is growing concern that patients may ultimately have no choice but to enroll in for-profit insurance carrier-owned MLTCs.
The individuals affected by this transition are primarily those with chronic conditions, many who are elderly or otherwise affected with life-limiting illness. Care and service decisions for these individuals should not be measured against profit margins of shareholders. Other states' experience in this area has proven that provider-based MLTCs, which most all of New York MLTCs currently are, deliver both the quality and the savings expected.
Legislative history
2013-2014: S6583 2015-2016: S379A
Fiscal implications
None.
Effective date
Immediately
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.