Bill Text: NY A10176 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires certain data to be included in reports on the administration of managed long term care plans; changes reporting period to annually.

Spectrum: Partisan Bill (Democrat 12-0)

Status: (Introduced) 2024-05-21 - reported referred to ways and means [A10176 Detail]

Download: New_York-2023-A10176-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          10176

                   IN ASSEMBLY

                                      May 10, 2024
                                       ___________

        Introduced by COMMITTEE ON RULES -- (at request of M. of A. Gonzalez-Ro-
          jas, Paulin) -- 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-
    23  active format. To the extent the data set forth in this subparagraph  is
    24  not  now reported by plans to the department, plans shall be required to
    25  report this data through a reporting mechanism that the department shall
    26  develop by October first, two thousand twenty-four:
    27    (A) Statewide and regional service utilization  data  for  each  plan,
    28  with  the  number  and percentage of "member months" authorized for each

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15241-02-4
        A. 10176                            2

     1  range of hours per month as reported in cost reports filed  under  para-
     2  graph  (a)  of this subdivision, and using "member months" as defined in
     3  the cost reports, including all required exhibits.   Data shall  include
     4  the  number  of  member months for whom each type of service was author-
     5  ized, and the percentage of each plan's total member  months  for  which
     6  members  were  authorized  for  each of the ranges of hours per month of
     7  each service.  These numbers and percentages shall be reported separate-
     8  ly for each of the following services: personal care, consumer  directed
     9  personal  care, private duty nursing and home health services, and shall
    10  be reported separately for each region of the state in  which  the  plan
    11  operates and on a statewide basis;
    12    (B)  Data  on "per member per month" expenditures by managed long term
    13  care plan,  as reported in cost reports filed  under  paragraph  (a)  of
    14  this  subdivision,  including  but not limited to, administrative costs,
    15  case management, personal care, consumer  directed  personal  assistance
    16  programs, home health care, private duty nursing, adult day health care,
    17  social adult day, dental care, vision care, audiology, podiatry, medical
    18  supplies, durable medical equipment, personal emergency response system,
    19  home-delivered  meals,    the various therapy and rehab services - phys-
    20  ical, occupational and speech therapy, and  nursing  facility  services.
    21  The  reports  shall  include,  for each plan on a statewide and regional
    22  basis, a calculation of the total percentage of all service expenditures
    23  expended for home and community-based long term care  services  and  the
    24  percentage  for  institutional  long  term  care services, and the total
    25  number of member months in which members received  home  and  community-
    26  based  long  term care services and the number of member months in which
    27  members received solely institutional services.    The reports shall  be
    28  in  an  interactive  format that enables a comparison between plans on a
    29  statewide basis and for each region;
    30    (C) Data on personal care and consumer  directed  personal  assistance
    31  program  contracting,  including  but  not  limited  to,  hours  of care
    32  provided and expenses allocated by contracted entity;
    33    (D) The total number of complaints, grievances, plan appeals, external
    34  appeals, and fair hearings for each plan, broken down by:
    35    (I) the number and percentage of cases decided  wholly  in  enrollee's
    36  favor,  partially  in enrollee's favor, wholly against the enrollee, and
    37  the number still pending;
    38    (II) the type of service involved in the complaint or appeal; and
    39    (III) the issue of the complaint or appeal, including denial of a  new
    40  service,  denial  of  an  increase in a service, reduction of a service,
    41  termination of a service, lateness, lack of staffing, or other issue;
    42    (E)  Metrics to track timely access to authorized services,  including
    43  but not limited to:
    44    (I)  the  number of enrollees whose plans of care are unstaffed or not
    45  fully staffed for periods of time that the commissioner shall determine,
    46  from one day to more than sixty days, and the  total  number  of  member
    47  days per month for which plans of care are not fully staffed; and
    48    (II)  the wait time for personal care, consumer directed personal care
    49  under section three hundred-sixty-five-f of the social services law,  or
    50  private duty nursing services to be initiated after authorization; and
    51    (F)   Metrics tracking rebalancing from institutional care to communi-
    52  ty-based care, including:
    53    (I) for each plan, statewide and by region, the rate of  admission  of
    54  enrollees from the community to nursing facilities;
    55    (II)  of  each  plan's  enrollees  admitted to a nursing facility, the
    56  percentage successfully discharged to the community,  meaning  remaining
        A. 10176                            3

     1  in  the community for sixty days or more, and the percentage disenrolled
     2  from the plan pursuant to clause thirteen of subparagraph (v)  of  para-
     3  graph (b) of this subdivision  and the percentage disenrolled because of
     4  death or for other reasons, categorized by length of nursing home stay;
     5    (III)  the  rate  of enrollment of new enrollees who, prior to enroll-
     6  ment, were in a nursing home, by length of nursing home stay;
     7    (IV) the rate of re-enrollment of enrollees who had  been  disenrolled
     8  from the plan within the prior six months because of a long-term nursing
     9  home stay (under clause thirteen of subparagraph (v) of paragraph (b) of
    10  this subdivision).
    11    (3)  The  commissioner  shall  publish  the report on the department's
    12  website and provide notice to the temporary president of the senate, the
    13  speaker of the assembly, the chair of the senate standing  committee  on
    14  health,  the  chair  of  the  assembly health committee and the Medicaid
    15  Managed Care Advisory Review Panel upon availability of the report.  The
    16  initial  report  shall  be  provided  by  September  first, two thousand
    17  twelve. The reports shall be made available by each February first,  and
    18  September  first  thereafter.  Such  reports shall be formatted to allow
    19  comparisons between plans.
    20    (4) The commissioner shall make the final audited versions of all past
    21  annual managed long term care cost reports  available  for  download  in
    22  full in CSV format on the department's website, and shall make the final
    23  audited  versions  of all future annual cost reports available for down-
    24  load within thirty days of completion of the final audited report.
    25    § 2. This act shall take effect immediately; provided,  however,  that
    26  the  amendments  to  section  4403-f  of  the public health law, made by
    27  section one  of this act shall not affect the repeal of  such    section
    28  and    shall  be deemed to repeal therewith; and provided, further, that
    29  the amendments to paragraph (b) of subdivision 7 of  section  4403-f  of
    30  the  public  health law made by section one of this act shall not affect
    31  the expiration of such paragraph and shall expire therewith.