BILL NUMBER: S2332
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, the social services law, the
elder law and the mental hygiene law, in relation to long term care
options; and to repeal certain provisions of the public health law
relating to managed long term care
 
PURPOSE:
The purpose of this bill is to eliminate the current partially capitated
Medicaid Long Term Care (MLTC) program and replace it with services
delivered through a fee-for-service model while preserving fully capi-
tated models.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 establishes legislative intent as it relates to including the
desire of the legislature to eliminate the partially capitated managed
long term care program and transition participants to a fee-for-service
model while preserving fully capitated programs such as Program of All-
inclusive Care of the Elderly (PACE), and Medicaid Advantage Plus (MAP).
Section 2 repeals and replaces section 4403-f of the Public Health Law
as it relates to the establishment of MLTC plans. This legislation would
direct the Commissioner of Health (COH) to seek the appropriate federal
approvals to provide Medicaid long term care services utilizing PACE,
MAP, or a fee-for-service model with services coordinated by a care
coordination entity. This legislation would also grant the COH the
authority to establish guidelines for the establishment and operation of
care coordination entities. Additionally, this legislation would estab-
lish a process that allows persons eligible to receive services to
select either a PACE or MAP provider when appropriate, or a care coordi-
nation entity to assist in the delivery of fee-for-service based long
term care care services. If a selection is not made in a timely fashion
the COH would assign a care coordination entity for the person to
receive long term care services in a fee-for-service model.
Section 3 amends section 365-a the Social Services Law as they relate to
directing the COH to make regulations for a delivery of long term care
services through a fee-for-service model. The regulations would include
but are not limited to: the establishment and operation of care coordi-
nation entities; continuity of care; and conflict-free case management.
This legislation would also direct the Department of Health (DOH) to
conduct an evaluation of the viability of using care coordination enti-
ties in place of the independent assessor for assessments or reassess-
ments when determining an individual's needs.
Section 4 establishes a new section of Unconsolidated Law as it relates
to directing the COH to convene an advisory group that is composed of
and informed by stakeholder representatives. Under this legislation, the
advisory group would be tasked with: promoting the transition of persons
in receipt of home and community-based long term care services into
fee-for-service arrangements; and determining a process to transition
providers to a fee-for-service reimbursement system. In implementing the
transition to a fee-for-service based model both the COH and the advi-
sory board are directed to consider and select programs and policies
that seek to maximize continuity of care, and minimize disruption to the
provider labor workforce, and shall continue to support providers based
on a commitment to quality and value. This legislation would establish a
biannual reporting process on implementation of the transition.
Sections 5-25 amend various sections of law as they relate to replacing
references to 4403-f of PHL and Managed Long Term Care (MLTC). The
references are replaced by "PACE or MAP", or "long term care options,"
which includes PACE, MAP, or fee-for-service based long term care, where
appropriate.
Section 26 establishes the effective date. Sections 1, 3, and 4 would
take effect immediately. The remaining sections would take effect April
1, 2026.
 
JUSTIFICATION:
New York State transitioned home care from a traditional fee-for-service
model to a Medicaid managed care program or MLTC Plans in 2011, under
direction from then Governor Andrew Cuomo's Medicaid Redesign Team.
Under this model, New York State began paying for-profit insurance
companies to manage and coordinate healthcare for several Medicaid
services, in an attempt to improve care by coordinating between doctors
and to save money by creating financial incentives to keep patients
healthy and out of high-cost hospitals and nursing homes. The original
intent was that MLTC plans would develop into fully capacitated plans
over time. This has not happened.
Instead, the majority of the services for-profit insurance companies
currently provide are solely home care. Because of this "care coordi-
nation" is limited, and the insurance companies administrative costs and
profit are a drain on the Medicaid system. These resources could be
reinvested to support the delivery of care through fee-for-service and
fully capitated models ensuring more uniform care for residents of the
state, as well as more adequate reimbursement to providers to support
wage increases. This will help to assist providers in addressing health-
care workforce challenges facing the state.
In the past 3.75 years, New York State has given $5.9 billion to the 24
for-profit insurance companies managing home care in administrative
costs and profit. In 2021 alone, the latest full year of data available,
private insurance companies posted $722 million in profits, twice the
national average.
To address this, the "Home Care Savings & Reinvestment Act" would repeal
the partially capitated MLTC program and instead provide appropriate
long term care benefits under a fee -for-service model or through a
fully capitated model where appropriate.
This bill is estimated to generate significant annual savings, which can
be used to reinvest and support the Medicaid program while addressing
healthcare workforce issues.
 
LEGISLATIVE HISTORY:
2023-2024: S7800/A8470 Paulin
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
Sections 1, 3, and 4 of the bill would take effect immediately. The
remaining sections would take effect April 1, 2027.

Statutes affected:
S2332: 4403-f public health law, 365-a social services law, 365-a(2) social services law, 365-a(10) social services law, 2801-e public health law, 2801-e(6) public health law, 2807-v public health law, 2807-v(1) public health law, 2807-x public health law, 3605 public health law, 3605(8) public health law, 3614 public health law, 3614(9) public health law, 3614(10) public health law, 4409 public health law, 4409(2) public health law, 364-j social services law, 364-j(3) social services law, 364-j(31) social services law, 364-jj social services law, 365-f social services law, 365-f(6) social services law, 365-h social services law, 365-h(4) social services law, 366 social services law, 366(14) social services law