N.Y. Social Services Law Section 365-N
Department of health assumption of program administration

1.

Notwithstanding the provisions of title two of article 3 (Local Public Welfare Organization)article three of this chapter or of § 365 (Responsibility for assistance)section three hundred sixty-five of this title or of any other law to the contrary, the commissioner of health (commissioner) is authorized to take actions explicitly authorized by this section that are necessary to transfer responsibility for the administration of the medical assistance program from local social services districts to the department of health (department) by March thirty-first, two thousand eighteen.

2.

For purposes of this section, the administration of the medical assistance program includes: processing applications for benefits and services available under this title and title eleven-D of this article; making determinations of initial and ongoing eligibility for such benefits and services; making coverage determinations with respect to benefits and services requiring prior authorization; notifying applicants and recipients of these determinations and of their rights and responsibilities, authorizing benefits and services for persons found eligible; exercising subrogation rights with respect to amounts received from insurance carriers or other liable third parties; imposing liens and pursuing recoveries; and any other such tasks and functions identified by the commissioner.

3.

Notwithstanding sections sixty-one, sixty-three, seventy, seventy-eight, seventy-nine, eighty-one and eighty-one-a of the civil service law or any provisions to the contrary contained in any general, special, or local laws, all lawful appointees of a county performing the functions established in subdivision two of this section as of the effective date of this section or any such appointees who meet the open competitive qualifications for positions established to perform these functions will be eligible for voluntary transfer to appropriate positions, in the department, that are classified to perform such functions without further examination, qualification, or probationary period; and, upon such transfer, will have all the rights and privileges of the jurisdictional classification to which such positions are allocated in the classified service of the state.

4.

Within one hundred twenty days of the effective date of this section, the department shall develop and implement a local department of social services statement of interest. The statement of interest will elicit from local departments of social services their interest in and capacity to contract with the department to perform the functions established in subdivision two of this section. To the extent practicable and in the best interest of the medical assistance program, the department shall contract with local social services districts to perform all or a portion of the functions described in subdivision two of this section. In no event, however, shall the department, by means of such a contract, delegate its authority to exercise administrative discretion in the administration or supervision of the state plan for medical assistance submitted pursuant to § 363-A (Federal aid)section three hundred sixty-three-a of this title, or to issue policies, rules, and regulations on program matters nor may any contracted entity be given the authority to change or disapprove any administrative decision of the department, or otherwise substitute such entity’s judgment for that of the department with respect to the application of policies, rules, and regulations issued by the department. Notwithstanding any inconsistent provision of sections one hundred twelve and one hundred sixty-three of the state finance law, or sections one hundred forty-two and one hundred forty-three of the economic development law, or any other contrary provision of law, the commissioner is authorized to enter into a contract with local departments of social services without a competitive bid or request for proposal process. 5-a.

(a)

The commissioner may take necessary action to review the accuracy of determinations of initial and ongoing eligibility under the medical assistance program, and to identify and eliminate inappropriate instances of concurrent or duplicate benefits and authorizations. The commissioner is authorized to contract with one or more entities to assist the state in implementing the provisions of this subdivision.

(b)

Notwithstanding the provisions of sections one hundred twelve and one hundred sixty-three of the state finance law, or Economic Development Law § 142 (Procurement opportunities newsletter)section one hundred forty-two of the economic development law, or any contrary provision of law, the commissioner is authorized to enter into a contract or contracts under paragraph (a) of this subdivision without a competitive bid or request for proposal process, provided, however, that:

(i)

The department of health shall post on its website, for a period of no less than thirty days: (1) A description of the proposed services to be provided pursuant to the contract or contracts; (2) The criteria for selection of a contractor or contractors; (3) The period of time during which a prospective contractor may seek selection, which shall be no less than thirty days after such information is first posted on the website; and (4) The manner by which a prospective contractor may seek such selection, which may include submission by electronic means;

(ii)

All reasonable and responsive submissions that are received from prospective contractors in timely fashion shall be reviewed by the commissioner; and

(iii)

The commissioner shall select such contractor or contractors that, in his or her discretion, are best suited to serve the purposes of this section; and

(iv)

No contract entered pursuant to this paragraph shall have a term that ends later than March thirty-first, two thousand seventeen.

6.

The commissioner shall submit an annual report to the governor, temporary president of the senate, speaker of the assembly, the chair of the senate health committee and the chair of the assembly health committee by December thirty-first, beginning in two thousand twelve and for each year thereafter until the year following full implementation. The initial report shall consist of modifications to the plan developed pursuant to section forty-seven-b of part B of chapter fifty-eight of the laws of two thousand ten, and shall include anticipated implementation of the revised plan, its elements, a timeline for such implementation, recommendations for legislative action, and such other matters as may be pertinent. The report shall include a plan and timeline for the state to:

(i)

assume specific functions related to the administration of the medical assistance program;

(ii)

coordinate the implementation of provisions of federal law with the assumption of the administration of the medical assistance program; and

(iii)

address the financing of the medical assistance program administration and any associated administrative cost relief to local social services districts. The report shall also indicate any function that the state intends to enter into a contract with a public and/or private entity to perform, and the date in which the state anticipates entering into any such contract. In addition, reports shall, at a minimum, indicate:

(i)

any progress the department has made regarding its proposed timeline, including a summary of all functions assumed by the state during the previous year;

(ii)

any anticipated and/or actual delay from the proposed timeline;

(iii)

the reason for any such delay; and

(iv)

actions the department has undertaken to mitigate any such delay.

7.

The commissioner shall promulgate such regulations that are necessary to carry out the provisions of this section. In addition, the commissioner shall make any amendments to the state plan for medical assistance, or develop and submit an application for any waiver or approval under the federal social security act, that are necessary and required to carry out the provisions of this section.

Source: Section 365-N — Department of health assumption of program administration, https://www.­nysenate.­gov/legislation/laws/SOS/365-N (updated May 6, 2016; accessed Dec. 21, 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 367‑Y
Reimbursement for treatment in place and transportation to alternative health care settings 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:
Dec. 21, 2024

Last modified:
May 6, 2016

§ 365-N’s source at nysenate​.gov

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