N.Y. Social Services Law Section 364-JJ
Special advisory review panel on Medicaid managed care

(a)

There is hereby established a special advisory review panel on Medicaid managed care. The panel shall consist of sixteen members who shall be appointed as follows: six by the governor, one of which shall serve as the chair; four each by the temporary president of the senate and the speaker of the assembly; and one each by the minority leader of the senate and the minority leader of the assembly. At least three members of such panel shall be members of the joint advisory panel established under section 13.40 of the mental hygiene law. The panel shall include a consumer representative for individuals with behavioral health needs, a consumer representative for individuals who are dually eligible for medicare and Medicaid, a representative of entities that provide or arrange for the provision of services to individuals with behavioral health needs, and a representative of entities that provide or arrange for the provision of services to individuals who are dually eligible for medicare and Medicaid. Members shall serve without compensation but shall be reimbursed for appropriate expenses. The department shall provide technical assistance and access to data as is required for the panel to effectuate the mission and purposes established herein.

(b)

The panel shall:

(i)

determine whether there is sufficient managed care provider participation in the Medicaid managed care program;

(ii)

determine whether managed care providers meet proper enrollment targets that permit as many Medicaid recipients as possible to make their own health plan decisions, thus minimizing the number of automatic assignments;

(iii)

review the phase-in schedule for enrollment, of managed care providers under both the voluntary and mandatory programs;

(iv)

assess the impact of managed care provider marketing and enrollment strategies, and the public education campaign conducted in New York city, on enrollees participation in Medicaid managed care plans;

(v)

evaluate the adequacy of managed care provider capacity by reviewing established capacity measurements and monitoring actual access to plan practitioners;

(vi)

examine the cost implications of populations excluded and exempted from Medicaid managed care;

(vii)

evaluate the adequacy and appropriateness of program materials;

(viii)

examine trends in service denials;

(ix)

assess the access to care for people with disabilities;

(x)

in accordance with the recommendations of the joint advisory council established pursuant to section 13.40 of the mental hygiene law, advise the commissioners of health and developmental disabilities with respect to the oversight of DISCOs and of health maintenance organizations and managed long term care plans providing services authorized, funded, approved or certified by the office for people with developmental disabilities, and review all managed care options provided to persons with developmental disabilities, including: the adequacy of support for habilitation services; the record of compliance with requirements for person-centered planning, person-centered services and community integration; the adequacy of rates paid to providers in accordance with the provisions of paragraph 1 of subdivision four of Public Health Law § 4403 (Health maintenance organizations)section forty-four hundred three of the public health law, paragraph (a-2) of subdivision eight of Public Health Law § 4403 (Health maintenance organizations)section forty-four hundred three of the public health law or paragraph (a-2) of subdivision twelve of Public Health Law § 4403-F (Managed long term care plans)section forty-four hundred three-f of the public health law; and the quality of life, health, safety and community integration of persons with developmental disabilities enrolled in managed care; and

(xi)

examine other issues as it deems appropriate.

(c)

Commencing January first, nineteen hundred ninety-seven and quarterly thereafter the panel shall submit a report regarding the status of Medicaid managed care in the state and provide recommendations if it deems appropriate to the governor, the temporary president and the minority leader of the senate, and the speaker and the minority leader of the assembly. * NB Effective until December 31, 2025 * § 364-jj. Special advisory review panel on Medicaid managed care.

(a)

There is hereby established a special advisory review panel on Medicaid managed care. The panel shall consist of nine members who shall be appointed as follows: three by the governor, one of which shall serve as the chair; two each by the temporary president of the senate and the speaker of the assembly; and one each by the minority leader of the senate and the minority leader of the assembly. All members shall be appointed no later than September first, nineteen hundred ninety-six. Members shall serve without compensation but shall be reimbursed for appropriate expenses. The department shall provide technical assistance and access to data as is required for the panel to effectuate the mission and purposes established herein.

(b)

The panel shall:

(i)

determine whether there is sufficient managed care provider participation in the Medicaid managed care program;

(ii)

determine whether managed care providers meet proper enrollment targets that permit as many Medicaid recipients as possible to make their own health plan decisions, thus minimizing the number of automatic assignments;

(iii)

review the phase-in schedule for enrollment, of managed care providers under both the voluntary and mandatory programs;

(iv)

assess the impact of managed care provider marketing and enrollment strategies, and the public education campaign conducted in New York city, on enrollees participation in Medicaid managed care plans;

(v)

evaluate the adequacy of managed care provider capacity by reviewing established capacity measurements and monitoring actual access to plan practitioners;

(vi)

examine the cost implications of populations excluded and exempted from Medicaid managed care; and

(vii)

examine other issues as it deems appropriate.

