N.Y. PBH Law § 4403-F — New York Code / Act PBH / Article 44 / Section 4403-F
Managed long term care plans
Status: in_force

* § 4403-f. Managed long term care plans. 1. Definitions. As used in\nthis section:\n  (a) "Managed long term care plan" means an entity that has received a\ncertificate of authority pursuant to this section to provide, or arrange\nfor, health and long term care services, on a capitated basis in\naccordance with this section, for a population, age eighteen and over,\nwhich the plan is authorized to enroll.\n  (b) "Eligible applicant" means an entity controlled or wholly owned by\none or more of the following: a hospital as defined in subdivision one\nof section twenty-eight hundred one of this chapter; a home care agency\nlicensed or certified pursuant to article thirty-six of this chapter; an\nentity that has received a certificate of authority pursuant to sections\nforty-four hundred three, forty-four hundred three-a or forty-four\nhundred eight-a of this article (as added by chapter six hundred\nthirty-nine of the laws of nineteen hundred ninety-six), or a health\nmaintenance organization authorized under article forty-three of the\ninsurance law; or a not-for-profit organization which has a history of\nproviding or coordinating health care services and long term care\nservices to the elderly and disabled.\n  (c) "Operating demonstration" means the following entities: the\nchronic care management demonstration programs authorized by chapter\nfive hundred thirty of the laws of nineteen hundred eighty-eight,\nchapter five hundred ninety-seven of the laws of nineteen hundred\nninety-four and chapter eighty-one of the laws of nineteen hundred\nninety-five as amended.\n  (d) "Health and long term care services" means services including, but\nnot limited to home and community-based and institution-based long term\ncare and ancillary services (that shall include medical supplies and\nnutritional supplements) that are necessary to meet the needs of persons\nwhom the plan is authorized to enroll. The managed long term care plan\nmay also cover primary care, acute care and behavioral health services\nif so authorized.\n  2. Certificate of authority; form. An eligible applicant shall submit\nan application for a certificate of authority to operate a managed long\nterm care plan upon forms prescribed by the commissioner. Such eligible\napplicant shall submit information and documentation to the commissioner\nwhich shall include, but not be limited to:\n  (a) a description of the service area proposed to be served by the\nplan with projections of enrollment that will result in a fiscally sound\nplan;\n  (b) a description of the proposed target population and the marketing\nplan;\n  (c) adequate documentation of the appropriate licenses, certifications\nor approvals to provide care as planned, including contracts with such\nproviders as may be necessary to provide the full complement of services\nrequired to be provided under this section.\n  3. Certificate of authority; approval. The commissioner shall not\napprove an application for a certificate of authority unless the\napplicant demonstrates to the commissioner's satisfaction:\n  (a) that it will have in place acceptable quality-assurance\nmechanisms, grievance procedures, mechanisms to protect the rights of\nenrollees and case management services to ensure continuity, quality,\nappropriateness and coordination of care;\n  (b) that it will include an enrollment process which shall ensure that\nenrollment in the plan is informed. The application shall describe the\ndisenrollment process, which shall provide that an otherwise eligible\nenrollee shall not be involuntarily disenrolled on the basis of health\nstatus;\n  (c) satisfactory evidence of the character and competence of the\nproposed operators and reasonable assurance that the applicant will\nprovide high quality services to an enrolled population;\n  (d) sufficient management systems capacity to meet the requirements of\nthis section and the ability to efficiently process payment for covered\nservices;\n  (e) readiness and capability to maximize reimbursement of and\ncoordinate services reimbursed pursuant to title XVIII of the federal\nsocial security act and all other applicable benefits, with such benefit\ncoordination including, but not limited to, measures to support sound\nclinical decisions, reduce administrative complexity, coordinate access\nto services, maximize benefits available pursuant to such title and\nensure that necessary care is provided;\n  (f) readiness and capability to arrange and manage covered services\nand coordinate non-covered services which could include primary,\nspecialty, and acute care services reimbursed pursuant to title XIX of\nthe federal social security act;\n  (g) willingness and capability of taking, or cooperating in, all steps\nnecessary to secure and integrate any potential sources of funding for\nservices provided by the managed long term care plan, including, but not\nlimited to, funding available under titles XVI, XVIII, XIX and XX of the\nfederal social security act, the federal older Americans act of nineteen\nhundred sixty-five, as amended, or any successor provisions subject to\napproval of the director of the state office for aging, and through\nfinancing options such as those authorized pursuant to section three\nhundred sixty-seven-f of the social services law;\n  (h) that the contractual arrangements for providers of health and long\nterm care services in the benefit package are sufficient to ensure the\navailability and accessibility of such services to the proposed enrolled\npopulation consistent with guidelines established by the commissioner;\nwith respect to individuals in receipt of such services prior to\nenrollment, such guidelines shall require the managed long term care\nplan to contract with agencies currently providing such services, in\norder to promote continuity of care. In addition, such guidelines shall\nrequire managed long term care plans to offer and cover consumer\ndirected personal assistance services for eligible individuals who elect\nsuch services pursuant to section three hundred sixty-five-f of the\nsocial services law; and\n  (i) that the applicant is financially responsible and may be expected\nto meet its obligations to its enrolled members.\n  4. Solvency. (a) The commissioner shall be responsible for evaluating,\napproving and regulating all matters relating to fiscal solvency,\nincluding reserves, surplus and provider contracts. The commissioner may\npromulgate regulations to implement this section. The commissioner, in\nthe administration of this subdivision:\n  (i) shall be guided by the standards which govern the fiscal solvency\nof a health maintenance organization, provided, however, that the\ncommissioner shall recognize the specific delivery components,\noperational capacity and financial capability of the eligible applicant\nfor a certificate of authority;\n  (ii) shall not apply financial solvency standards that exceed those\nrequired for a health maintenance organization; and\n  (iii) shall establish reasonable capitalization and contingent reserve\nrequirements.\n  (b) Standards established pursuant to this subdivision shall be\nadequate to protect the interests of enrollees in managed long term care\nplans.  The commissioner shall be satisfied that the eligible applicant\nis financially sound, and has made adequate provisions to pay for\nservices.\n  4-a. Role of the superintendent of financial services. (a) The\nsuperintendent of financial services shall determine and approve\npremiums in accordance with the insurance law whenever any population of\nenrollees not eligible under title XIX of the federal social security\nact is to be covered. The determination and approval of the\nsuperintendent of financial services shall relate to premiums charged to\nsuch enrollees not eligible under title XIX of the federal social\nsecurity act.