Repeals managed long term care provisions for Medicaid recipients; establishes provisions for fully integrated plans for long term care including PACE and MAP plans.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8470
SPONSOR: Paulin 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 program and replace it with long term care
services delivered through a fee-for-service model while preserving
fully capitated models.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 establishes legislative intent, 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
which established MLTC plans. The new section directs 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.
The new section grants the Commissioner of Health the authority to
establish guidelines for the establishment and operation of care coordi-
nation entities. The new section would also establish a process that
allows persons eligible to receive services to select either a PACE or
MAP provider/plan when appropriate, or a care coordination entity to
assist in the delivery of fee-for-service based long term care services.
If a selection is not made in a timely fashion the Commissioner of
Health would assign a care coordination entity for the person to receive
long term care services in a fee-for-service model.
Section 3 modifies the social services law to direct the COH to promul-
gate regulations for a delivery of long-term care services through a
fee-for-service model. The regulations would include but not be limited
to: the establishment and operation of care coordination entities;
continuity of care; and conflict-free case management. Section 3 would
also direct the Department of Health (DOH) to conduct an evaluation of
the viability of using care coordination entities in place of the inde-
pendent assessor for assessments or reassessments when determining an
individual's needs.
Section 4 establishes a new section of unconsolidated law that directs
the COH to convene an advisory group that is composed of and informed by
stakeholder representatives. 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-ser-
vice based model both the Commissioner and the advisory board are
directed to consider and select programs and policies that seek to maxi-
mize continuity of care and minimize disruption to the provider labor
workforce. The section also states a commitment to support providers
based on a commitment to quality and value. The section would establish
a biannual reporting process on implementation of the transition.
Sections 5 through 25 make conforming changes to various sections of law
replacing references to 4403-f of the public health law 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 managed care plans to
manage and coordinate healthcare for several Medicaid services.. 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 arranged are solely home care.
Because of this "care coordination" is limited, and the plan administra-
tive 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 healthcare workforce challenges facing the state.
In the past 3.75 years, New York State has allocated $5.9 billion to 24
managed care plans managing home care in administrative costs and
profit. In 2021 alone, the latest full year of data available, MLTC
plans 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.
PRIOR LEGISLATIVE HISTORY:
New bill.
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, 2026.
