NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A700
SPONSOR: Gonzalez-Rojas TITLE OF BILL:
An act to amend the public health law, in relation to data reporting
required on the administration of managed long term care plans
PURPOSE OR GENERAL IDEA OF BILL:
To promote greater transparency in the use of public funds by Managed
Long Term Care plans. SUMMARY OF PROVISIONS:
Section 1: Amends the public health law's provisions governing Managed
Long Term Care plans to require greater transparency in the reporting
and sharing of data with the public about the utilization of each plan's
services, associated expenditures and usage rates by members, the types
of complaints and issues received by each plan, and metrics about timely
access to authorized services.
Section 2: sets the effective date.
JUSTIFICATION:
This bill would promote transparency concerning how MLTC plans spend
billions in public funds they receive as monthly premiums for each
member each year. MLTC plans already report extensive data to the
Department of Health every year that show how much they spend on each of
the services covered by MLTC plans - from personal care and CDPAP to
dental care, adult day care, and short-term nursing home care, and how
many members receive each of these services. Plans also report, for each
type of home care, how many members receive the highest number of hours,
the lowest number of hours, and various ranges in between. This bill
would make that data publicly available, to improve accountability and
consumer choice by allowing them to compare plans.
Data would also be made public on how many appeals and complaints
members file challenging plans' denials of services, and the outcomes of
these appeals. This data should both enable better oversight by the
Department of Health and consumer choice.
With the severe shortage of home care workers, MLTC plans often delay
providing home care services they have authorized. Despite the recommen-
dation by the federal Medicaid agency CMS ~"(1 the NYS Comptroller's
report that thousands of MLTC enrollees went without services, New York
has never instituted measures to track timely access to services.This
bill would adopt measures to track staffing capacity recommended by CMS
and make this data public. Armed with this data, the State as well as
the public can hold plans accountable for failing to provide timely
access.
Additionally, it has been reported that New York lags behind other
states in tracking how plans are performing in "rebalancing" long term
care, meaning how good a job they are doing in shifting long-term care
expenditures from nursing homes to community-based services. If a plan
refuses to reinstate services for many of its enrollees who are ready
for discharge after a short-term stay in a rehabilitation facility,
those enrollees are "disenrolled" from the MLTC plan and become perma-
nent nursing home residents. This practice has increased since 2020,
when long-term nursing home care was "carved out" of the MLTC benefit.
Adopting some of the recommendations made by CMS data would be made
public showing the rate of each plan's nursing home admissions, with the
percentage successfully discharged back to the community with MLTC
services reinstated versus the percentage who remained permanently in
the nursing home. Also, measures would track the extent to which each
MLTC plan is willing to enroll new members had been in a nursing home
prior to enrollment, accomplishing the goal of rebalancing long-term
care. Tracking this data could become the basis for new quality measures
to reward plans for rebalancing success.
All of this data would be added to the existing reports by the Depart-
ment of Health, which would be increased from bi-annually to annually.
The data would also be available in an interactive format online, allow-
ing for comparisons between plans. This should not be burdensome as the
Department already makes much data available online in interactive
format at
HTTPS://HEALTH.DATA.NY.GOV/.ct. Finally, the data would be
available for each plan on a statewide basis and also separately for
each geographic region in which the plan operates.
PRIOR LEGISLATIVE HISTORY:
2024: Introduced and Reported to Health Committee
FISCAL IMPACT:
To be determined.
EFFECTIVE DATE:
Immediately
STATE OF NEW YORK
________________________________________________________________________
700
2025-2026 Regular Sessions
IN ASSEMBLY(Prefiled)
January 8, 2025
___________
Introduced by M. of A. GONZALEZ-ROJAS, PAULIN, SIMON, LUPARDO, SIMONE,
WEPRIN, ROSENTHAL, KELLES, MAMDANI, DINOWITZ, SAYEGH, SHRESTHA,
FORREST, REYES, GALLAGHER, ALVAREZ, GLICK, KIM, EPSTEIN -- read once
and referred to the Committee on Health
AN ACT to amend the public health law, in relation to data reporting
required on the administration of 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. Subparagraph (ix) of paragraph (b) of subdivision 7 of
2 section 4403-f of the public health law, as added by section 56-a of
3 part D of chapter 56 of the laws of 2012 and as relettered by section 4
4 of part B of chapter 57 of the laws of 2018, is amended to read as
5 follows:
6 (ix) (1) The commissioner shall report [biannually] annually on the
7 implementation of this subdivision. The reports shall include, but not
8 be limited to:
9 (A) satisfaction of enrollees with care coordination/case management;
10 timeliness of care;
11 (B) service utilization data including changes in the level, hours,
12 frequency, and types of services and providers;
13 (C) enrollment data, including auto-assignment rates by plan;
14 (D) quality data; and
15 (E) continuity of care for participants as they move to managed long
16 term care, with respect to community based and nursing home populations,
17 including pediatric nursing home populations, and medically fragile
18 children being served by home care agencies affiliated with pediatric
19 nursing homes and diagnostic and treatment centers primarily serving
20 medically fragile children.