\n  (b) The superintendent of financial services shall evaluate and\napprove any enrollee contracts whenever such enrollee contracts are to\ncover any population of enrollees not eligible under title XIX of the\nfederal social security act.\n  5. Applicability of other laws. A managed long term care plan shall be\nsubject to the provisions of the insurance law and regulations\napplicable to health maintenance organizations, this article and\nregulations promulgated pursuant thereto. To the extent that the\nprovisions of this section are inconsistent with the provisions of this\nchapter or the provisions of the insurance law, the provisions of this\nsection shall prevail.\n  6. Approval authority.  (a) An applicant shall be issued a certificate\nof authority as a managed long term care plan upon a determination by\nthe commissioner that the applicant complies with the operating\nrequirements for a managed long term care plan under this section. The\ncommissioner shall issue no more than seventy-five certificates of\nauthority to managed long term care plans pursuant to this section.\n  (a-1) Nothing in this section shall be construed as requiring the\ndepartment to contract with or to contract for a particular line of\nbusiness with an entity certified under this section for the provision\nof services available under title eleven of article five of the social\nservices law. A managed long term care plan that has been issued a\ncertificate of authority, or an applicant for a certificate of authority\nas a managed long term care plan that has in any of the three calendar\nyears immediately preceding the application, met any of the following\ncriteria shall not be eligible for a contract for the provision of\nservices available under title eleven of article five of the social\nservices law: (i) classified as a poor performer, or substantially\nsimilar terminology, by the centers for medicare and medicaid services;\nor (ii) an excessive volume of penalties, statements of findings,\nstatements of deficiency, intermediate sanctions or enforcement actions,\nregardless of whether the applicant has addressed such issues in a\ntimely manner.\n  (b) An operating demonstration shall be issued a certificate of\nauthority as a managed long term care plan upon a determination by the\ncommissioner that such demonstration complies with the operating\nrequirements for a managed long term care plan under this section.\nNothing in this section shall be construed to affect the continued legal\nauthority of an operating demonstration to operate its previously\napproved program.\n  (c) For the period beginning April first, two thousand twelve and\nending March thirty-first, two thousand fifteen, the majority leader of\nthe senate and the speaker of the assembly may each recommend to the\ncommissioner, in writing, up to four eligible applicants to convert to\nbe approved managed long term care plans. An applicant shall only be\napproved and issued a certificate of authority if the commissioner\ndetermines that the applicant meets the requirements of subdivision\nthree of this section. The majority leader of the senate or the speaker\nof the assembly may assign their authority to recommend one or more\napplicants under this section to the commissioner.\n  (d) (i) Effective April first, two thousand twenty, and expiring March\nthirty-first, two thousand twenty-seven, the commissioner shall place a\nmoratorium on the processing and approval of applications seeking a\ncertificate of authority as a managed long term care plan pursuant to\nthis section, including applications seeking authorization to expand an\nexisting managed long term care plan's approved service area or scope of\neligible enrollee populations. Such moratorium shall not apply to:\n  (A) applications submitted to the department prior to January first,\ntwo thousand twenty;\n  (B) applications seeking approval to transfer ownership or control of\nan existing managed long term care plan;\n  (C) applications demonstrating to the commissioner's satisfaction that\nsubmission of the application for consideration would be appropriate to\naddress a serious concern with care delivery, such as a lack of adequate\naccess to managed long term care plans in a geographic area or a lack of\nadequate and appropriate care, language and cultural competence, or\nspecial needs services; and\n  (D) applications seeking to operate under the PACE (Program of\nAll-Inclusive Care for the Elderly) model as authorized by federal\npublic law 105-33, subtitle I of title IV of the Balanced Budget Act of\n1997, or to serve individuals dually eligible for services and benefits\nunder titles XVIII and XIX of the federal social security act in\nconjunction with an affiliated Medicare Dual Eligible Special Needs\nPlan, based on the need for such plans and the experience of applicants\nin serving dually eligible individuals as determined by the commissioner\nin their discretion.\n  (ii) For the duration of the moratorium, the commissioner shall assess\nthe public need for managed long term care plans that are not integrated\nwith an affiliated Medicare plan, the ability of such plans to provide\nhigh quality and cost effective care for their membership, and based on\nsuch assessment develop a process and conduct an orderly wind-down and\nelimination of such plans, which shall coincide with the expiration of\nthe moratorium unless the commissioner determines that a longer\nwind-down period is needed.\n  (e) For the duration of the moratorium under paragraph (d) of this\nsubdivision, the commissioner shall establish, and enforce by means of a\npremium withholding equal to three percent of the base rate, an annual\ncap on total enrollment (enrollment cap) for each managed long term care\nplan, subject to subparagraphs (ii) and (iii) of this paragraph, based\non a percentage of each plan's reported enrollment as of October first,\ntwo thousand twenty.\n  (i) The specific percentage of each plan's enrollment cap shall be\nestablished by the commissioner based on: (A) the ability of individuals\neligible for such plans to access health and long term care services,\n(B) plan quality of care scores, (C) historical plan disenrollment, (D)\nthe projected growth of individuals eligible for such plans in different\nregions of the state, (E) historical plan enrollment of patients with\nvarying levels of need and acuity, and (F) other factors in the\ncommissioner's discretion to ensure compliance with federal\nrequirements, appropriate access to plan services, and choice by\neligible individuals.\n  (ii) In the event that a plan exceeds its annual enrollment cap, the\ncommissioner is authorized under this paragraph to retain all or a\nportion of the premium withheld based on the amount over which a plan\nexceeds its enrollment cap. Penalties assessed pursuant to this\nsubdivision shall be determined by regulation.\n  (iii) The commissioner may not establish an annual cap on total\nenrollment under this paragraph for plans' lines of business operating\nunder the PACE (Program of All-Inclusive Care for the Elderly) model as\nauthorized by federal public law 105-33, subtitle I of title IV of the\nBalanced Budget Act of 1997, or that serve individuals dually eligible\nfor services and benefits under titles XVIII and XIX of the federal\nsocial security act in conjunction with an affiliated Medicare Dual\nEligible Special Needs Plan.\n  (f) In implementing the provisions of paragraphs (d) and (e) of this\nsubdivision, the commissioner shall, to the extent practicable, consider\nand select methodologies that seek to maximize continuity of care and\nminimize disruption to the provider labor workforce, and shall, to the\nextent practicable and consistent with the ratios set forth herein,\ncontinue to support contracts between managed long term care plans and\nlicensed home care services agencies that are based on a commitment to\nquality and value.