2023 New York Laws › MHY - Mental Hygiene › Title C - Developmental Disabilties Act › Article 13 - Office for People With Developmental Disabilities › 13.40 - People First Waiver Program.

§ 13.40 People first waiver program.
(a)  The  commissioner  and  the  commissioner of health shall jointly
establish a people first waiver program for  purposes  of  developing  a
care  coordination  model that integrates various long-term habilitation
supports and/or health care.  The  people  first  waiver  program  shall
include  the use of developmental disability individual support and care
coordination organizations, herein referred to as  DISCOs,  pursuant  to
section  forty-four  hundred  three-g  of  the public health law, health
maintenance  organizations,  herein  referred  to  as  HMOs,   providing
services  under subdivision eight of section forty-four hundred three of
the public health law, and managed long term care plans, herein referred
to as MLTCs, providing services under subdivisions twelve, thirteen  and
fourteen of section forty-four hundred three-f of the public health law.
Services  shall  be  provided as described in section forty-four hundred
three-g  of  the  public  health  law,  subdivision  eight  of   section
forty-four  hundred  three  of  the  public health law, and subdivisions
twelve, thirteen and fourteen of section forty-four hundred  three-f  of
the public health law.
(b) Entities providing services pursuant to this section shall provide
health  and  long  term  care services as the term is defined in section
forty-four hundred three-g of the public health law.
(c) No person with a developmental  disability  who  is  receiving  or
applying  for  medical  assistance  and who is receiving, or eligible to
receive, services operated, funded, certified, authorized or approved by
the office, shall be required to enroll in a DISCO, HMO or MLTC in order
to receive such services until program features and reimbursement  rates
are  approved  by  the  commissioner and the commissioner of health, and
until such commissioners determine that a  sufficient  number  of  plans
that  are authorized to coordinate care for individuals pursuant to this
section or that are authorized to  operate  and  to  exclusively  enroll
persons   with   developmental   disabilities  pursuant  to  subdivision
twenty-seven  of  section  three  hundred  sixty-four-j  of  the  social
services  law are operating in such person's county of residence to meet
the needs of persons with  developmental  disabilities,  and  that  such
entities meet the standards of this section. No person shall be required
to enroll in a DISCO, HMO or MLTC in order to receive services operated,
funded,  certified, authorized or approved by the office until there are
at least two entities operating under  this  section  in  such  person's
county  of  residence,  unless  federal  approval  is secured to require
enrollment when there are less than two such entities operating in  such
county.  Notwithstanding the foregoing or any other law to the contrary,
any health care provider: (i) enrolled in the Medicaid program and  (ii)
rendering  hospital  services,  as  such  term  is  defined  in  section
twenty-eight hundred one of the public health law, to an individual with
a developmental disability who is enrolled in a DISCO, HMO or MLTC, or a
prepaid health services plan operating pursuant  to  section  forty-four
hundred three-a of the public health law, including, but not limited to,
an  individual  who  is  enrolled  in a plan authorized by section three
hundred sixty-four-j or the social services law, shall  accept  as  full
reimbursement  the  negotiated  rate  or,  in the event that there is no
negotiated rate, the rate of  payment  that  the  applicable  government
agency would otherwise pay for such rendered hospital services.
(d)  DISCOs, HMOs and MLTCs operating under this section shall ensure,
to the greatest extent practicable, that their assessment, services, and
the grievance and appeals processes are  culturally  and  linguistically
competent.
(e)  1. The commissioner and the commissioner of health shall identify
one or more  valid  and  reliable  quality  assurance  instruments  that

