NY Soc Serv L § 365-M (2021)
2021 New York Laws SOS - Social Services Article 5 - Assistance and Care Title 11 - Medical Assistance for Needy Persons 365-M - Administration and Management of Behavioral Health Services.

§  365-m. Administration and management of behavioral health services. 1.  The commissioners of the office of mental health and the  office  of alcoholism  and  substance  abuse  services,  in  consultation  with the commissioner of health, the impacted local governmental units  and  with the  approval  of  the division of the budget, shall have responsibility for jointly designating regional entities to provide administrative  and management services for the purposes of prior approving and coordinating the provision of behavioral health services, facilitating the continuity of   post-hospitalization  behavioral  health  and  the  integration  of behavioral health services with  other  services  available  under  this title,  for  recipients  of  medical  assistance who are not enrolled in managed  care,  and  for  such  approval,   coordination,   facilitating continuity  and  integration  of behavioral health services that are not provided through managed care programs under this title for  individuals regardless  of  whether  or not such individuals are enrolled in managed care programs. Such regional entities  shall  also  be  responsible  for promoting  appropriate  care  and service utilization while safeguarding against unnecessary utilization of such care and services  and  assuring that  payments are consistent with the efficient and economical delivery of quality care.   2. In exercising this responsibility, the commissioners of the  office of  mental  health  and  the  office  of  alcoholism and substance abuse services  are  authorized  to  contract,  after  consultation  with  the commissioner  of  health and the impacted local governmental units, with regional  behavioral  health  organizations  or  other  entities.   Such contracts   may   include   responsibility   for  receipt,  review,  and determination of prior authorization requests for behavioral health care and services under subdivision one  of  this  section,  consistent  with criteria  established  or approved by the commissioners of mental health and alcoholism  and  substance  abuse  services,  and  authorization  of appropriate care and services based on documented patient medical need.   3.  Notwithstanding any inconsistent provision of sections one hundred twelve and one hundred sixty-three of the state finance law, or  section one  hundred forty-two of the economic development law, or any other law to the contrary, the commissioners of the office of  mental  health  and the  office of alcoholism and substance abuse services are authorized to enter into a contract or contracts under subdivisions  one  and  two  of this  section without a competitive bid or request for proposal process, provided, however, that:  (a) the office of mental health  and  the  office  of  alcoholism  and substance  abuse  services shall post on their websites, for a period of no less than thirty days:  (i) a description of the proposed services to be provided pursuant  to the contractor contracts;  (ii) the criteria for selection of a contractor or contractors;  (iii)  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  (iv)  the  manner  by  which  a  prospective  contractor may seek such selection, which may include submission by electronic means;  (b) all reasonable and responsive submissions that are  received  from prospective  contractors  in  timely  fashion  shall  be reviewed by the commissioners; and  (c) the commissioners of the office of mental health and the office of alcoholism and  substance  abuse  services,  in  consultation  with  the commissioner  of health and the impacted local governmental units, shall select such contractor or contractors that, in  their  discretion,  have demonstrated  the  ability to effectively, efficiently, and economically  integrate behavioral health and  health  services;  have  the  requisite expertise   and   financial  resources;  have  demonstrated  that  their directors, sponsors, members, managers, partners or operators  have  the requisite  character,  competence and standing in the community, and are best suited to serve the purposes of this  section.  In  selecting  such contractor or contractors, the commissioners shall:  (i)  ensure  that  any such contractor or contractors have an adequate network of providers to meet the behavioral health and health  needs  of enrollees,  and  shall review the adequacy prior to approval of any such contract or contracts, and upon contract renewal or  expansion.  To  the extent  that the network has been determined to meet standards set forth in subdivision five of section four thousand four hundred three  of  the public health law, such network shall be deemed adequate.  (ii)  ensure  that  such contractor or contractors shall make level of care and  coverage  determinations  utilizing  evidence-based  tools  or guidelines   designated  to  address  the  behavioral  health  needs  of enrollees.  (iii)  ensure  sufficient  access  to  behavioral  health  and  health services   for   eligible   enrollees  by  establishing  and  monitoring penetration rates of any such contractor or contractors.  (iv) establish standards to encourage the use  of  services,  products and   care   recommended,   ordered  or  prescribed  by  a  provider  to sufficiently address the behavioral health and health services needs  of enrollees;  and monitor the application of such standards to ensure that they sufficiently address the  behavioral  health  and  health  services needs of enrollees.   4.  The  commissioners  of  the office of mental health, the office of alcoholism and substance abuse services and the  department  of  health, shall  have  the  responsibility  for  jointly designating on a regional basis, after consultation with the local social  services  district  and local  governmental  unit, as such term is defined in the mental hygiene law, of a city with a population of over one million persons, and  after consultation  of  other  affected  counties, a limited number of special needs managed care plans under section  three  hundred  sixty-four-j  of this  title capable of managing the behavioral and physical health needs of medical  assistance  enrollees  with  significant  behavioral  health needs.  Initial  designations of such plans should be made no later than April first, two thousand fourteen, provided, however, such designations shall be contingent upon a determination  by  such  state  commissioners that  the  entities  to  be  designated  have the capacity and financial ability to provide services in such plans, and that  the  region  has  a sufficient  population  and  service  base  to  support such plans. Once designated, the commissioner of health shall make arrangements to enroll such enrollees in such plans and to pay such plans  on  a  capitated  or other  basis  to manage, coordinate, and pay for behavioral and physical health medical assistance services for such  enrollees.  