\n  6-a. Performance standards. (a) On or before January first, two\nthousand twenty-four, each managed long term care plan that has been\nissued a certificate of authority pursuant to this section shall have an\nactive Medicare Dual Eligible Special Needs Plan in operation whose\nH-contract either has a current quality star rating from the Centers for\nMedicare and Medicaid Services of three stars or higher, or has not been\nissued a quality star rating from the Centers for Medicare and Medicaid\nServices.  In addition, the managed long term care plan shall\nsufficiently demonstrate success in the following performance\ncategories:\n  (i) in addition to meeting the requirements of paragraph (j) of\nsubdivision seven of this section, in order to ensure network adequacy a\ncommitment to contracting with an adequate number of licensed home care\nservice agencies needed to provide necessary personal care services to\nthe greatest practicable number of enrollees, and with an adequate\nnumber of fiscal intermediaries needed to provide necessary consumer\ndirected personal assistance services to the greatest practicable number\nof enrollees in accordance with section three hundred sixty-five-f of\nthe social services law;\n  (ii) readiness to timely implement and adhere to maximum wait time\ncriteria for key categories of service in accordance with laws, rules\nand regulations of the department or the Centers for Medicare and\nMedicaid Services;\n  (iii) commitment to quality improvement;\n  (iv) accessibility and geographic distribution of network providers,\ntaking into account the needs of persons with disabilities and the\ndifferences between rural, suburban, and urban settings;\n  (v) demonstrated cultural and language competencies specific to the\npopulation of participants;\n  (vi) ability to serve enrollees across the continuum of care, as\ndemonstrated by the type and number of products the managed long term\ncare operates or has applied to operate, including integrated care for\nparticipants who are dually eligible for Medicaid and Medicare, and\nthose operated under title one-A of article twenty-five of this chapter\nand section three hundred sixty-nine-gg of the social services law; and\n  (vii) value based care readiness and experience.\n  (b) The commissioner shall require any managed long term care plan\nwith a Medicare Dual Eligible Special Needs Plan in operation that at\nany time has a current quality star rating from the Centers for Medicare\nand Medicaid Services of less than three stars to establish and\nimplement a performance improvement plan acceptable to the commissioner,\nand which shall be consistent with the standards of the Medicare\nAdvantage Quality Rating System.\n  (c) The commissioner shall have the authority to promulgate\nregulations to effectuate the provisions of this subdivision.\n  (d) The provisions of this subdivision shall not apply for managed\nlong term care plans operating under a certificate of authority pursuant\nto subdivision twelve, as added by section seventy-six of part A of\nchapter fifty-six of the laws of two thousand thirteen, or subdivision\nthirteen of this section, or to the program of all-inclusive care for\nthe elderly under article twenty-nine-EE of this chapter.\n  7. Program oversight and administration. (a)(i) The commissioner shall\npromulgate regulations to implement this section and to ensure the\nquality, appropriateness and cost-effectiveness of the services provided\nby managed long term care plans. The commissioner may waive rules and\nregulations of the department, including but not limited to, those\npertaining to duplicative requirements concerning record keeping, boards\nof directors, staffing and reporting, when such waiver will promote the\nefficient delivery of appropriate, quality, cost-effective services and\nwhen the health, safety and general welfare of enrollees will not be\nimpaired as a result of such waiver. In order to achieve managed long\nterm care plan system efficiencies and coordination and to promote the\nobjectives of high quality, integrated and cost effective care, the\ncommissioner may establish a single coordinated surveillance process,\nallow for a comprehensive quality improvement and review process to meet\ncomponent quality requirements, and require a uniform cost report. The\ncommissioner shall require managed long term care plans to utilize\nquality improvement measures, based on health outcomes data, for\ninternal quality assessment processes and may utilize such measures as\npart of the single coordinated surveillance process.\n  (ii) Notwithstanding any inconsistent provision of the social services\nlaw to the contrary, the commissioner shall, pursuant to regulation,\ndetermine whether and the extent to which the applicable provisions of\nthe social services law or regulations relating to approvals and\nauthorizations of, and utilization limitations on, health and long term\ncare services reimbursed pursuant to title XIX of the federal social\nsecurity act, including, but not limited to, fiscal assessment\nrequirements, are inconsistent with the flexibility necessary for the\nefficient administration of managed long term care plans and such\nregulations shall provide that such provisions shall not be applicable\nto enrollees or managed long term care plans, provided that such\ndeterminations are consistent with applicable federal law and\nregulation, and subject to the provisions of subdivision eight of\nsection three hundred sixty-five-a of the social services law.\n  * (b) (i) The commissioner shall, to the extent necessary, submit the\nappropriate waivers, including, but not limited to, those authorized\npursuant to sections eleven hundred fifteen and nineteen hundred fifteen\nof the federal social security act, or successor provisions, and any\nother waivers necessary to achieve the purposes of high quality,\nintegrated, and cost effective care and integrated financial eligibility\npolicies under the medical assistance program or pursuant to title XVIII\nof the federal social security act. In addition, the commissioner is\nauthorized to submit the appropriate waivers, including but not limited\nto those authorized pursuant to sections eleven hundred fifteen and\nnineteen hundred fifteen of the federal social security act or successor\nprovisions, and any other waivers necessary to require on or after April\nfirst, two thousand twelve, medical assistance recipients who are\ntwenty-one years of age or older and who require community-based long\nterm care services, as specified by the commissioner, for a continuous\nperiod of more than one hundred and twenty days, to receive such\nservices through an available plan certified pursuant to this section or\nother program model that meets guidelines specified by the commissioner\nthat support coordination and integration of services. Such guidelines\nshall address the requirements of paragraphs (a), (b), (c), (d), (e),\n(f), (g), (h), and (i) of subdivision three of this section as well as\npayment methods that ensure provider accountability for cost effective\nquality outcomes. Such other program models may include long term home\nhealth care programs that comply with such guidelines. Copies of such\noriginal waiver applications and amendments thereto shall be provided to\nthe chairs of the senate finance committee, the assembly ways and means\ncommittee and the senate and assembly health committees simultaneously\nwith their submission to the federal government.\n  (ii) The commissioner, shall seek input from representatives of home\nand community-based long term care services providers, recipients, and\nthe Medicaid managed care advisory review panel, among others, to\nfurther evaluate and promote the transition of persons in receipt of\nhome and community-based long term care services into managed long term\ncare plans and other care coordination models and to develop guidelines\nfor such care coordination models. The guidelines shall be finalized and\nposted on the department's website no later than November fifteen, two\nthousand eleven.