BILL NUMBER: S707
SPONSOR: MAY
 
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 and 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 arc performing in "rebalancing" long term
care, meaning how good a job they are doing in shifting longterm 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 EMS, 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 he 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/. Finally, the data would be avail-
able for each plan on a statewide basis and also separately for each
geographic region in which the plan operates.
 
PRIOR LEGISLATIVE HISTORY:
2023-2024: S9266 (May) / A10176 (Gonzales-Rojas)
 
FISCAL IMPACT:
To be determined.
 
EFFECTIVE DATE:
Immediately.