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A00155 Summary:

COSPNSRDinowitz, Lalor, Barron, Bichotte Hermelyn
Amd 4403-f, Pub Health L; amd 366-a, Soc Serv L
Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.
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A00155 Actions:

01/06/2021referred to health
04/27/2021reported referred to ways and means
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A00155 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law and the social services law, in relation to automatic enrollment and recertification simplification for Medicaid eligible recipients   PURPOSE OR GENERAL IDEA OF BILL: to shorten and simplify Medicaid long term care eligibility processes.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends Public Health Law § 4403-f to enable auto-assignment in a managed long term care plan when a person determined to be eligible has not chosen a plan within the first 75 days of eligibility, and extends that eligibility if auto-assignment is not completed within 75th days. Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid recertification process less burdensome and error-prone by allowing attestation of resources that are unchanged or have diminished, and providing automatic recertification for Managed Long Term Care (MLTC) enrollees, mainstream managed care members receiving personal care services, enrollees in the Aged, Blind, and Disabled Category without excess income and Medicare Savings Program recipients.   JUSTIFICATION: People who have successfully applied for Medicaid in order to enroll in a MLTC plan face many hurdles and delays before they are effectively enrolled. First, an in-home eligibility assessment by a nurse can take several weeks to schedule and this assessment is valid for only 75 days. After that assessment is completed, the Medicaid recipient will schedule in-home assessments with prospective MLTC plans to determine the level of care each will provide. It can take several weeks to schedule and complete those visits. Once the recipient agrees to a plan, the plan will process enrollment, which is effective either the first of the following month, or, if it is already after the 18th, effective the first of the month after the following month. If 75 days have lapsed at this point, the process restarts at the beginning, resulting in care delays. Currently, Medicaid recipients complete a mail renewal form, attesting to their income, once a year in order to continue to receive health care coverage. This is true even if the recipient is on a fixed income. The recertification process is so prone to errors that it frequently results in a discontinuance of eligibility. The recipient may not receive the discontinuance notice on time or at all, or may not be able to request a fair hearing within 10 days, which automatically triggers dis-enroll- ment. In 2011, the Medicaid program recognized the problems and initi- ated a demonstration program to automate renewals for Aged, Blind and Disabled Medicaid recipients with fixed incomes. This bill extends the benefits of that demonstration to the rest of the program.   PRIOR LEGISLATIVE HISTORY: 2019: A.7578-A - Vetoed 2020: A.9017 - referred to Health Committee   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: 180 days after enactment.
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A00155 Text:

                STATE OF NEW YORK
                               2021-2022 Regular Sessions
                   IN ASSEMBLY
                                     January 6, 2021
        Introduced  by  M.  of  A.  GOTTFRIED,  DINOWITZ, LALOR -- read once and
          referred to the Committee on Health
        AN ACT to amend the public health law and the social  services  law,  in
          relation  to  automatic  enrollment and recertification simplification
          for Medicaid eligible recipients

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Paragraph  (b)  of subdivision 7 of section 4403-f of the
     2  public health law is amended by adding a new subparagraph (iv)  to  read
     3  as follows:
     4    (iv) Where a person determined eligible for Medicaid ("Medicaid recip-
     5  ient") has been determined by the commissioner or his or her designee to
     6  require  community-based long term care services for more than a contin-
     7  uous period of one hundred twenty days, and the Medicaid  recipient  has
     8  not  selected and enrolled in a managed long term care plan prior to any
     9  expiration date of such determination of need for long term care,  after
    10  being  provided with information to make an informed choice, the commis-
    11  sioner shall assign the recipient to a  managed  long  term  care  plan,
    12  taking  into  account  consistency with any prior community-based direct
    13  care workers having recently served the recipient,  quality  performance
    14  criteria,  capacity, and geographic accessibility.  The commissioner may
    15  assign participants pursuant to such criteria on a weighted  basis.    A
    16  recipient  assigned to a managed long term care plan under this subpara-
    17  graph shall be deemed to have been determined to be in need of long term
    18  care services for more than a continuous period of  one  hundred  twenty
    19  days and eligible to be enrolled in a managed long term care plan.
    20    §  2.  Paragraph  (b)  of subdivision 2 of section 366-a of the social
    21  services law, as added by section 51 of part A of chapter 1 of the  laws
    22  of 2002, is amended to read as follows:
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 155                              2
     1    (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
     2  sion, an applicant or recipient may attest to the amount of his  or  her
     3  accumulated  resources,  unless  such  applicant or recipient is seeking
     4  medical assistance payment for long term care  services  for  the  first
     5  time.  A  recipient  who has already provided documentation of resources
     6  may attest to the amount of accumulated resources if it has remained the
     7  same or is less than the amount originally documented.  For purposes  of
     8  this  paragraph,  long  term  care  services shall mean care, treatment,
     9  maintenance, and services described in paragraph (b) of subdivision  [1]
    10  one  of  section  three  hundred  sixty-seven-f  of this title, with the
    11  exception of short term rehabilitation, as defined by  the  commissioner
    12  of health.
    13    §  3.  Paragraph  (d)  of subdivision 5 of section 366-a of the social
    14  services law, as amended by section 12 of part D of chapter  56  of  the
    15  laws  of 2013, is relettered paragraph (e) and three new paragraphs (f),
    16  (g) and (h) are added to read as follows:
    17    (f) Notwithstanding paragraph (b) of subdivision two of  this  section
    18  and  paragraphs (a), (b), (c) and (d) of this subdivision, the following
    19  recipients will be recertified automatically, unless there  has  been  a
    20  finding of lack of eligibility for Medicaid:
    21    (i)  enrollees  in Medicaid managed long term care plans as defined in
    22  section forty-four hundred three-f of the public health law;
    23    (ii) enrollees in Medicaid managed care plans as  defined  in  section
    24  three  hundred  sixty-four-j  of  this  title  who receive personal care
    25  services pursuant to paragraph (e) of subdivision two of  section  three
    26  hundred sixty-five-a of this title or consumer directed personal assist-
    27  ance  services  pursuant  to  section three hundred sixty-five-f of this
    28  title;
    29    (iii) enrollees receiving Medicaid in the  Aged,  Blind  and  Disabled
    30  category  who  receive  fixed  income  from the Social Security Adminis-
    31  tration (SSA); and
    32    (iv) Medicare Savings Program (MSP) recipients who have a fixed income
    33  from the Social Security Administration (SSA).
    34    (g) Nothing in paragraph (e) of this subdivision should  be  construed
    35  to  alter a Medicaid recipient's obligation to inform the public welfare
    36  district of changes in income or other factors that might impact  eligi-
    37  bility pursuant to subdivision four of this section.
    38    (h)  Upon  a  finding of lack of eligibility, recipients identified in
    39  paragraph (e) of this subdivision will be entitled to notice and hearing
    40  rights as provided in section twenty-two of this chapter.
    41    § 4. This act shall take effect on the one hundred eightieth day after
    42  it shall have become a law; provided that the  amendments  to  paragraph
    43  (b)  of subdivision 7 of section 4403-f of the public health law made by
    44  section one of this act shall be subject to the expiration and reversion
    45  of such paragraph and shall expire and be deemed repealed therewith  and
    46  provided  further  that  such  amendments shall not affect the repeal of
    47  such section and shall expire and be deemed repealed  therewith.  Effec-
    48  tive  immediately, the commissioner of health shall make regulations and
    49  take other actions reasonably necessary to implement this  act  on  that
    50  date.
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