include  assessments of individual and family satisfaction, provision of
services, and personal outcomes. The instruments shall:
(1)  provide  nationally  validated, benchmarked, consistent, reliable
and measurable data for a comprehensive quality improvement  and  review
process, and
(2) include outcome-based measures such as health, safety, well-being,
relationships,  interactions  with  people who do not have a disability,
employment, quality of life, integration, choice, service  and  consumer
satisfaction.
2. Within available appropriations, the instruments identified in this
subdivision  may  be  expanded  to  collect additional data requested by
other offices, departments or agencies of the state,  local  or  federal
government.
3.  The  commissioner  may  contract  with  an  independent  agency or
organization for the development of the  quality  assurance  instruments
described in this subdivision.
4.  The  commissioner  shall  establish  the  methodology by which the
quality assurance instruments shall be administered.
5. The commissioner, in consultation with stakeholders, shall annually
review  the  data  collected  from  the  quality  assurance  instruments
described in this subdivision and shall review recommendations regarding
additional  or  different criteria for the quality assurance instruments
in  order  to  assess  the  performance  of  the  state's  developmental
disabilities services system and improve services for consumers.
(f)   There   shall  be  a  joint  advisory  council  chaired  by  the
commissioner and the commissioner of health that shall be  charged  with
advising  both  commissioners in regard to the oversight of DISCOs, HMOs
providing services under subdivision eight of section forty-four hundred
three of the public health  law,  and  MLTCs  providing  services  under
subdivisions twelve, thirteen and fourteen of section forty-four hundred
three-f  of  the  public  health  law. The joint advisory council may be
comprised of the  members  of  existing  advisory  councils  or  similar
entities  serving  the  office,  provided  that it shall be comprised of
twelve members, including individuals with  developmental  disabilities,
family  members  of,  advocates for, and providers of services to people
with developmental disabilities. Three members  of  the  joint  advisory
council  shall  also  be members of the special advisory review panel on
medicaid  managed  care  established   under   section   three   hundred
sixty-four-jj  of  the  social  services law. The joint advisory council
shall review all managed  care  options  provided  to  individuals  with
developmental  disabilities,  including:  the  adequacy  of habilitation
services;  the  record  of  compliance  with  person-centered  planning,
person-centered  services  and  community  integration;  the adequacy of
rates paid to providers in accordance with the provisions  of  paragraph
one  of  subdivision  four  of  section  forty-four hundred three of the
public health law, paragraph  a-two  of  subdivision  eight  of  section
forty-four  hundred three of the public health law or paragraph a-two of
subdivision twelve of section forty-four hundred three-f of  the  public
health   law;   and  quality  of  life,  health,  safety  and  community
integration of individuals with developmental disabilities  enrolled  in
managed  care.    The  commissioner  and  commissioner of the office for
people with developmental disabilities or their designees  shall  attend
all  meetings  of the joint advisory council. The joint advisory council
shall report its findings, recommendations, and any proposed  amendments
to   pertinent   sections  of  the  law  to  the  commissioner  and  the
commissioner of health, the senate majority leader and  speaker  of  the
assembly.  The  joint  advisory council shall have access to any and all

information that may be lawfully disclosed to it and that  is  necessary
to perform its functions under this section.
(g) 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  commissioner and the commissioner of health are
authorized  to  enter  into  a  contract  or  contracts  under   section
forty-four  hundred  three-g of the public health law, subdivision eight
of section forty-four hundred  three  of  the  public  health  law,  and
subdivision  twelve  of section forty-four hundred three-f of the public
health law, provided, however, that:
1. the office 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;
2.  all  reasonable  and responsive submissions that are received from
prospective contractors in a timely fashion shall  be  reviewed  by  the
commissioners; and
3.  the commissioner and the commissioner of health may jointly select
such  contractor  or  contractors  that,  in  their   discretion,   have
demonstrated  the  ability  to effectively, efficiently and economically
integrate health and long term  care  services  as  defined  in  section
forty-four  hundred  three-g  of  the  public  health  law, and meet the
standards for a certificate of authority in the public  health  law  for
the  provision  of  services  operated, funded, certified, authorized or
approved by the office for people with  developmental  disabilities  and
applicable  to  the  type  of  managed  care  plan  that such contractor
proposes to operate.
* (h) Consistent with and subject to the terms  of  federal  approval,
the  commissioner  shall  establish  the  managed  care for persons with
developmental disabilities advocacy program, hereinafter referred to  as
the  advocacy  program.  The activities of the advocacy program shall be
coordinated with the independent Medicaid managed care  ombuds  services
provided  to  persons  with  disabilities  enrolling in Medicaid managed
care. The advocacy program shall advise individuals of applicable rights
and responsibilities, provide information and assistance to address  the
needs of individuals with disabilities, and pursue legal, administrative
and other appropriate remedies or approaches to ensure the protection of
and advocacy for the rights of the enrollees. The advocacy program shall
provide  support to eligible individuals with developmental disabilities
enrolling  in  developmental  disability  individual  support  and  care
coordination   organizations  pursuant  to  section  forty-four  hundred
three-g of the  public  health  law,  health  maintenance  organizations
providing  services  pursuant to subdivision eight of section forty-four
hundred three of the public health law, managed  long  term  care  plans
providing  services  under subdivisions twelve, thirteen and fourteen of
section forty-four hundred three-f of the public health law,  and  fully
integrated  dual  advantage  plans  providing services under subdivision
twenty-seven  of  section  three  hundred  sixty-four-j  of  the  social
services  law. The commissioner shall select an independent organization
or organizations to provide advocacy services under this subdivision.
* NB Effective upon approval by the federal centers for  medicare  and
medicaid  services  of  a  managed care advocacy program for individuals
with developmental disabilities