Relates to certain data required in an annual report on the administration of managed long term care plans

• Democratic7

◆ The sponsor's argument

Why Rachel May says this is needed

This bill would promote transparency concerning how MLTC plans spend billions in public funds they receive as monthly premiums for each member each year. MLTC plans already report extensive data to the Department of Health every year that show how much they spend on each of the services covered by MLTC plans - from personal care and CDPAP to dental care, adult day care, and short-term nursing home care, and how many members receive each of these services. Plans also report, for each type of home care, how many members receive the highest number of hours, the lowest number of hours, and various ranges in between. This bill would make that data publicly available, to improve accountability and consumer choice by allowing them to compare plans. Data would also be made public on how many appeals and complaints members file challenging plans' denials of services, and the outcomes of these appeals. This data should both enable better oversight by the Department of Health and consumer choice. With the severe shortage of home care workers, MLTC plans often delay providing home care services they have authorized. Despite the recommen- dation by the federal Medicaid agency CMS and the NYS Comptroller's report that thousands of MLTC enrollees went without services, New York has never instituted measures to track timely access to services. This bill would adopt measures to track staffing capacity recommended by CMS and make this data public Armed with this data, the State as well as the public can hold plans accountable for failing to provide timely access. Additionally, it has been reported that New York lags behind other states in tracking how plans are performing in "rebalancing" long teini care, meaning how good a job they are doing in shifting longterm care expenditures from nursing homes to community-based services. If a plan refuses to reinstate services for many of its enrollees who are ready for discharge after a short-teitii stay in a rehabilitation facility, those enrollees are "disenrolled" from the MLTC plan and become perma- nent nursing home residents. This practice has increased since 2020, when long-term nursing home care was "carved out" of the MLTC benefit. Adopting some of the recommendations made by CMS, data would be made public showing the rate of each plan's nursing home admissions, with the percentage successfully discharged back to the community with MLTC services reinstated versus the percentage who remained permanently in the nursing home. Also, measures would track the extent to which each MLTC plan is willing to enroll new members had been in a nursing home prior to enrollment, accomplishing the goal of rebalancing long term care. Tracking this data could become the basis for new quality measures to reward plans for rebalancing success. All of this data would he added to the existing reports by the Depart- ment of Health, which would be increased from bi-annually to annually. The data would also be available in an interactive format online, allow- ing for comparisons between plans. This should not be burdensome as the Department already makes much data available online in interactive format at https://health.data.ny.gov/. Finally, the data would be avail- able for each plan on a statewide basis and also separately for each geographic region in which the plan operates.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.