\n  (iii) Notwithstanding and in addition to any provision of subparagraph\n(i) of this paragraph and subject to any federal requirements, persons\ndually eligible for medical assistance and benefits under the federal\nMedicare program who are enrolled in a Medicare Dual Eligible Special\nNeeds Plan and who do not require community-based long term care\nservices, as specified by the commissioner, for a continuous period of\nmore than one hundred and twenty days shall be required to enroll with\nan available affiliated plan certified pursuant to this section when\nprogram features and reimbursement rates are approved by the\ncommissioner.\n  (v) The following medical assistance recipients shall not be eligible\nto participate in a managed long term care program or other care\ncoordination model established pursuant to this paragraph until program\nfeatures and reimbursement rates are approved by the commissioner and,\nas applicable, the commissioner of developmental disabilities:\n  (1) a person enrolled in a managed care plan pursuant to section three\nhundred sixty-four-j of the social services law;\n  (2) a participant in the traumatic brain injury waiver program or a\nperson whose circumstances would qualify him or her for the program as\nit existed on January first, two thousand fifteen;\n  (3) a participant in the nursing home transition and diversion waiver\nprogram or a person whose circumstances would qualify him or her for the\nprogram as it existed on January first, two thousand fifteen;\n  (4) a person enrolled in the assisted living program;\n  (5) a person enrolled in home and community based waiver programs\nadministered by the office for people with developmental disabilities;\n  (6) a person who is expected to be eligible for medical assistance for\nless than six months, for a reason other than that the person is\neligible for medical assistance only through the application of excess\nincome toward the cost of medical care and services;\n  (7) a person who is eligible for medical assistance benefits only with\nrespect to tuberculosis-related services;\n  (8) a person receiving hospice services at time of enrollment;\nprovided, however, that this clause shall not be construed to require an\nindividual enrolled in a managed long term care plan or another care\ncoordination model, who subsequently elects hospice, to disenroll from\nsuch program;\n  (9) a person who has primary medical or health care coverage available\nfrom or under a third-party payor which may be maintained by payment, or\npart payment, of the premium or cost sharing amounts, when payment of\nsuch premium or cost sharing amounts would be cost-effective, as\ndetermined by the social services district;\n  (10) a person receiving family planning services pursuant to\nsubparagraph six of paragraph (b) of subdivision one of section three\nhundred sixty-six of the social services law;\n  (11) a person who is eligible for medical assistance pursuant to\nparagraph (b) of subdivision four of section three hundred sixty-six of\nthe social services law;\n  (12) Native Americans;\n  (13) a person who is permanently placed in a nursing home for a\nconsecutive period of three months or more. In implementing this\nprovision, the department shall continue to support service delivery and\noutcomes that result in community living for enrollees; and\n  (14) a person who has not been assessed as needing at least limited\nassistance with physical maneuvering with more than two activities of\ndaily living, or for individuals with a dementia or Alzheimer's\ndiagnosis, assessed as needing at least supervision with more than one\nactivity of daily living, as defined and determined using an evidenced\nbased validated assessment instrument approved by the commissioner and\nin accordance with applicable state and federal law and regulations of\nthe department, provided that the provisions of this clause shall not\napply to a person who has been continuously enrolled in a managed long\nterm care program beginning prior to October first, two thousand twenty.\n  (v-a) For purposes of clause two of subparagraph (v) of this\nparagraph, program features shall be substantially comparable to those\nservices available to traumatic brain injury waiver participants as of\nJanuary first, two thousand fifteen, subject to federal financial\nparticipation.\n  (v-b) For purposes of clause three of subparagraph (v) of this\nparagraph, program features shall be substantially comparable to those\nservices offered to nursing home transition and diversion waiver\nparticipants as of January first, two thousand fifteen, subject to\nfederal financial participation.\n  (v-c) Any managed care program providing services under clause two or\nthree of subparagraph (v) of this paragraph shall have an adequate\nnetwork of trained providers to meet the needs of enrollees and provide\nservices under this subdivision.\n  (v-d) Any individual providing service coordination pursuant to\nsubparagraph (v-a) or (v-b) of this paragraph shall exercise his or her\nprofessional duties in the interests of the patient. Nothing in this\nsubparagraph shall be construed as diminishing the authority and\nobligations of a managed long term care plan under this article and\narticle forty-nine of this chapter.\n  (vi) persons required to enroll in the managed long term care program\nor other care coordination model established pursuant to this paragraph\nshall have no less than thirty days to select a managed long term care\nprovider, and shall be provided with information to make an informed\nchoice. Where a participant has not selected such a provider, the\ncommissioner shall assign such participant to a managed long term care\nprovider, taking into account consistency with any prior community-based\ndirect care workers having recently served the recipient, quality\nperformance criteria, capacity and geographic accessibility. During the\nperiod prior to receiving services from a managed long term care\nprovider assigned under this subparagraph, the person may receive\nservices under fee for service Medicaid.\n  (vii) If another long term care plan certified under this section is\navailable, medical assistance recipients required to enroll in such\nplans pursuant to this section, including recipients who have been\nassigned to a provider by the commissioner, may change plans without\ncause within ninety days of either notification of enrollment or the\neffective date of enrollment into a plan, whichever is later, by\nsubmitting a request to the entity designated by the department in a\nformat to be determined by the department. In accordance with federal\nstatutes and regulations, after such ninety-day period, the department\nmay prohibit a recipient from changing plans more frequently than once\nevery twelve months, except for good cause. Good cause may include poor\nquality of care, lack of access to covered services, lack of access to\nproviders experienced in dealing with the enrollee's care needs, or as\notherwise determined by the commissioner.\n  (viii) Managed long term care provided and plans certified or other\ncare coordination model established pursuant to this paragraph shall\ncomply with the provisions of paragraphs (d), (i), (t), and (u) and\nsubparagraph (iii) of paragraph (a) and subparagraph (iv) of paragraph\n(e) of subdivision four of section three hundred sixty-four-j of the\nsocial services law.\n  (ix) (1) The commissioner shall report biannually on the\nimplementation of this subdivision. The reports shall include, but not\nbe limited to:\n  (A) satisfaction of enrollees with care coordination/case management;\ntimeliness of care;\n  (B) service utilization data including changes in the level, hours,\nfrequency, and types of services and providers;\n  (C) enrollment data, including auto-assignment rates by plan;\n  (D) quality data; and\n  (E) continuity of care for participants as they move to managed long\nterm care, with respect to community based and nursing home populations,\nincluding pediatric nursing home populations, and medically fragile\nchildren being served by home care agencies affiliated with pediatric\nnursing homes and diagnostic and treatment centers primarily serving\nmedically fragile children.