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

§  365-l. Health homes. 1. Notwithstanding any law, rule or regulation to  the  contrary,  the  commissioner  of  health  is   authorized,   in consultation  with  the  commissioners  of  the office of mental health, office of alcoholism and substance abuse services, and office for people with developmental disabilities, to (a) establish,  in  accordance  with applicable  federal  law and regulations, standards for the provision of health home services to Medicaid enrollees with chronic conditions,  (b) establish  payment  methodologies  for  health  home  services  based on factors including but not limited to the complexity  of  the  conditions providers  will  be  managing, the anticipated amount of patient contact needed to manage such conditions,  and  the  health  care  cost  savings realized  by  provision  of  health  home  services,  (c)  establish the criteria under which a Medicaid enrollee will be designated as being  an eligible  individual  with  chronic  conditions  for  purposes  of  this program, (d) assign any Medicaid  enrollee  designated  as  an  eligible individual  with  chronic  conditions  to  a  provider  of  health  home services.   2. In addition to payments made for health home services  pursuant  to subdivision  one  of this section, the commissioner is authorized to pay additional amounts to  providers  of  health  home  services  that  meet process  or  outcome  standards  specified  by  the  commissioner.  Such additional amounts  may  be  paid  with  state  funds  only  if  federal financial participation for such payments is unavailable.   2-a.  Up  to  fifteen  million dollars in state funding may be used to fund health home infrastructure development. Such funds shall be used to develop enhanced systems to support  Health  Home  operations  including assignments,  workflow,  and  transmission of data. Funding will also be disbursed pursuant to a formula established by the  commissioner  to  be designated  health  homes.  Such  formula  may  consider prior access to similar  funding  opportunities,  geographic  and  demographic  factors, including   the   population   served,   and  prevalence  of  qualifying conditions, connectivity to providers, and other criteria as established by the commissioner.   2-b. The commissioner is authorized  to  make  lump  sum  payments  or adjust  rates  of  payment  to  providers  up  to a gross amount of five million dollars, to establish coordination between the health homes  and the  criminal  justice  system and for the integration of information of health homes with state and local correctional facilities, to the extent permitted by law. Such rate adjustments may  be  made  to  health  homes participating  in  a  criminal justice pilot program with the purpose of enrolling incarcerated individuals with serious mental illness,  two  or more   chronic  conditions,  including  substance  abuse  disorders,  or HIV/AIDS, into such health home. Health homes receiving funds under this subdivision shall be required to document and demonstrate the  effective use of funds distributed herein.   2-c.  The  commissioner  is  authorized  to  make grants up to a gross amount of one million dollars for certified application  counselors  and assistors   to  facilitate  the  enrollment  of  persons  in  high  risk populations, including but not limited to  persons  with  mental  health and/or  substance abuse conditions that have been recently discharged or are pending release from state and local correctional facilities.  Funds allocated  for  certified  application counselors and assistors shall be expended through a request for proposal process.   2-d. The commissioner shall establish reasonable  targets  for  health home  participation  by  enrollees  of  special needs managed care plans designated  pursuant  to  subdivision  four  of  section  three  hundred sixty-five-m  of this title and by high-risk enrollees of other Medicaid managed  care  plans  operating  pursuant  to  section   three   hundred  sixty-four-j  of  this  title, and shall encourage both the managed care providers and the health homes to work collaboratively with  each  other to  achieve  such  targets.  The commissioner may assess penalties under this  subdivision  in  instances  of  failure  to meet the participation targets established pursuant to this subdivision, where  the  department has  determined  that such failure reflected the absence of a good faith and reasonable effort to achieve the participation targets, except  that managed  care  providers  shall  not  be  penalized for the failure of a health home to work collaboratively  toward  meeting  the  participation targets  and  a  health home shall not be penalized for the failure of a managed  care  provider  to  work  collaboratively  toward  meeting  the participation targets.   3.  Until  such  time  as  the  commissioner obtains necessary waivers and/or approvals of the federal social security act, Medicaid  enrollees assigned to providers of health home services will be allowed to opt out of  such  services.  In  addition, upon enrollment, an enrollee shall be offered an option of at least two providers of health home services,  to the extent practicable.   4.  Payments  authorized  pursuant  to  this section will be made with state funds only,  to  the  extent  that  such  funds  are  appropriated therefore,  until  such  time  as federal financial participation in the costs of such services is available.   