What's happening
This bill requires Medicaid managed care providers to include contact information for consumer assistance programs and ombudsmen in all adverse determination, grievance, and appeal notices.
Why it matters
Empowers Medicaid recipients. by ensuring they have clear, direct access to independent consumer assistance and ombudsman services when facing denials or issues, making it easier to navigate complex appeals or grievances.
Enhances transparency and accountability. for Medicaid managed care providers, as they must now consistently share contact information for help resources, potentially reducing confusion and administrative barriers for recipients.
Addresses mental health and substance use disorder concerns. specifically, by requiring notice of specialized ombudsman services, which may help vulnerable populations better protect their rights and access needed care.
Could reduce disparities and improve outcomes. by making it more likely that Medicaid enrollees—especially those unfamiliar with the system—are informed of their support options at crucial moments, possibly leading to more successful appeals and fairer resolutions.
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Who cares
Headline styles
Require Health Help Notices
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Approval memo.28
- Signed chap.318
- Delivered to governor
- Returned to assembly
- Passed senateVote 58–2
- 3rd reading cal.311
- Substituted for S7241
- Referred to health
- Delivered to senate
- Passed assembly
- Advanced to third reading cal.412
- Reported
Show 1 earlier action
- 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.
Notify Patients of Help
Senate Floor Calendar · Sponsor Gustavo Rivera
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
9538
IN ASSEMBLY
January 24, 2020
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health
AN ACT to amend the social services law and the public health law, in relation to adverse determination notices to Medicaid recipients
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 9 of section 364-j of the social services law, as amended by chapter 433 of the laws of 1997, is amended to read as follows:
9. Managed care providers shall inform participants of such provider's grievance procedure and utilization review procedures [required pursuant to sections forty-four hundred eight-c and] under article forty-nine [hundred] of the public health law. A managed care provider or local social services district, as appropriate, shall provide notice to participants of their respective rights to a fair hearing and aid continuing in accordance with applicable state and federal law. Managed care providers shall provide written notice of the name, address, phone number and website of the department of health designated independent consumer assistance program and the independent substance use disorder and mental health ombudsman established by section 33.27 of the mental hygiene law on all notices of adverse determinations, grievances and appeals.
§ 2. Paragraph (b) of subdivision 2 and subdivision 7 of section 4408-a of the public health law, as added by chapter 705 of the laws of 1996, are amended to read as follows:
(b) The notice to an enrollee describing the grievance process shall explain: (i) the process for filing a grievance with the organization; (ii) the timeframes within which a grievance determination must be made; [and] (iii) the right of an enrollee to designate a representative to file a grievance on behalf of the enrollee; and (iv) notice of the name, address, phone number and website of the department designated consumer assistance program and the independent substance use disorder and mental health ombudsman established by section 33.27 of the mental hygiene law on all notices of adverse determinations, grievances and appeals.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14155-02-9
A. 9538 2
7. The notice of a determination shall include: (i) the detailed reasons for the determination; (ii) in cases where the determination has a clinical basis, the clinical rationale for the determination; [and] (iii) the procedures for the filing of an appeal of the determination, including a form for the filing of such an appeal; and (iv) notice of the name, address, phone number and website of the department designated consumer assistance program and the independent substance use disorder and mental health ombudsman established by section 33.27 of the mental hygiene law on all notices of adverse determinations, grievances and appeals.
§ 3. This act shall take effect on the one hundred eightieth day after it shall have become a law; provided, however, the amendments made to subdivision 9 of section 364-j of the social services 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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.