Relates to the performance standards that must be met by managed long term care plans; enables managed long term care plans operated by organizations that also operate an Institutional Special Needs Plan (ISNP) or a PACE program, but not a Medicare Dual Eligible Special Needs Plan, to continue to meet managed long term care plans performance standards.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7554
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law, in relation to the performance
standards that must be met by managed long term care plans
TITLE OF BILL:
An act to amend the public health law, in relation to the performance
standards that must be met by managed long term care plans
PURPOSE:
The purpose of this bill is to enable managed long term care (MLTC)
plans that operate a Medicare Advantage Institutional Special Needs Plan
(ISNP)or a Program of All-Inclusive Care for the Elderly (PACE) program,
but not a Medicare Advantage Dual Eligible Special Needs (DSNP), to
continue to meet performance standards. The bill also removes from
performance standards the offering of Child Health Plus and Basic Health
Program products because those products are irrelevant to the delivery
of integrated care for dual eligibles.
SUMMARY OF PROVISIONS:
Section one of the bill amends subdivision 6-a of section 4403-f of the
Public Health Law to:
* Expand the performance standards imposed on MLTC plans to allow MLTC
plans that operate ISNPs or PACE programs to continue to meet those
standards;
* Remove from MLTC performance standards offering products under the
Child Health Plus and Basic Health ("Essential Plan") programs.
Section two of the bill provides an immediate effective date.
JUSTIFICATION:
This legislation would modify the performance standards required of MLTC
plans to enable MLTC plans that operate a PACE program or an ISNP, but
not a DSNP, to continue meet those standards. Under legislation enacted
with the SFY 2023-24 budget, MLTC plans must operate a DSNP by January
1, 2024 in order to meet performance standards. In addition, the
performance standards include offering products under the Child Health
Plus and Basic Health programs. However, under current law, MLTC plans
that also operate ISNPs or PACE programs would be deemed out of compli-
ance with those standards.
The DSNP performance standard was imposed in order to ensure that MLTC
plans are engaged in providing care management, coordination, and cover-
age that integrates Medicare-covered services and Medicaid-covered
services. ISNPS and PACE programs, like DSNPs, also serve dual eligibles
and integrate Medicare and Medicaid services. In fact, unlike DSNPs,
both ISNPs and PACE programs serve individuals who require a long-term
care services (although ISNPs are named "institutional," they may serve
individuals who live in the community, as long as they require a nursing
home level of care).
Moreover, by defining the performance standard based on the operation of
a DSNP only, the current law imposes a condition that is impossible to
meet for MLTC plans that are not currently operating one. According to
Medicare's schedule for approving new DSNPs, a plan would have had to
submit an application by February 2023 in order to be operational in
January 2024. Thus, at the time the current performance standard was
enacted, plans that had not already submitted an application fora DSNP
would not be able to begin operating a DSNP until January 2025.
Finally, the ability to offer Child Health Plus and Basic Health Plan
products is irrelevant to the MLTC program. There is very little, if
any, overlap between the individuals served by Child Health Plus or the
Essential Plan and MLTC plans. MLTC plans are specialized plans that
serve individuals who are age 18 or over, eligible for Medicaid, typi-
cally eligible for Medicare as well, and require long-term care services
for a period of 120 days or more. By contrast, Basic Health Program
enrollees must be under age 65 and not eligible for Medicaid.
Child Health Plus Program enrollees must be under age 19 and not eligi-
ble for Medicaid. Neither the Basic Health Program nor the Child Health
Plus Program may enroll the population that would generally be eligible
for MLTC.
PRIOR LEGISLATIVE HISTORY:
New Bill
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
7554
2023-2024 Regular Sessions
IN ASSEMBLY
May 25, 2023
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to the performance
standards that must be met by managed long term care plans
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph (a) of subdivision 6-a of section 4403-f of the
2 public health law, as added by section 4 of part I of chapter 57 of the
3 laws of 2023, is amended to read as follows:
4 (a) On or before January first, two thousand twenty-four, each managed
5 long term care plan that has been issued a certificate of authority
6 pursuant to this section shall have an active Institutional Special
7 Needs Plan or a Medicare Dual Eligible Special Needs Plan in operation
8 whose H-contract either has a current quality star rating from the
9 Centers for Medicare and Medicaid Services of three stars or higher, or
10 has not been issued a quality star rating from the Centers for Medicare
11 and Medicaid Services, or a Program of All-Inclusive Care for the Elder-
12 ly (PACE). In addition, the managed long term care plan shall suffi-
13 ciently demonstrate success in the following performance categories:
14 (i) in addition to meeting the requirements of paragraph (j) of subdi-
15 vision seven of this section, in order to ensure network adequacy a
16 commitment to contracting with an adequate number of licensed home care
17 service agencies needed to provide necessary personal care services to
18 the greatest practicable number of enrollees, and with an adequate
19 number of fiscal intermediaries needed to provide necessary consumer
20 directed personal assistance services to the greatest practicable number
21 of enrollees in accordance with section three hundred sixty-five-f of
22 the social services law;
23 (ii) readiness to timely implement and adhere to maximum wait time
24 criteria for key categories of service in accordance with laws, rules
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11574-01-3
A. 7554 2
1 and regulations of the department or the Centers for Medicare and Medi-
2 caid Services;
3 (iii) commitment to quality improvement;
4 (iv) accessibility and geographic distribution of network providers,
5 taking into account the needs of persons with disabilities and the
6 differences between rural, suburban, and urban settings;
7 (v) demonstrated cultural and language competencies specific to the
8 population of participants;
9 (vi) ability to serve enrollees across the continuum of care, as
10 demonstrated by the type and number of products the managed long term
11 care operates or has applied to operate, including integrated care for
12 participants who are dually eligible for Medicaid and Medicare[, and
13 those operated under title one-A of article twenty-five of this chapter
14 and section three hundred sixty-nine-gg of the social services law]; and
15 (vii) value based care readiness and experience.
16 § 2. This act shall take effect immediately; provided, however, that
17 the amendments to section 4403-f of the public health law made by
18 section one of this act shall not affect the repeal of such section and
19 shall be deemed repealed therewith.
