§ 364-JJ — Special advisory review panel on Medicaid managed care

New York § 364-JJ

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

* § 364-jj. Special advisory review panel on Medicaid managed care.\n(a) There is hereby established a special advisory review panel on\nMedicaid managed care. The panel shall consist of sixteen members who\nshall be appointed as follows: six by the governor, one of which shall\nserve as the chair; four each by the temporary president of the senate\nand the speaker of the assembly; and one each by the minority leader of\nthe senate and the minority leader of the assembly. At least three\nmembers of such panel shall be members of the joint advisory panel\nestablished under section 13.40 of the mental hygiene law. The panel\nshall include a consumer representative for individuals with behavioral\nhealth needs, a consumer representative for individuals who are dually\neligible for medicare and Medicaid, a representative of entities that\nprovide or arrange for the provision of services to individuals with\nbehavioral health needs, and a representative of entities that provide\nor arrange for the provision of services to individuals who are dually\neligible for medicare and Medicaid. Members shall serve without\ncompensation but shall be reimbursed for appropriate expenses. The\ndepartment shall provide technical assistance and access to data as is\nrequired for the panel to effectuate the mission and purposes\nestablished herein.\n (b) The panel shall:\n (i) determine whether there is sufficient managed care provider\nparticipation in the Medicaid managed care program;\n (ii) determine whether managed care providers meet proper enrollment\ntargets that permit as many Medicaid recipients as possible to make\ntheir own health plan decisions, thus minimizing the number of automatic\nassignments;\n (iii) review the phase-in schedule for enrollment, of managed care\nproviders under both the voluntary and mandatory programs;\n (iv) assess the impact of managed care provider marketing and\nenrollment strategies, and the public education campaign conducted in\nNew York city, on enrollees participation in Medicaid managed care\nplans;\n (v) evaluate the adequacy of managed care provider capacity by\nreviewing established capacity measurements and monitoring actual access\nto plan practitioners;\n (vi) examine the cost implications of populations excluded and\nexempted from Medicaid managed care;\n (vii) evaluate the adequacy and appropriateness of program materials;\n (viii) examine trends in service denials;\n (ix) assess the access to care for people with disabilities;\n (x) in accordance with the recommendations of the joint advisory\ncouncil established pursuant to section 13.40 of the mental hygiene law,\nadvise the commissioners of health and developmental disabilities with\nrespect to the oversight of DISCOs and of health maintenance\norganizations and managed long term care plans providing services\nauthorized, funded, approved or certified by the office for people with\ndevelopmental disabilities, and review all managed care options provided\nto persons with developmental disabilities, including: the adequacy of\nsupport for habilitation services; the record of compliance with\nrequirements for person-centered planning, person-centered services and\ncommunity integration; the adequacy of rates paid to providers in\naccordance with the provisions of paragraph 1 of subdivision four of\nsection forty-four hundred three of the public health law, paragraph\n(a-2) of subdivision eight of section forty-four hundred three of the\npublic health law or paragraph (a-2) of subdivision twelve of section\nforty-four hundred three-f of the public health law; and the quality of\nlife, health, safety and community integration of persons with\ndevelopmental disabilities enrolled in managed care; and\n (xi) examine other issues as it deems appropriate.\n (c) Commencing January first, nineteen hundred ninety-seven and\nquarterly thereafter the panel shall submit a report regarding the\nstatus of Medicaid managed care in the state and provide recommendations\nif it deems appropriate to the governor, the temporary president and the\nminority leader of the senate, and the speaker and the minority leader\nof the assembly.\n * NB Effective until December 31, 2027\n * § 364-jj. Special advisory review panel on Medicaid managed care.\n(a) There is hereby established a special advisory review panel on\nMedicaid managed care. The panel shall consist of nine members who shall\nbe appointed as follows: three by the governor, one of which shall serve\nas the chair; two each by the temporary president of the senate and the\nspeaker of the assembly; and one each by the minority leader of the\nsenate and the minority leader of the assembly. All members shall be\nappointed no later than September first, nineteen hundred ninety-six.\nMembers shall serve without compensation but shall be reimbursed for\nappropriate expenses. The department shall provide technical assistance\nand access to data as is required for the panel to effectuate the\nmission and purposes established herein.\n (b) The panel shall:\n (i) determine whether there is sufficient managed care provider\nparticipation in the Medicaid managed care program;\n (ii) determine whether managed care providers meet proper enrollment\ntargets that permit as many Medicaid recipients as possible to make\ntheir own health plan decisions, thus minimizing the number of automatic\nassignments;\n (iii) review the phase-in schedule for enrollment, of managed care\nproviders under both the voluntary and mandatory programs;\n (iv) assess the impact of managed care provider marketing and\nenrollment strategies, and the public education campaign conducted in\nNew York city, on enrollees participation in Medicaid managed care\nplans;\n (v) evaluate the adequacy of managed care provider capacity by\nreviewing established capacity measurements and monitoring actual access\nto plan practitioners;\n (vi) examine the cost implications of populations excluded and\nexempted from Medicaid managed care; and\n (vii) examine other issues as it deems appropriate.\n (c) Commencing January first, nineteen hundred ninety-seven and\nquarterly thereafter the panel shall submit a report regarding the\nstatus of Medicaid managed care in the state and provide recommendations\nif it deems appropriate to the governor, the temporary president and the\nminority leader of the senate, and the speaker and the minority leader\nof the assembly.\n * NB Effective December 31, 2027\n