\n  (2) The commissioner shall publish the report on the department's\nwebsite and provide notice to the temporary president of the senate, the\nspeaker of the assembly, the chair of the senate standing committee on\nhealth, the chair of the assembly health committee and the Medicaid\nManaged Care Advisory Review Panel upon availability of the report. The\ninitial report shall be provided by September first, two thousand\ntwelve. The reports shall be made available by each February first, and\nSeptember first thereafter. Such reports shall be formatted to allow\ncomparisons between plans.\n  * NB Effective until April 1, 2027\n  * (b) The commissioner shall, to the extent necessary, submit the\nappropriate waivers, including, but not limited to, those authorized\npursuant to sections eleven hundred fifteen and nineteen hundred fifteen\nof the federal social security act, or successor provisions, and any\nother waivers necessary to achieve the purposes of high quality,\nintegrated, and cost effective care and integrated financial eligibility\npolicies under the medical assistance program or pursuant to title XVIII\nof the federal social security act. Copies of such original waiver\napplications shall be provided to the chairman of the senate finance\ncommittee and the chairman of the assembly ways and means committee\nsimultaneously with their submission to the federal government.\n  * NB Effective April 1, 2027\n  (c)(i) A managed long term care plan shall not use deceptive or\ncoercive marketing methods to encourage participants to enroll. A\nmanaged long term care plan shall not distribute marketing materials to\npotential enrollees before such materials have been approved by the\ncommissioner.\n  (ii) The commissioner shall ensure, through periodic reviews of\nmanaged long term care plans, that enrollment was an informed choice;\nsuch plan has only enrolled persons whom it is authorized to enroll, and\nplan services are promptly available to enrollees when appropriate. Such\nperiodic reviews shall be made according to standards as determined by\nthe commissioner in regulations.\n  (d) Notwithstanding any provision of law, rule or regulation to the\ncontrary, the commissioner may issue a request for proposals to carry\nout reviews of enrollment and assessment activities in managed long term\ncare plans and operating demonstrations with respect to enrollees\neligible to receive services under title XIX of the federal social\nsecurity act to determine if enrollment meets the requirements of\nsubparagraph (ii) of paragraph (c) of this subdivision; and that\nassessments of such enrollees' health, functional and other status, for\nthe purpose of adjusting premiums, were accurate.\n  (e) The commissioner may, in his or her discretion for the purpose of\nprotection of enrollees, impose measures including, but not limited to,\nbans on further enrollments and requirements for use of enrollment\nbrokers until any identified problems are resolved to the satisfaction\nof the commissioner.\n  (f) Continuation of a certificate of authority issued under this\nsection shall be contingent upon satisfactory performance by the managed\nlong term care plan in the delivery, continuity, accessibility, cost\neffectiveness and quality of the services to enrolled members;\ncompliance with applicable provisions of this section and rules and\nregulations promulgated thereunder; the continuing fiscal solvency of\nthe organization; and, federal financial participation in payments on\nbehalf of enrollees who are eligible to receive services under title XIX\nof the federal social security act.\n  (g) * (i) Managed long term care plans and demonstrations may enroll\neligible persons in the plan or demonstration upon the completion of a\ncomprehensive assessment that shall include, but not be limited to, an\nevaluation of the medical, social, cognitive, and environmental needs of\neach prospective enrollee in such program. This assessment shall also\nserve as the basis for the development and provision of an appropriate\nplan of care for the enrollee, including appropriate community-based\nreferrals. Upon approval of federal waivers pursuant to paragraph (b) of\nthis subdivision which require medical assistance recipients who require\ncommunity-based long term care services to enroll in a plan, and upon\napproval of the commissioner, a plan may enroll an applicant who is\ncurrently receiving home and community-based services and complete the\ncomprehensive assessment within thirty days of enrollment provided that\nthe plan continues to cover transitional care until such time as the\nassessment is completed.\n  * NB Effective until April 1, 2027\n  * (i) Managed long term care plans and demonstrations may enroll\neligible persons in the plan or demonstration upon the completion of a\ncomprehensive assessment that shall include, but not be limited to, an\nevaluation of the medical, social and environmental needs of each\nprospective enrollee in such program. This assessment shall also serve\nas the basis for the development and provision of an appropriate plan of\ncare for the prospective enrollee, including appropriate community-based\nreferrals.\n  * NB Effective April 1, 2027\n  (ii) The assessment shall be completed by a representative of the\nmanaged long term care plan or demonstration, in consultation with the\nprospective enrollee's health care practitioner as necessary. The\ncommissioner shall prescribe the forms on which the assessment shall be\nmade.\n  (iii) The enrollment application shall be submitted by the managed\nlong term care plan or demonstration to the entity designated by the\ndepartment prior to the commencement of services under the managed long\nterm care plan or demonstration. Enrollments conducted by a plan or\ndemonstration shall be subject to review and audit by the department or\na contractor selected pursuant to paragraph (d) of this subdivision.\n  (iv) Continued enrollment in a managed long term care plan or\ndemonstration paid for by government funds shall be based upon a\ncomprehensive assessment of the medical, social and environmental needs\nof the recipient of the services. Such assessment shall be performed at\nleast annually by the managed long term care plan serving the enrollee.\nThe commissioner shall prescribe the forms on which the assessment will\nbe made.\n  (h) * The commissioner and, in the case of a plan arranging for or\nproviding services operated, certified, funded, authorized or approved\nby the office for people with developmental disabilities, the\ncommissioner of the office for people with developmental disabilities,\nshall, upon request by a managed long term care plan or operating\ndemonstration, and consistent with federal regulations promulgated\npursuant to the Health Insurance Portability and Accountability Act,\nshare with such plan or demonstration the following data if it is\navailable:\n  * NB Effective until December 31, 2027\n  * The commissioner shall, upon request by a managed long term care\nplan or operating demonstration, and consistent with federal regulations\npromulgated pursuant to the Health Insurance Portability and\nAccountability Act, share with such plan or demonstration the following\ndata if it is available:\n  * NB Effective December 31, 2027\n  (i) information concerning utilization of services and providers by\neach of its enrollees prior to and during enrollment, including but not\nlimited to utilization of emergency department services, prescription\ndrugs, and hospital and nursing facility admissions.\n  (ii) aggregate data concerning utilization and costs for enrollees and\nfor comparable cohorts served through the Medicaid fee-for-service\nprogram.\n  (j) Limitations on licensed home care service agency contracts. (i)\nThe commissioner may establish methodologies to limit the number of\nlicensed home care services agencies licensed pursuant to article\nthirty-six of the public health law with which managed long term care\nplans may enter into contracts, provided that such limitations are\nconsistent with the specifications set forth in this paragraph.