Notwithstanding any inconsistent provision of section one hundred twelve and one hundred sixty-three  of the state finance law, and section one hundred forty-two of the economic development law, or any other law to the  contrary,  the designations  of such plans, and any resulting contracts with such plans or  providers  are  authorized  to  be  entered  into  by   such   state commissioners without a competitive bid or request for proposal process, provided however that:  (a)  the  department  of  health,  the office of mental health and the office of alcoholism and substance abuse services shall  post  on  their websites, for a period of not less than thirty days:  (i) a description of the proposed services to be provided by the plans or systems;  (ii) the criteria for selection of a plan or system;  (iii) the period of time during which a prospective plan or system may seek  selection,  which  shall  be  no  less than thirty days after such information is first posted on the website; and  (iv) the manner by which a prospective plan or system  may  seek  such selection, which may include submission by electronic means;  (b)  all  reasonable and responsive submissions that are received from prospective plans or systems in timely fashion shall be reviewed by  the commissioners; and  (c) the commissioners of the office of mental health and the office of alcoholism  and  substance  abuse  services,  in  consultation  with the commissioner of health, shall select such  plans  or  systems  that,  in their   discretion,   have  demonstrated  the  ability  to  effectively, efficiently, and economically manage the behavioral and physical  health needs of medical assistance enrollees with significant behavioral health needs;  have  the  requisite  expertise  and  financial  resources; have demonstrated that their directors, sponsors, members, managers, partners or operators have the requisite character, competence  and  standing  in the  community,  and  are  best  suited  to  serve  the purposes of this section. Oversight of such  contracts  with  such  plans,  providers  or provider  systems  shall  be  the  joint  responsibility  of  such state commissioners, and for contracts affecting a city with a  population  of over  one  million  persons,  also with the city's local social services district and local governmental unit, as such term  is  defined  in  the mental hygiene law. In selecting such plans or systems, the commissioners shall:  (i)  ensure that any such plans or systems have an adequate network of providers to meet the behavioral health and health needs  of  enrollees, and  shall  review  the  adequacy prior to approval of any such plans or systems, and upon contract renewal or expansion. To the extent that  the network  has  been determined to meet standards set forth in subdivision five of section four thousand four hundred three of  the  public  health law, such network shall be deemed adequate.  (ii)  ensure  that  such plans or systems shall make level of care and coverage determinations utilizing  evidence-based  tools  or  guidelines designed to address the behavioral health needs of enrollees.  (iii)  ensure  sufficient  access  to  behavioral  health  and  health services  for  eligible  enrollees  by   establishing   and   monitoring penetration rates of any such plans or systems.  (iv)  establish  standards  to encourage the use of services, products and  care  recommended,  ordered  or  prescribed  by   a   provider   to sufficiently  address the behavioral health and health services needs of enrollees; and monitor the application of such standards to ensure  that they  sufficiently  address  the  behavioral  health and health services needs of enrollees.   5. Pursuant to appropriations, the department of health shall reinvest funds allocated for behavioral health services, which are  general  fund savings  directly  related to savings realized through the transition of populations  covered  by  this  section  from  the  applicable  Medicaid fee-for-service  system  to  a  managed  care  model,  including savings resulting from the reduction  of  inpatient  and  outpatient  behavioral health  services  provided  under  the  Medicaid  programs  licensed  or certified pursuant to article thirty-one or  thirty-two  of  the  mental hygiene  law,  or  programs  that  are licensed pursuant to both article thirty-one of the mental hygiene law and  article  twenty-eight  of  the public  health  law,  or  certified under both article thirty-two of the mental hygiene law and article twenty-eight of the  public  health  law, for  the  purpose of increasing investment in community based behavioral  health services, including residential services certified by the  office of  alcoholism  and  substance abuse services. The methodologies used to calculate the savings shall be developed by the commissioner  of  health and the director of the budget in consultation with the commissioners of the  office  of mental health and the office of alcoholism and substance abuse services. In no event shall the full annual value of the community based behavioral health service reinvestment savings attributable to the transition to  managed  care  exceed  the  twelve  month  value  of  the department  of  health  general  fund  reductions  resulting  from  such transition. Within any fiscal year  where  appropriation  increases  are recommended for reinvestment, insofar as managed care transition savings do  not occur as estimated, and general fund savings do not result, then spending for such reinvestment may be reduced in the next year's  annual budget   itemization.   The  commissioner  of  health  shall  promulgate regulations, and prior to  October  first,  two  thousand  fifteen,  may promulgate   emergency  regulations  as  required  to  distribute  funds pursuant to this subdivision;  provided,  however,  that  any  emergency regulations  promulgated  pursuant to this section shall expire no later than December thirty-first, two thousand fifteen. The commissioner shall include detailed descriptions  of  the  methodology  used  to  calculate savings  for  reinvestment,  the results of applying such methodologies, the details regarding implementation of such  reinvestment  pursuant  to this section, and any regulations promulgated under this subdivision, in the  annual  report  required  under  section  forty-five-c of part A of chapter fifty-six of the laws of two thousand thirteen.