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S05841 Summary:

Amd 364-j, Soc Serv L
Relates to a review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services.
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S05841 Actions:

06/20/2017referred to health
01/03/2018died in assembly
01/03/2018returned to senate
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S05841 Text:

                STATE OF NEW YORK
                               2017-2018 Regular Sessions
                    IN SENATE
                                       May 2, 2017
        Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health
        AN ACT to amend the social services law, in relation to  the  review  of
          reimbursement  methodologies under contracts or agreements with insur-
          ers under the medical assistance program for home and  community-based
          long term care services
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subdivision 18 of section 364-j of the social services law,
     2  as amended by chapter 649 of the laws of 1996, paragraph (b) as  amended
     3  by  chapter  433  of the laws of 1997, paragraph (c) as added by section
     4  40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d)
     5  as added by section 55 of part B of chapter 57 of the laws of  2015,  is
     6  amended to read as follows:
     7    18.  (a) The department of health may, where not inconsistent with the
     8  rate setting authority of other state agencies and subject  to  approval
     9  of  the  director  of  the division of the budget, develop reimbursement
    10  methodologies and fee schedules for determining the amount of payment to
    11  be made to managed care providers under the managed care  program.  Such
    12  reimbursement methodologies and fee schedules may include provisions for
    13  payment of managed care fees and capitation arrangements.
    14    (b)  The  department  of  health  in  consultation  with organizations
    15  representing managed care providers shall select an independent  actuary
    16  to  review  any such reimbursement rates. Such independent actuary shall
    17  review and make recommendations concerning appropriate actuarial assump-
    18  tions relevant to the establishment of rates including but  not  limited
    19  to  the adequacy of the rates in relation to the population to be served
    20  adjusted for case mix, the scope of services the plans must provide, the
    21  utilization of services and the network of providers necessary  to  meet
    22  state  standards.  The independent actuary shall issue a report no later
    23  than December thirty-first, nineteen hundred ninety-eight  and  annually
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        S. 5841                             2
     1  thereafter. Such report shall be provided to the governor, the temporary
     2  president  and the minority leader of the senate and the speaker and the
     3  minority leader of the assembly. The department of health  shall  assess
     4  managed  care providers under the managed care program on a per enrollee
     5  basis to cover the cost of such report.
     6    (c) In setting such reimbursement methodologies, the department  shall
     7  consider  costs  borne by the managed care program to ensure actuarially
     8  sound and adequate rates of payment to ensure quality of care.
     9    [(c)] (d) The department of health shall require the independent actu-
    10  ary selected pursuant to paragraph (b) of this subdivision to provide  a
    11  complete actuarial memorandum, along with all actuarial assumptions made
    12  and  all other data, materials and methodologies used in the development
    13  of rates, to managed care providers thirty days prior to  submission  of
    14  such  rates  to  the  centers  for  medicare  and  medicaid services for
    15  approval. Managed care providers may request additional  review  of  the
    16  actuarial soundness of the rate setting process and/or methodology.
    17    [(d)]  (e)(i)  The department of health shall select and contract with
    18  an independent actuary to study and review adequate reimbursement  meth-
    19  odologies  under contracts or agreements with insurers under the medical
    20  assistance program for home and community-based long term care  services
    21  provided under this article, by fiscal intermediaries operating pursuant
    22  to  section three hundred sixty-five-f of this title or rates of payment
    23  for such services under the medical assistance program  to  ensure  such
    24  contracts or rates shall support compensation for persons providing such
    25  home  care  aide  services  and  consumer  directed  personal assistance
    26  services to ensure the retention of a  qualified  workforce  capable  of
    27  providing  high quality care to recipients of such services in both wage
    28  parity and non-wage parity regions. Such compensation shall at a minimum
    29  include wage parity compensation as required  under  section  thirty-six
    30  hundred  fourteen-c  of  the  public health law or such wage as required
    31  under article nineteen or  nineteen-A  of  the  labor  law  as  required
    32  together  with  the following costs: recruitment, training and retention
    33  of direct care personnel including wage; salary; mandatory contributions
    34  pursuant to Title 26, Subtitle C, Chapter 21 of the United  States  Code
    35  (FICA);  costs  attributed  to  workers compensation; county living wage
    36  laws as appropriate; provisions of the federal Fair Labor Standards  Act
    37  for employees' overtime and other mandatory benefits; and an administra-
    38  tive and general cost factor indexed annually.
    39    (ii) The department of health shall report on the results of the inde-
    40  pendent  actuary  findings  under  this  paragraph  to the governor, the
    41  temporary president of the senate, the  speaker  of  the  assembly,  the
    42  chairs  of  the senate health committee and assembly health committee on
    43  or before January fifteenth, two thousand eighteen.
    44    (f) The department of health shall annually provide to  the  temporary
    45  president of the senate and the speaker of the assembly the annual Medi-
    46  caid  managed  care  operating  reports submitted to the department from
    47  managed care plans that contract  with  the  state  to  manage  services
    48  provided under the Medicaid program.
    49    §  2. This act shall take effect immediately; provided that the amend-
    50  ments made to section 364-j of the social services law by section one of
    51  this act shall not affect the repeal of such section and shall be deemed
    52  repealed therewith.
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