(c)

Commencing January first, nineteen hundred ninety-seven and quarterly thereafter the panel shall submit a report regarding the status of Medicaid managed care in the state and provide recommendations if it deems appropriate to the governor, the temporary president and the minority leader of the senate, and the speaker and the minority leader of the assembly. * NB Effective December 31, 2025

Source: Section 364-JJ — Special advisory review panel on Medicaid managed care, https://www.­nysenate.­gov/legislation/laws/SOS/364-JJ (updated May 12, 2023; accessed May 4, 2024).

363
Declaration of objects 363‑A
Federal aid 363‑B
Agreements for federal determination of eligibility of aged, blind and disabled persons for medical assistance 363‑C
Medicaid management 363‑D
Provider compliance program 363‑E
Medicaid plan, applications for waivers and plan amendments 363‑F
Electronic visit verification for personal care and home health providers 364
Responsibility for standards 364‑A
Cooperation of state departments 364‑B
Residential and medical care placement demonstration projects 364‑C
National long term care channeling demonstration project 364‑D
Medical assistance research and demonstration projects 364‑E
Aid to families with dependent children homemaker/home health aide demonstration projects 364‑F
Primary care case management programs 364‑G
Medical assistance capitation rate demonstration project 364‑H
Foster family care demonstration programs for elderly or disabled persons 364‑I
Medical assistance presumptive eligibility program 364‑J
Managed care programs 364‑J‑2
Transitional supplemental payments 364‑JJ
Special advisory review panel on Medicaid managed care 364‑KK
Condition of Participation 364‑M
Statewide patient centered medical home program 364‑N
Diabetes and chronic disease self-management pilot program 365
Responsibility for assistance 365‑A
Character and adequacy of assistance 365‑B
Local medical plans: professional directors 365‑C
Medical advisory committee 365‑D
Medicaid evidence based benefit review advisory committee 365‑E
Optional or continued membership in entities offering comprehensive health services plans 365‑F
Consumer directed personal assistance program 365‑G
Utilization review for certain care, services and supplies 365‑H
Provision and reimbursement of transportation costs 365‑J
Advisory opinions 365‑K
Provision of prenatal care services 365‑L
Health homes 365‑M
Administration and management of behavioral health services 365‑N
Department of health assumption of program administration 365‑O
Provision and coverage of services for living organ donors 365‑P
Doulas for Medicaid 366
Eligibility 366‑A
Applications for assistance 366‑B
Penalties for fraudulent practices 366‑C
Treatment of income and resources of institutionalized persons 366‑D
Medical assistance provider 366‑E
Certified home health agency medicare billing 366‑F
Persons acting in concert with a medical assistance provider 366‑G
Newborn enrollment for medical assistance 366‑H
Automated system 366‑I
Long-term care financing demonstration program 367
Authorization for hospital care 367‑A
Payments 367‑B
Medical assistance information and payment system 367‑C
Payment for long term home health care programs 367‑D
Personal care need determination 367‑E
Payment for AIDS home care programs 367‑F
Partnership for long term care program 367‑G
Authorization and provision of personal emergency response services 367‑H
Payment for assisted living programs 367‑I
Personal care services provider assessments 367‑O
Health insurance demonstration programs 367‑P
Responsibilities of local districts for personal care services, home care services and private duty nursing 367‑P*2
Payment for limited home care services agencies 367‑Q
Personal care services worker recruitment and retention program 367‑R
Private duty nursing services worker recruitment and retention program 367‑S
Long term care demonstration program 367‑S*2
Emergency medical transportation services 367‑T
Payment for emergency physician services 367‑U
Payment for home telehealth services 367‑V
County long-term care financing demonstration program 367‑W
Health care and mental hygiene worker bonuses 367‑X
Payment for violence prevention programs 368
Quarterly estimates 368‑A
State reimbursement 368‑B
State reimbursement to local health districts 368‑C
Audit of state rates of payment to providers of health care services 368‑D
Reimbursement to public school districts and state operated/state supported schools which operate pursuant to article eighty-five, eighty... 368‑E
Reimbursement to counties for pre-school children with handicapping conditions 368‑F
Reimbursement of costs under the early intervention program 369
Application of other provisions
Green check means up to date. Up to date

Accessed:
May 4, 2024

Last modified:
May 12, 2023

§ 364-JJ’s source at nysenate​.gov

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