5. The commissioner is authorized to submit amendments  to  the  state plan  for  medical assistance and/or submit one or more applications for waivers of the federal social security act, to obtain federal  financial participation  in the costs of health home services provided pursuant to this section, and as provided in subdivision three of this section.   6. Notwithstanding any limitations imposed by  section  three  hundred sixty-four-l  of  this  title on entities participating in demonstration projects established pursuant  to  such  section,  the  commissioner  is authorized  to  allow  such entities which meet the requirements of this section to provide health home services.   7. Notwithstanding any law, rule, or regulation to the  contrary,  the commissioners  of the department of health, the office of mental health, the office for people with developmental disabilities, and the office of alcoholism and  substance  abuse  services  are  authorized  to  jointly establish  a  single  set  of operating and reporting requirements and a single set of construction and survey requirements for entities that:  (a) can demonstrate experience in the delivery of health,  and  mental health  and/or  alcohol  and substance abuse services and/or services to persons with developmental  disabilities,  and  the  capacity  to  offer integrated  delivery  of  such services in each location approved by the commissioner; and  (b) meet the standards established pursuant to subdivision one of this section for providing and receiving payment for  health  home  services; provided,  however,  that  an  entity  meeting the standards established pursuant to subdivision one of this section shall not be required to  be an integrated service provider pursuant to this subdivision.   In  establishing  a single set of operating and reporting requirements and a single set of construction and survey  requirements  for  entities described  in  this  subdivision, the commissioners of the department of health, the  office  of  mental  health,  the  office  for  people  with developmental  disabilities,  and the office of alcoholism and substance abuse services are authorized to waive any  regulatory  requirements  as are  necessary  to  avoid  duplication  of requirements and to allow the integrated delivery of services in a rational and efficient manner.   8. (a) The commissioner of health is authorized to contract  with  one or  more  entities to assist the state in implementing the provisions of  this section. Such entity or  entities  shall  be  the  same  entity  or entities  chosen  to  assist  in  the  implementation  of the multipayor patient centered medical home program pursuant  to  section  twenty-nine hundred  fifty-nine-a  of the public health law. Responsibilities of the contractor  shall  include   but   not   be   limited   to:   developing recommendations  with  respect  to program policy, reimbursement, system requirements, reporting requirements, evaluation protocols, and provider and patient enrollment;  providing  technical  assistance  to  potential medical  home  and health home providers; data collection; data sharing; program evaluation, and preparation of reports.  (b) 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, the  commissioner  of  health  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 of health; and  (iii) The commissioner of  health  shall  select  such  contractor  or contractors that, in his or her discretion, are best suited to serve the purposes of this section.   9.  The  contract  entered into by the commissioner of health prior to January first, two thousand thirteen pursuant to  subdivision  eight  of this  section  may  be  amended  or  modified  without  the  need  for a competitive bid or request for proposal process, and without  regard  to the   provisions   of  sections  one  hundred  twelve  and  one  hundred sixty-three of the state finance law, section one hundred  forty-two  of the  economic  development law, or any other provision of law, excepting the responsible vendor requirements of the state finance law, including, but not limited to, sections one hundred  sixty-three  and  one  hundred thirty-nine-k  of  the  state  finance  law,  to  allow  the purchase of additional personnel and services, subject to available funding, for the limited purpose of assisting the department of health with  implementing the  Balancing  Incentive  Program, the Fully Integrated Duals Advantage Program,  the  Vital  Access  Provider  Program,  the  Medicaid   waiver amendment  associated  with  the  public  hospital  transformation,  the addition of behavioral health services as a managed care  plan  benefit, the  delivery  system  reform  incentive  payment  plan,  activities  to facilitate the transition of  vulnerable  populations  to  managed  care and/or  any  workgroups required to be established by the chapter of the laws  of  two  thousand  thirteen  that  added  this  subdivision.   The department  is  authorized  to  extend such contract for a period of one year, without a competitive bid or request for  proposal  process,  upon determination  that  the existing contractor is qualified to continue to provide such services; provided, however, that the department of  health shall  submit  a  request  for applications for such contract during the time period specified in this subdivision and may terminate the contract  identified herein prior to expiration of  the  extension  authorized  by this subdivision.