§ 365-L — Health homes

§ 365-l. Health homes. 1. Notwithstanding any law, rule or regulation\nto the contrary, the commissioner of health is authorized, in\nconsultation with the commissioners of the office of mental health,\noffice of alcoholism and substance abuse services, and office for people\nwith developmental disabilities, to (a) establish, in accordance with\napplicable federal law and regulations, standards for the provision of\nhealth home services to Medicaid enrollees with chronic conditions, (b)\nestablish payment methodologies for health home services based on\nfactors including but not limited to the complexity of the conditions\nproviders will be managing, the anticipated amount of patient contact\nneeded to manage such conditions, and the health care cost savings\nrealized by provision of health home services, (c) establish the\ncriteria under which a Medicaid enrollee will be designated as being an\neligible individual with chronic conditions for purposes of this\nprogram, (d) assign any Medicaid enrollee designated as an eligible\nindividual with chronic conditions to a provider of health home\nservices.\n 2. In addition to payments made for health home services pursuant to\nsubdivision one of this section, the commissioner is authorized to pay\nadditional amounts to providers of health home services that meet\nprocess or outcome standards specified by the commissioner. Such\nadditional amounts may be paid with state funds only if federal\nfinancial participation for such payments is unavailable.\n 2-a. Up to fifteen million dollars in state funding may be used to\nfund health home infrastructure development. Such funds shall be used to\ndevelop enhanced systems to support Health Home operations including\nassignments, workflow, and transmission of data. Funding will also be\ndisbursed pursuant to a formula established by the commissioner to be\ndesignated health homes. Such formula may consider prior access to\nsimilar funding opportunities, geographic and demographic factors,\nincluding the population served, and prevalence of qualifying\nconditions, connectivity to providers, and other criteria as established\nby the commissioner.\n 2-b. The commissioner is authorized to make lump sum payments or\nadjust rates of payment to providers up to a gross amount of five\nmillion dollars, to establish coordination between the health homes and\nthe criminal justice system and for the integration of information of\nhealth homes with state and local correctional facilities, to the extent\npermitted by law. Such rate adjustments may be made to health homes\nparticipating in a criminal justice pilot program with the purpose of\nenrolling incarcerated individuals with serious mental illness, two or\nmore chronic conditions, including substance abuse disorders, or\nHIV/AIDS, into such health home. Health homes receiving funds under this\nsubdivision shall be required to document and demonstrate the effective\nuse of funds distributed herein.\n 2-c. The commissioner is authorized to make grants up to a gross\namount of one million dollars for certified application counselors and\nassistors to facilitate the enrollment of persons in high risk\npopulations, including but not limited to persons with mental health\nand/or substance abuse conditions that have been recently discharged or\nare pending release from state and local correctional facilities. Funds\nallocated for certified application counselors and assistors shall be\nexpended through a request for proposal process.\n 2-d. The commissioner shall establish reasonable targets for health\nhome participation by enrollees of special needs managed care plans\ndesignated pursuant to subdivision four of section three hundred\nsixty-five-m of this title and by high-risk enrollees of other Medicaid\nmanaged care plans operating pursuant to section three hundred\nsixty-four-j of this title, and shall encourage both the managed care\nproviders and the health homes to work collaboratively with each other\nto achieve such targets. The commissioner may assess penalties under\nthis subdivision in instances of failure to meet the participation\ntargets established pursuant to this subdivision, where the department\nhas determined that such failure reflected the absence of a good faith\nand reasonable effort to achieve the participation targets, except that\nmanaged care providers shall not be penalized for the failure of a\nhealth home to work collaboratively toward meeting the participation\ntargets and a health home shall not be penalized for the failure of a\nmanaged care provider to work collaboratively toward meeting the\nparticipation targets.\n 3. Until such time as the commissioner obtains necessary waivers\nand/or approvals of the federal social security act, Medicaid enrollees\nassigned to providers of health home services will be allowed to opt out\nof such services. In addition, upon enrollment, an enrollee shall be\noffered an option of at least two providers of health home services, to\nthe extent practicable.\n 4. Payments authorized pursuant to this section will be made with\nstate funds only, to the extent that such funds are appropriated\ntherefore, until such time as federal financial participation in the\ncosts of such services is available.\n 5. The commissioner is authorized to submit amendments to the state\nplan for medical assistance and/or submit one or more applications for\nwaivers of the federal social security act, to obtain federal financial\nparticipation in the costs of health home services provided pursuant to\nthis section, and as provided in subdivision three of this section.\n 6. Notwithstanding any limitations imposed by section three hundred\nsixty-four-l of this title on entities participating in demonstration\nprojects established pursuant to such section, the commissioner is\nauthorized to allow such entities which meet the requirements of this\nsection to provide health home services.