\n  (ii) Managed long term care plans operating in the city of New York\nand/or the counties of Nassau, Suffolk, and Westchester may enter into\ncontracts with licensed home care services agencies in such region in a\nmaximum number calculated based upon the following methodology:\n  (A) As of October first, two thousand eighteen, one contract per\nseventy-five members enrolled in the plan within such region; and\n  (B) As of October first, two thousand nineteen, one contract per one\nhundred members enrolled in the plan within such region.\n  (iii) Managed long term care plans operating in counties other than\nthose in the city of New York and the counties of Nassau, Suffolk, and\nWestchester may enter into contracts with licensed home care services\nagencies in such region in a maximum number calculated based upon the\nfollowing methodology:\n  (A) As of October first, two thousand eighteen, one contract per\nforty-five members enrolled in the plan within such region.\n  (B) As of October first, two thousand nineteen, one contract per sixty\nmembers enrolled in the plan within such region.\n  (iv) Notwithstanding subparagraphs (ii) and (iii) of this paragraph, a\nmanaged long term care plan shall not enter into less than the number of\ncontracts with licensed home care services agencies in each county in\nwhich the plan operates as is necessary to remain consistent with\nnetwork adequacy standards, as determined by the department in\naccordance with federal regulations.\n  (v) When calculating the number of additional contracts that a managed\nlong term care plan may enter using the methodologies established\npursuant to this paragraph, any fractional result shall be rounded down.\n  (vi) The commissioner may increase the number of licensed home care\nservices agencies with which a managed long term care plan may contract,\non a county by county basis, if the commissioner determines that such\nincrease is necessary to: ensure adequate access to services in the\ngeographic area including, but not limited to, special needs services\nand services that are culturally and linguistically appropriate; or to\navoid disruption in services in the geographic area.\n  (vii) Any licensed home care services agency that ceases operation as\na result of this paragraph shall conform with all applicable\nrequirements, including but not limited to demonstrating to the\ndepartment's satisfaction continuity of care for individuals receiving\nservices from the agency.\n  (viii) The commissioner may require managed long term care plans to\nprovide evidence of compliance with this paragraph, on an annual basis.\n  (ix) In implementing the provisions of this paragraph, the\ncommissioner shall, to the extent practicable, consider and select\nmethodologies that seek to maximize continuity of care and minimize\ndisruption to the provider labor workforce, and shall, to the extent\npracticable and consistent with the ratios set forth herein, continue to\nsupport contracts between managed long term care plans and licensed home\ncare services agencies that are based on a commitment to quality and\nvalue.\n  (x) This subparagraph applies where implementation of the limits on\ncontracts with licensed home care service agencies of this paragraph (i)\nwould otherwise require an enrollee's care to be transferred from the\nenrollee's current licensed home care service agency to another licensed\ncare service agency, and (ii) the enrollee (or the enrollee's authorized\nrepresentative) wants the enrollee to continue to be cared for by one or\nmore employees of the current licensed home care service agency, and\nthat continuation would otherwise be provided. In such a case: the\nenrollee's managed long term care plan may contract with the enrollee's\ncurrent licensed home care service agency for the purpose of continuing\nthe enrollee's care by such employee or employees, and the contract\nshall not count towards the limits on contracts under this paragraph for\na period of three months.\n  (k) Increased rates, terms or scope of payment for behavioral health\nservices under this section, where payment is made by an entity under\nthis section, as a result of a rate, coverage or other change made\npursuant to a law, regulation, rule or official guidance, shall be\ndeemed in effect on the same date that such change would have taken\neffect if payment were made other than by the entity. Where payment is\nnot made as of the effective date, the entity shall make retroactive\npayments to the appropriate service providers.\n  8. Payment rates for managed long term care plan enrollees eligible\nfor medical assistance. The commissioner shall establish payment rates\nfor services provided to enrollees eligible under title XIX of the\nfederal social security act. Such payment rates shall be subject to\napproval by the director of the division of the budget and shall reflect\nsavings to both state and local governments when compared to costs which\nwould be incurred by such program if enrollees were to receive\ncomparable health and long term care services on a fee-for-service basis\nin the geographic region in which such services are proposed to be\nprovided. Payment rates shall be risk-adjusted to take into account the\ncharacteristics of enrollees, or proposed enrollees, including, but not\nlimited to:  frailty, disability level, health and functional status,\nage, gender, the nature of services provided to such enrollees, and\nother factors as determined by the commissioner. The risk adjusted\npremiums may also be combined with disincentives or requirements\ndesigned to mitigate any incentives to obtain higher payment categories.\nIn setting such payment rates, the commissioner shall consider costs\nborne by the managed care program to ensure actuarially sound and\nadequate rates of payment to ensure quality of care shall comply with\nall applicable laws and regulations, state and federal, including\nregulations as to actuarial soundness for medicaid managed care.\n  8-a. Rates for certain residential health care facilities.\nNotwithstanding any other provision of law or regulation to the\ncontrary, any residential health care facility established pursuant to\narticle twenty-eight of this chapter located in a county with a\npopulation of more than seventy-two thousand and less than seventy-five\nthousand persons based on the two thousand ten federal census shall be\nreimbursed by any managed long term care plan, approved pursuant to this\nsection and contracting with the department, at a rate of no less than\none hundred four percent of the average rate of reimbursement in\nexistence on March first, two thousand eighteen for such county.\n  9. Reports. The department shall provide an interim report to the\ngovernor, temporary president of the senate and the speaker of the\nassembly on or before April first, two thousand three and a final report\non or before April first, two thousand six on the results of the managed\nlong term care plans under this section. Such results shall be based on\ndata provided by the managed long term care plans and shall include but\nnot be limited to the quality, accessibility and appropriateness of\nservices; consumer satisfaction; the mean and distribution of impairment\nmeasures of the enrollees by payor for each plan; the current method of\ncalculating premiums and the cost of comparable health and long term\ncare services provided on a fee-for-service basis for enrollees eligible\nfor services under title XIX of the federal social security act; and the\nresults of periodic reviews of enrollment levels and practices. Such\nreports shall provide data on the demographic and clinical\ncharacteristics of enrollees, voluntary and involuntary disenrollments\nfrom plans, and utilization of services and shall examine the\nfeasibility of increasing the number of plans that may be approved. Data\ncollected pursuant to this section shall be available to the public in\nan aggregated format to protect individual confidentiality, however\nunder no circumstance will data be released on items with cells with\nsmaller than statistically acceptable standards.