New York State Assembly

 
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A09538 Summary:

A09538 Actions:

A09538 Committee Votes:

Committee:HEALTH   Chair:Gottfried      
DATE:02/11/2020AYE/NAY:22/0  Action: Favorable         
Gottfried
Aye
Byrne
Aye
Schimminger
Aye
McDonough
Aye
Galef
Aye
Garbarino
Aye
Dinowitz
Aye
Byrnes
Aye
Cahill
Aye
Ashby
Excused
Paulin
Excused
Miller
Aye
Cymbrowitz
Aye
Salka
Aye
Gunther
Aye
Rosenthal
Aye
Hevesi
Aye
Jaffee
Excused
Steck
Aye
Abinanti
Aye
Braunstein
Aye
Kim
Aye
Solages
Aye
Bichotte
Excused
Barron
Aye
Sayegh
Aye

A09538 Floor Votes:

A09538 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A9538
 
SPONSOR: Gottfried

 
TITLE OF BILL:
 
An act to amend the social services law and the public health law, in
relation to adverse determination notices to Medicaid recipients
 
 
PURPOSE OR GENERAL IDEA OF BILL:
 
To require Medicaid managed care plans to provide written notice of the
name, address, phone number and website of the department of health
designated independent consumer assistance program and the independent
substance use disorder and mental health ombudsman on all notices of
adverse determinations, grievances and appeals.
 
 
SUMMARY OF SPECIFIC PROVISIONS:
 
Section one amends subdivision 9 of section 364-j of the social services
law to require notice of the department of health designated independent
consumer assistance program and the independent substance use disorder
and mental health ombudsman on all notices of adverse determinations,
grievances and appeals.
 
Section two of the bill amends subdivision 2 and subdivision 7 of
section 4408-a of the public health law to require notice of the depart-
ment of health designated independent consumer assistance program and
the independent substance use disorder and mental health ombudsman on
all notices of adverse determinations, grievances and appeals.
 
Section 3 of the bill establishes the effective date.
 
 
JUSTIFICATION:
 
Navigating the health care system is difficult. This is especially true
for people who are covered by managed care plans charged with adminis-
tering the state's Medicaid program.

Recognizing these challenges, independent consumer assistance programs
were established and initially funded as part of the Affordable Care
Act. New York has continued the program with funding supported by the
Legislature and the Governor.
 
This bill requires notice of this important consumer assistance program
on all adverse determinations made by Medicaid managed care plans thus
providing recipients access to an independent resource for assistance.
 
 
PRIOR LEGISLATIVE HISTORY:
 
New bill.
 
 
FISCAL IMPLICATIONS:
 
None to the state.
 
 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law.

A09538 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          9538
 
                   IN ASSEMBLY
 
                                    January 24, 2020
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health
 
        AN ACT to amend the social services law and the public  health  law,  in
          relation to adverse determination notices to Medicaid recipients
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 9 of section 364-j of the social services  law,
     2  as  amended  by  chapter  433 of the laws of 1997, is amended to read as
     3  follows:
     4    9. Managed care providers shall inform participants of such provider's
     5  grievance procedure and utilization review procedures [required pursuant
     6  to sections forty-four hundred eight-c  and]  under  article  forty-nine
     7  [hundred]  of  the  public  health law. A managed care provider or local
     8  social services  district,  as  appropriate,  shall  provide  notice  to
     9  participants  of  their  respective  rights  to  a  fair hearing and aid
    10  continuing in accordance with applicable state and federal law.  Managed
    11  care providers shall provide written notice of the name, address,  phone
    12  number  and  website  of the department of health designated independent
    13  consumer assistance program and the independent substance  use  disorder
    14  and  mental  health ombudsman established by section 33.27 of the mental
    15  hygiene law on all notices of  adverse  determinations,  grievances  and
    16  appeals.
    17    §  2.  Paragraph  (b)  of  subdivision  2 and subdivision 7 of section
    18  4408-a of the public health law, as added by chapter 705 of the laws  of
    19  1996, are amended to read as follows:
    20    (b)  The  notice to an enrollee describing the grievance process shall
    21  explain: (i) the process for filing a grievance with  the  organization;
    22  (ii) the timeframes within which a grievance determination must be made;
    23  [and]  (iii)  the  right of an enrollee to designate a representative to
    24  file a grievance on behalf of the enrollee; and (iv) notice of the name,
    25  address, phone number and website of the department designated  consumer
    26  assistance program and the independent substance use disorder and mental
    27  health  ombudsman established by section 33.27 of the mental hygiene law
    28  on all notices of adverse determinations, grievances and appeals.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14155-02-9
        A. 9538                             2
 
     1    7. The notice of a  determination  shall  include:  (i)  the  detailed
     2  reasons for the determination; (ii) in cases where the determination has
     3  a  clinical  basis,  the clinical rationale for the determination; [and]
     4  (iii) the procedures for the filing of an appeal of  the  determination,
     5  including  a  form  for the filing of such an appeal; and (iv) notice of
     6  the name, address, phone number and website of the department designated
     7  consumer assistance program and the independent substance  use  disorder
     8  and  mental  health ombudsman established by section 33.27 of the mental
     9  hygiene law on all notices of  adverse  determinations,  grievances  and
    10  appeals.
    11    § 3. This act shall take effect on the one hundred eightieth day after
    12  it  shall  have  become a law; provided, however, the amendments made to
    13  subdivision 9 of section 364-j  of  the  social  services  law  made  by
    14  section one of this act shall not affect the repeal of such section, and
    15  shall be deemed repealed therewith.