\n 7. Notwithstanding any law, rule, or regulation to the contrary, the\ncommissioners of the department of health, the office of mental health,\nthe office for people with developmental disabilities, and the office of\nalcoholism and substance abuse services are authorized to jointly\nestablish a single set of operating and reporting requirements and a\nsingle set of construction and survey requirements for entities that:\n (a) can demonstrate experience in the delivery of health, and mental\nhealth and/or alcohol and substance abuse services and/or services to\npersons with developmental disabilities, and the capacity to offer\nintegrated delivery of such services in each location approved by the\ncommissioner; and\n (b) meet the standards established pursuant to subdivision one of this\nsection for providing and receiving payment for health home services;\nprovided, however, that an entity meeting the standards established\npursuant to subdivision one of this section shall not be required to be\nan integrated service provider pursuant to this subdivision.\n In establishing a single set of operating and reporting requirements\nand a single set of construction and survey requirements for entities\ndescribed in this subdivision, the commissioners of the department of\nhealth, the office of mental health, the office for people with\ndevelopmental disabilities, and the office of alcoholism and substance\nabuse services are authorized to waive any regulatory requirements as\nare necessary to avoid duplication of requirements and to allow the\nintegrated delivery of services in a rational and efficient manner.\n 8. (a) The commissioner of health is authorized to contract with one\nor more entities to assist the state in implementing the provisions of\nthis section. Such entity or entities shall be the same entity or\nentities chosen to assist in the implementation of the multipayor\npatient centered medical home program pursuant to section twenty-nine\nhundred fifty-nine-a of the public health law. Responsibilities of the\ncontractor shall include but not be limited to: developing\nrecommendations with respect to program policy, reimbursement, system\nrequirements, reporting requirements, evaluation protocols, and provider\nand patient enrollment; providing technical assistance to potential\nmedical home and health home providers; data collection; data sharing;\nprogram evaluation, and preparation of reports.\n (b) Notwithstanding any inconsistent provision of sections one hundred\ntwelve and one hundred sixty-three of the state finance law, or section\none hundred forty-two of the economic development law, or any other law,\nthe commissioner of health is authorized to enter into a contract or\ncontracts under paragraph (a) of this subdivision without a competitive\nbid or request for proposal process, provided, however, that:\n (i) The department of health shall post on its website, for a period\nof no less than thirty days:\n (1) A description of the proposed services to be provided pursuant to\nthe contract or contracts;\n (2) The criteria for selection of a contractor or contractors;\n (3) The period of time during which a prospective contractor may seek\nselection, which shall be no less than thirty days after such\ninformation is first posted on the website; and\n (4) The manner by which a prospective contractor may seek such\nselection, which may include submission by electronic means;\n (ii) All reasonable and responsive submissions that are received from\nprospective contractors in timely fashion shall be reviewed by the\ncommissioner of health; and\n (iii) The commissioner of health shall select such contractor or\ncontractors that, in his or her discretion, are best suited to serve the\npurposes of this section.\n 9. The contract entered into by the commissioner of health prior to\nJanuary first, two thousand thirteen pursuant to subdivision eight of\nthis section may be amended or modified without the need for a\ncompetitive bid or request for proposal process, and without regard to\nthe provisions of sections one hundred twelve and one hundred\nsixty-three of the state finance law, section one hundred forty-two of\nthe economic development law, or any other provision of law, excepting\nthe responsible vendor requirements of the state finance law, including,\nbut not limited to, sections one hundred sixty-three and one hundred\nthirty-nine-k of the state finance law, to allow the purchase of\nadditional personnel and services, subject to available funding, for the\nlimited purpose of assisting the department of health with implementing\nthe Balancing Incentive Program, the Fully Integrated Duals Advantage\nProgram, the Vital Access Provider Program, the Medicaid waiver\namendment associated with the public hospital transformation, the\naddition of behavioral health services as a managed care plan benefit,\nthe delivery system reform incentive payment plan, activities to\nfacilitate the transition of vulnerable populations to managed care\nand/or any workgroups required to be established by the chapter of the\nlaws of two thousand thirteen that added this subdivision. The\ndepartment is authorized to extend such contract for a period of one\nyear, without a competitive bid or request for proposal process, upon\ndetermination that the existing contractor is qualified to continue to\nprovide such services; provided, however, that the department of health\nshall submit a request for applications for such contract during the\ntime period specified in this subdivision and may terminate the contract\nidentified herein prior to expiration of the extension authorized by\nthis subdivision.\n