21 (2) The following data shall be included in the report under this
22 subdivision and shall be posted on the department's website in an inter-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01012-01-5
A. 700 2
1 active format. To the extent the data set forth in this subparagraph is
2 not now reported by plans to the department, plans shall be required to
3 report this data through a reporting mechanism that the department shall
4 develop by October first, two thousand twenty-five:
5 (A) Statewide and regional service utilization data for each plan,
6 with the number and percentage of "member months" authorized for each
7 range of hours per month as reported in cost reports filed under para-
8 graph (a) of this subdivision, and using "member months" as defined in
9 the cost reports, including all required exhibits. Data shall include
10 the number of member months for whom each type of service was author-
11 ized, and the percentage of each plan's total member months for which
12 members were authorized for each of the ranges of hours per month of
13 each service. These numbers and percentages shall be reported separate-
14 ly for each of the following services: personal care, consumer directed
15 personal care, private duty nursing and home health services, and shall
16 be reported separately for each region of the state in which the plan
17 operates and on a statewide basis;
18 (B) Data on "per member per month" expenditures by managed long term
19 care plan, as reported in cost reports filed under paragraph (a) of
20 this subdivision, including but not limited to, administrative costs,
21 case management, personal care, consumer directed personal assistance
22 programs, home health care, private duty nursing, adult day health care,
23 social adult day, dental care, vision care, audiology, podiatry, medical
24 supplies, durable medical equipment, personal emergency response system,
25 home-delivered meals, the various therapy and rehab services - phys-
26 ical, occupational and speech therapy, and nursing facility services.
27 The reports shall include, for each plan on a statewide and regional
28 basis, a calculation of the total percentage of all service expenditures
29 expended for home and community-based long term care services and the
30 percentage for institutional long term care services, and the total
31 number of member months in which members received home and community-
32 based long term care services and the number of member months in which
33 members received solely institutional services. The reports shall be
34 in an interactive format that enables a comparison between plans on a
35 statewide basis and for each region;
36 (C) Data on personal care and consumer directed personal assistance
37 program contracting, including but not limited to, hours of care
38 provided and expenses allocated by contracted entity;
39 (D) The total number of complaints, grievances, plan appeals, external
40 appeals, and fair hearings for each plan, broken down by:
41 (I) the number and percentage of cases decided wholly in enrollee's
42 favor, partially in enrollee's favor, wholly against the enrollee, and
43 the number still pending;
44 (II) the type of service involved in the complaint or appeal; and
45 (III) the issue of the complaint or appeal, including denial of a new
46 service, denial of an increase in a service, reduction of a service,
47 termination of a service, lateness, lack of staffing, or other issue;
48 (E) Metrics to track timely access to authorized services, including
49 but not limited to:
50 (I) the number of enrollees whose plans of care are unstaffed or not
51 fully staffed for periods of time that the commissioner shall determine,
52 from one day to more than sixty days, and the total number of member
53 days per month for which plans of care are not fully staffed; and
54 (II) the wait time for personal care, consumer directed personal care
55 under section three hundred-sixty-five-f of the social services law, or
56 private duty nursing services to be initiated after authorization; and
A. 700 3
1 (F) Metrics tracking rebalancing from institutional care to communi-
2 ty-based care, including:
3 (I) for each plan, statewide and by region, the rate of admission of
4 enrollees from the community to nursing facilities;
5 (II) of each plan's enrollees admitted to a nursing facility, the
6 percentage successfully discharged to the community, meaning remaining
7 in the community for sixty days or more, and the percentage disenrolled
8 from the plan pursuant to clause thirteen of subparagraph (v) of para-
9 graph (b) of this subdivision and the percentage disenrolled because of
10 death or for other reasons, categorized by length of nursing home stay;
11 (III) the rate of enrollment of new enrollees who, prior to enroll-
12 ment, were in a nursing home, by length of nursing home stay;
13 (IV) the rate of re-enrollment of enrollees who had been disenrolled
14 from the plan within the prior six months because of a long-term nursing
15 home stay (under clause thirteen of subparagraph (v) of paragraph (b) of
16 this subdivision).
17 (3) The commissioner shall publish the report on the department's
18 website and provide notice to the temporary president of the senate, the
19 speaker of the assembly, the chair of the senate standing committee on
20 health, the chair of the assembly health committee and the Medicaid
21 Managed Care Advisory Review Panel upon availability of the report. The
22 initial report shall be provided by September first, two thousand
23 twelve. The reports shall be made available by each February first, and
24 September first thereafter. Such reports shall be formatted to allow
25 comparisons between plans.
26 (4) The commissioner shall make the final audited versions of all past
27 annual managed long term care cost reports available for download in
28 full in CSV format on the department's website, and shall make the final
29 audited versions of all future annual cost reports available for down-
30 load within thirty days of completion of the final audited report.
31 § 2. This act shall take effect immediately; provided, however, that
32 the amendments to section 4403-f of the public health law made by
33 section one of this act shall not affect the repeal of such section
34 and shall be deemed repealed therewith; and provided, further, that the
35 amendments to paragraph (b) of subdivision 7 of section 4403-f of the
36 public health law made by section one of this act shall not affect the
37 expiration of such paragraph and shall expire and be deemed repealed
38 therewith.
