2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 364-JJ - Special Advisory Review Panel on Medicaid Managed Care.

* §  364-jj.  Special  advisory review panel on Medicaid managed care.
(a) There is hereby established  a  special  advisory  review  panel  on
Medicaid  managed  care.  The panel shall consist of sixteen members who
shall be appointed as follows: six by the governor, one of  which  shall
serve  as  the chair; four each by the temporary president of the senate
and the speaker of the assembly; and one each by the minority leader  of
the  senate  and  the  minority  leader  of the assembly. At least three
members of such panel shall be  members  of  the  joint  advisory  panel
established  under  section  13.40  of the mental hygiene law. The panel
shall include a consumer representative for individuals with  behavioral
health  needs,  a consumer representative for individuals who are dually
eligible for medicare and Medicaid, a representative  of  entities  that
provide  or  arrange  for  the provision of services to individuals with
behavioral health needs, and a representative of entities  that  provide
or  arrange  for the provision of services to individuals who are dually
eligible  for  medicare  and  Medicaid.  Members  shall  serve   without
compensation  but  shall  be  reimbursed  for  appropriate expenses. The
department shall provide technical assistance and access to data  as  is
required   for   the  panel  to  effectuate  the  mission  and  purposes
established herein.
(b) The panel shall:
(i) determine  whether  there  is  sufficient  managed  care  provider
participation in the Medicaid managed care program;
(ii)  determine  whether managed care providers meet proper enrollment
targets that permit as many Medicaid  recipients  as  possible  to  make
their own health plan decisions, thus minimizing the number of automatic
assignments;
(iii)  review  the  phase-in  schedule for enrollment, of managed care
providers under both the voluntary and mandatory programs;
(iv)  assess  the  impact  of  managed  care  provider  marketing  and
enrollment  strategies,  and  the public education campaign conducted in
New York city, on  enrollees  participation  in  Medicaid  managed  care
plans;
(v)  evaluate  the  adequacy  of  managed  care  provider  capacity by
reviewing established capacity measurements and monitoring actual access
to plan practitioners;
(vi)  examine  the  cost  implications  of  populations  excluded  and
exempted from Medicaid managed care;
(vii) evaluate the adequacy and appropriateness of program materials;
(viii) examine trends in service denials;
(ix) assess the access to care for people with disabilities;
(x)  in  accordance  with  the  recommendations  of the joint advisory
council established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental  disabilities  with
respect   to   the   oversight  of  DISCOs  and  of  health  maintenance
organizations and  managed  long  term  care  plans  providing  services
authorized,  funded, approved or certified by the office for people with
developmental disabilities, and review all managed care options provided
to persons with developmental disabilities, including: the  adequacy  of
support  for  habilitation  services;  the  record  of  compliance  with
requirements for person-centered planning, person-centered services  and
community  integration;  the  adequacy  of  rates  paid  to providers in
accordance with the provisions of paragraph 1  of  subdivision  four  of
section  forty-four  hundred  three  of the public health law, paragraph
(a-2) of subdivision eight of section forty-four hundred  three  of  the
public  health  law  or paragraph (a-2) of subdivision twelve of section
forty-four hundred three-f of the public health law; and the quality  of

life,   health,   safety  and  community  integration  of  persons  with
developmental disabilities enrolled in managed care; and
(xi) examine other issues as it deems appropriate.
(c)  Commencing  January  first,  nineteen  hundred  ninety-seven  and
quarterly thereafter the panel  shall  submit  a  report  regarding  the
status of Medicaid managed care in the state and provide recommendations
if it deems appropriate to the governor, the temporary president and the
minority  leader  of the senate, and the speaker and the minority leader
of the assembly.
* NB Effective until December 31, 2025
* § 364-jj. Special advisory review panel on  Medicaid  managed  care.
(a)  There  is  hereby  established  a  special advisory review panel on
Medicaid managed care. The panel shall consist of nine members who shall
be appointed as follows: three by the governor, one of which shall serve
as the chair; two each by the temporary president of the senate and  the
speaker  of  the  assembly;  and  one each by the minority leader of the
senate and the minority leader of the assembly.  All  members  shall  be
appointed  no  later  than September first, nineteen hundred ninety-six.
Members shall serve without compensation but  shall  be  reimbursed  for
appropriate  expenses. The department shall provide technical assistance
and access to data as is  required  for  the  panel  to  effectuate  the
mission and purposes established herein.
(b) The panel shall:
(i)  determine  whether  there  is  sufficient  managed  care provider
participation in the Medicaid managed care program;
(ii) determine whether managed care providers meet  proper  enrollment
targets  that  permit  as  many  Medicaid recipients as possible to make
their own health plan decisions, thus minimizing the number of automatic
assignments;
(iii) review the phase-in schedule for  enrollment,  of  managed  care
providers under both the voluntary and mandatory programs;
(iv)  assess  the  impact  of  managed  care  provider  marketing  and
enrollment strategies, and the public education  campaign  conducted  in
New  York  city,  on  enrollees  participation  in Medicaid managed care
plans;
(v) evaluate  the  adequacy  of  managed  care  provider  capacity  by
reviewing established capacity measurements and monitoring actual access
to plan practitioners;
(vi)  examine  the  cost  implications  of  populations  excluded  and
exempted from Medicaid managed care; and
(vii) examine other issues as it deems appropriate.
(c)  Commencing  January  first,  nineteen  hundred  ninety-seven  and
quarterly  thereafter  the  panel  shall  submit  a report regarding the
status of Medicaid managed care in the state and provide recommendations
if it deems appropriate to the governor, the temporary president and the
minority leader of the senate, and the speaker and the  minority  leader
of the assembly.
* NB Effective December 31, 2025