What's happening
This bill requires managed care providers to include contact information for independent consumer assistance and ombudsman programs on all Medicaid adverse determination, grievance, and appeal notices.
Why it matters
Empowers Medicaid recipients and their advocates. by ensuring they are informed about independent consumer assistance and ombudsman programs, making it easier to get help navigating complex appeals or grievances with managed care plans.
Improves transparency and access to support. in cases of denied care, grievances, or appeals, which may help recipients understand their rights and options, potentially reducing confusion or lost appeals due to lack of information.
Targets vulnerable populations. , including those dealing with substance use disorder and mental health issues, by specifically requiring notice about specialized ombudsman programs designed to advocate for these groups.
May incentivize higher accountability from managed care providers. knowing that consumers are more likely to seek third-party assistance could encourage plans to resolve issues more thoroughly and fairly at the outset.
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Who cares
Medicaid managed care participants
They would receive contact information for independent consumer assistance and the substance use disorder and mental health ombudsman on adverse determination, grievance and appeal notices.
Managed care providers
They would have to add the assistance programs’ names, addresses, phone numbers and websites to required notices.
Health plan enrollees filing grievances
Grievance process and determination notices would include contacts for independent assistance alongside information about their grievance and appeal rights.
Independent consumer assistance programs and the mental health and substance use disorder ombudsman
Their contact information would be included in required notices to enrollees seeking to challenge plan decisions.
Headline styles
Notify Patients of Help
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Substituted by A9538
- Advanced to third reading
- 2nd report cal.
- 1st report cal.311
- 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.
Require Health Help Notices
Signed by Governor · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7241
IN SENATE
January 13, 2020
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed 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
S. 7241 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.
Sponsor's memo
Title of bill
An act to amend the social services law and the public health law, in relation to adverse determination notices to Medicaid recipients
Purpose or general idea of bill
To require Medicaid managed care plans to 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 on all notices of adverse determinations, grievances and appeals.
Summary of specific provisions
Section one amends subdivision 9 of section 364-j of the social services law to require notice of the department of health designated independent consumer assistance program and the independent substance use disorder and mental health ombudsman on all notices of adverse determinations, grievances and appeals.
Section two of the bill amends subdivision 2 and subdivision 7 of section 4408-a of the public health law to require notice of the depart- ment of health designated independent consumer assistance program and the independent substance use disorder and mental health ombudsman on all notices of adverse determinations, grievances and appeals.
Section 3 of the bill establishes the effective date.
Justification
Navigating the health care system is difficult. This is especially true for people who are covered by managed care plans charged with adminis- tering the state's Medicaid program. Recognizing these challenges, independent consumer assistance programs were established and initially funded as part of the Affordable Care Act. New York has continued the program with funding supported by the Legislature and the Governor. This bill requires notice of this important consumer assistance program on all adverse determinations made by Medicaid managed care plans thus providing recipients access to an independent resource for assistance.
Prior legislative history
New bill.
Fiscal implications
None to the state.
Effective date
This act shall take effect on the one hundred eightieth day after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.