\n  10. Notwithstanding any inconsistent provision to the contrary, the\nenrollment and disenrollment process and services provided or arranged\nby all operating demonstrations or any program that receives designation\nas a Program of All-Inclusive Care for the Elderly (PACE) as authorized\nby federal public law 105-33, subtitle I of title IV of the Balanced\nBudget Act of 1997, must meet all applicable federal requirements.\nServices may include, but need not be limited to, housing, inpatient and\noutpatient hospital services, nursing home care, home health care, adult\nday care, assisted living services provided in accordance with article\nforty-six-B of this chapter, adult care facility services, enriched\nhousing program services, hospice care, respite care, personal care,\nhomemaker services, diagnostic laboratory services, therapeutic and\ndiagnostic radiologic services, emergency services, emergency alarm\nsystems, home delivered meals, physical adaptations to the client's\nhome, physician care (including consultant and referral services),\nancillary services, case management services, transportation, and\nrelated medical services.\n  11. The department shall develop transition and continuity of care\npolicies for participants in home and community based long term care,\nincluding the long term home health care program, as they move to\nmanaged long term care plans addressing:\n  (a) a timetable and plan for implementation and transition by\nparticipants, plans and providers;\n  (b) informative disclosure of participants' options as to impending\nactions affecting or relating to the home care services they receive;\n  (c) reasonable opportunity for plans' and providers' good faith\npursuit of contracts, program changes or state approvals relevant to\nplan implementation;\n  (d) notice that a participant with a previously established plan of\ncare provided by a certified home health agency or long term home health\ncare program, or provided pursuant to the personal care or consumer\ndirected personal assistance service programs, may elect to have such\ncare plan continued subject to the participant's next comprehensive\nassessment; and\n  (e) delineation of responsibilities for service delivery and care\ncoordination, so as to avoid conflict, duplication and unnecessary\ndisruption of direct care staffing for the patient, and maintain\ncompliance with state and federal statute and regulation, including the\nprovisions of this section, article thirty-six of this chapter and\nsection three hundred sixty-five-f of the social services law.\n  In addition, the department shall provide technical assistance to long\nterm home health care providers with contracting options under this\nsection. The department shall work with affected stakeholders in the\ndevelopment of these policies.\n  11-a. In transitioning individuals to managed long term care, the\ndepartment shall provide oversight of long term managed care by\nensuring:\n  (a) participants are appropriately notified of the upcoming changes to\ntheir health care, and their rights and options;\n  (b) access to appropriate enrollment assistance, consumer assistance\nand complaint mechanisms;\n  (c) access to quality care by requiring network transparency and\nchoice of long term care plans, allowing patients to choose the plan\nthat best fits their needs;\n  (d) transparency and accountability from providers, which shall\ninclude a mechanism by which staff, participants and family members can\nconfidentially report concerns relating to quality to the plan and the\nstate;\n  (e) plans and providers are assessed periodically and data is\npublished regarding enrollment in integrated care designs, network\nadequacy, new service designs, outcome measures, including the extent to\nwhich care plans are continued or altered based upon new comprehensive\nassessments, and the types and amounts of services health plans have\nauthorized;\n  (f) mechanisms are in place to state oversight of enrollment and\nservices to prevent waste and abuse in the managed long term care\nsystem; and\n  (g) incentives are provided for a variety of indicators, including but\nnot limited to, smooth patient transitions, appropriate enrollment,\nquality care, high staff retention and positive health care outcomes\nachieved at a low cost.\n  11-b. In cases of a managed long term care plan merger, acquisition,\nor other similar arrangement approved by the department, any receiving\nplan that is a party to the arrangement shall submit a report to the\ndepartment within twelve months of the effective date of the\ntransaction. Such reports shall be in a form and format to be determined\nby the department and shall include, but not be limited to, information\nabout the enrollees transferred and enrollee service authorization data\nbefore and after transfer. The department shall make a summary of the\nreport available to the public.\n  ** 12. The commissioner may make any necessary amendments to a\ncontract pursuant to this section with a managed long term care plan, as\ndefined in paragraph (a) of subdivision one of this section, to allow\nsuch managed long term care plan to participate as a qualified health\nplan in a state health benefit exchange established pursuant to the\nfederal Patient Protection and Affordable Care Act (P.L. 111-148), as\namended by the federal Health Care and Education Reconciliation Act of\n2010 (P.L.  111-152).\n  ** NB There are 2 sb 12's\n  ** 12. Notwithstanding any provision to the contrary, a managed long\nterm care plan may expand the services it provides or arranges for to\ninclude services operated, certified, funded, authorized or approved by\nthe office for people with developmental disabilities for a population\nof persons with developmental disabilities, as such term is defined in\nthe mental hygiene law, including habiltiation services as defined in\nparagraph (c) of subdivision one of section forty-four hundred three-g\nof this article, subject to the following:\n  (a) Such plan must have the ability to provide or coordinate services\nfor persons with developmental disabilities as demonstrated by criteria\nto be determined by the commissioner and the commissioner of the office\nfor people with developmental disabilities. Such criteria shall include,\nbut not be limited to, adequate experience providing or coordinating\nservices for persons with developmental disabilities;\n  (a-1) If the commissioner and the commissioner of the office for\npeople with developmental disabilities determine that such plan lacks\nthe experience required in paragraph (a) of this subdivision, the plan\nshall have an affiliation arrangement with an entity or entities that\nare non-profit organizations or organizations whose shareholders are\nsolely controlled by non-profit organizations with experience serving\npersons with developmental disabilities, as demonstrated by criteria to\nbe determined by the commissioner and the commissioner of the office for\npeople with developmental disabilities, with such criteria including,\nbut not limited to, residential, day and employment services, such that\nthe affiliated entity will coordinate and plan services operated,\ncertified, funded, authorized or approved by the office for people with\ndevelopmental disabilities or will oversee and approve such coordination\nand planning;\n  (a-2) Each enrollee shall receive services designed to achieve\nperson-centered outcomes, to enable that person to live in the most\nintegrated setting appropriate to that person's needs, and to enable\nthat person to interact with nondisabled persons to the fullest extent\npossible in social, workplace and other community settings, provided\nthat all such services are consistent with such person's wishes to the\nextent that such wishes are known. With respect to an individual\nreceiving non-residential services operated, certified, funded,\nauthorized or approved by the office for people with developmental\ndisabilities prior to enrollment in the plan, such guidelines shall\nrequire the plan to contract with the current provider of such\nnon-residential services at the rates established by the office for\nninety days in order to ensure continuity of care. With respect to an\nindividual living in a residential facility operated or certified by the\noffice for people with developmental disabilities prior to enrollment in\nthe plan, the plan shall contract with the provider of residential\nservices for that residence at the rates established by the office for\npeople with developmental disabilities for so long as such individual\nlives in that residence pursuant to an approved plan of care;\n  (b) The provision by such plan of services operated, certified,\nfunded, authorized or approved by the office for people with\ndevelopmental disabilities shall be subject the joint oversight and\nreview of both the department and the office for people with\ndevelopmental disabilities.  The department and such office shall\nrequire such organization to provide comprehensive care planning, assess\nquality, meet quality assurance requirements and ensure the enrollee is\ninvolved in care planning;\n  (c) Such plan shall not provide or arrange for services operated,\ncertified, funded, authorized or approved by the office for people with\ndevelopmental disabilities until the commissioner and the commissioner\nof the office for people with developmental disabilities approve program\nfeatures and rates that include such services, and determine that such\norganization meets the requirements of this subdivision and any other\nrequirements set forth by the commissioner of the office for people with\ndevelopmental disabilities;\n  (d) An otherwise eligible enrollee receiving services through the plan\nthat are operated, certified, funded, authorized or approved by the\noffice for people with developmental disabilities shall not be\ninvoluntarily disenrolled from such plan without the prior approval of\nthe commissioner of the office for people with developmental\ndisabilities. Notice shall be provided to the enrollee and the enrollee\nmay request a fair hearing regarding such disenrollment;\n  (e) The office for people with developmental disabilities shall\ndetermine the eligibility of individuals receiving services operated,\ncertified, funded, authorized or approved by such office to enroll in\nsuch plan and shall enroll individuals it determines eligible in a plan\nchosen by such individual, guardian or other legal representative;\n  (f) The office for people with developmental disabilities, or its\ndesignee, shall complete a comprehensive assessment for enrollees who\nreceive services operated, certified, funded, authorized or approved by\nsuch office. This assessment shall include, but not be limited to, an\nevaluation of the medical, social, habilitative and environmental needs\nof each prospective enrollee as such needs relate to each individual's\nhealth, safety, living environment and wishes, to the extent that such\nwishes are known. This assessment shall also serve as the basis for the\ndevelopment and provision of an appropriate plan of care for the\nenrollee. Such plan of care shall be focused on the achievement of\nperson-centered outcomes and shall be consistent with and help inform\nany other person-centered plan required for the enrollee by the\ncommissioner of the office for people with developmental disabilities.\nThe initial assessment shall be completed by such office or a designee\nother than the plan and shall be completed in consultation with the\nprospective enrollee's health care practitioner as necessary.\nReassessments shall be completed by such office or its designee, which\nmay be the managed long term care plan in which the person is enrolled\nor proposes to enroll. The commissioner of the office for people with\ndevelopmental disabilities shall prescribe the forms on which the\nassessment shall be made.\n  (f-1) The plan shall provide the department and the office for people\nwith developmental disabilities with a description of the proposed\nmarketing plan and how marketing materials will be presented to persons\nwith developmental disabilities or their authorized decision makers for\nthe purposes of enabling them to make an informed choice.\n  (g) Plans providing services operated, certified, funded, authorized\nor approved by the office for people with developmental disabilities\nshall be subject to all requirements applicable to DISCOs operating\nunder section forty-four hundred three-g of this article with respect to\nquality assurance, grievances and appeals, informed choice,\nparticipation in development of plans of care and requirements with\nrespect to marketing, to the extent that such requirements are not\ninconsistent with this section.\n  (h) No person with a developmental disability shall be required to\nenroll in a managed long term care plan as a condition of receiving\nmedical assistance and services operated, certified, funded, authorized\nor approved by the office for people with developmental disabilities\nuntil program features and reimbursement rates are approved by the\ncommissioner and the commissioner of the office for people with\ndevelopmental disabilities and until such commissioners determine that\nthere are a sufficient number of plans authorized to coordinate care for\npersons with developmental disabilities pursuant to this article\noperating in the person's county of residence to meet the needs of\npersons with developmental disabilities, and that such plans meet the\nstandards of this section.\n  ** NB Repealed December 31, 2027\n  ** NB There are 2 sb 12's\n  ** 13. Notwithstanding any inconsistent provision to the contrary, the\ncommissioner may issue a certificate of authority to no more than three\neligible applicants who are eligible for Medicare and medical assistance\nto operate managed long term care plans that are authorized to\nexclusively enroll persons with developmental disabilities, as such term\nis defined in section 1.03 of the mental hygiene law. The commissioner\nmay only issue certificates of authority pursuant to this subdivision\nif, and to the extent that, the department has received federal approval\nto operate a fully integrated duals advantage program for the\nintegration of services for persons enrolled in Medicare and medical\nassistance. The commissioner may waive any of the department's\nregulations as the commissioner, in consultation with the commissioner\nof the office for people with developmental disabilities, deems\nnecessary to allow such managed long term care plans to provide or\narrange for services for persons with developmental disabilities that\nare adequate and appropriate to meet the needs of such individuals and\nthat will ensure their health and safety.\n  ** NB Repealed December 31, 2027\n  ** 14. The provisions of subdivisions twelve and thirteen of this\nsection shall only be effective if, for so long as, and to the extent\nthat federal financial participation is available for the costs of\nservices provided thereunder to recipients of medical assistance\npursuant to title eleven of article five of the social services law. The\ncommissioner shall make any necessary amendments to the state plan for\nmedical assistance submitted pursuant to section three hundred\nsixty-three-a of the social services law, and/or submit one or more\napplications for waivers of the federal social security act, as may be\nnecessary to ensure such federal financial participation. To the extent\nthat the provisions of subdivision twelve and thirteen of this section\nare inconsistent with other provisions of this article or with the\nprovisions of section three hundred sixty-four-j of the social services\nlaw, the provisions of this subdivision shall prevail.\n  ** NB Repealed December 31, 2027\n  * NB Repealed December 31, 2029\n