2012 New York Consolidated Laws
PBH - Public Health
Article 44 - (4400 - 4414) HEALTH MAINTENANCE ORGANIZATIONS
4403-F - Managed long term care plans.

 
    * §  4403-f.  Managed long term care plans. 1. Definitions. As used in
  this section:
    (a) "Managed long term care plan" means an entity that has received  a
  certificate of authority pursuant to this section to provide, or arrange
  for,  health  and  long  term  care  services,  on  a capitated basis in
  accordance with this section, for a population, age eighteen  and  over,
  which the plan is authorized to enroll.
    (b) "Eligible applicant" means an entity controlled or wholly owned by
  one  or  more of the following: a hospital as defined in subdivision one
  of section twenty-eight hundred one of this chapter; a home care  agency
  licensed or certified pursuant to article thirty-six of this chapter; an
  entity that has received a certificate of authority pursuant to sections
  forty-four  hundred  three,  forty-four  hundred  three-a  or forty-four
  hundred eight-a of  this  article  (as  added  by  chapter  six  hundred
  thirty-nine  of  the  laws  of nineteen hundred ninety-six), or a health
  maintenance organization authorized under  article  forty-three  of  the
  insurance  law;  or a not-for-profit organization which has a history of
  providing or coordinating  health  care  services  and  long  term  care
  services to the elderly and disabled.
    (c)  "Operating  demonstration"  means  the  following  entities:  the
  chronic care management demonstration  programs  authorized  by  chapter
  five  hundred  thirty  of  the  laws  of  nineteen hundred eighty-eight,
  chapter five hundred  ninety-seven  of  the  laws  of  nineteen  hundred
  ninety-four  and  chapter  eighty-one  of  the  laws of nineteen hundred
  ninety-five as amended.
    (d) "Health and long term care services" means services including, but
  not limited to home and community-based and institution-based long  term
  care  and  ancillary  services  (that shall include medical supplies and
  nutritional supplements) that are necessary to meet the needs of persons
  whom the plan is authorized to enroll. The managed long term  care  plan
  may also cover primary care and acute care if so authorized.
    2.  Certificate of authority; form. An eligible applicant shall submit
  an application for a certificate of authority to operate a managed  long
  term  care plan upon forms prescribed by the commissioner. Such eligible
  applicant shall submit information and documentation to the commissioner
  which shall include, but not be limited to:
    (a) a description of the service area proposed to  be  served  by  the
  plan with projections of enrollment that will result in a fiscally sound
  plan;
    (b)  a description of the proposed target population and the marketing
  plan;
    (c) adequate documentation of the appropriate licenses, certifications
  or approvals to provide care as planned, including contracts  with  such
  providers as may be necessary to provide the full complement of services
  required to be provided under this section.
    3.  Certificate  of  authority;  approval.  The commissioner shall not
  approve an  application  for  a  certificate  of  authority  unless  the
  applicant demonstrates to the commissioner's satisfaction:
    (a)   that   it   will  have  in  place  acceptable  quality-assurance
  mechanisms, grievance procedures, mechanisms to protect  the  rights  of
  enrollees  and  case  management services to ensure continuity, quality,
  appropriateness and coordination of care;
    (b) that it will include an enrollment process which shall ensure that
  enrollment in the plan is informed. The application shall  describe  the
  disenrollment  process,  which  shall provide that an otherwise eligible
  enrollee shall not be involuntarily disenrolled on the basis  of  health
  status;

    (c)  satisfactory  evidence  of  the  character  and competence of the
  proposed operators and reasonable  assurance  that  the  applicant  will
  provide high quality services to an enrolled population;
    (d) sufficient management systems capacity to meet the requirements of
  this  section and the ability to efficiently process payment for covered
  services;
    (e)  readiness  and  capability  to  maximize  reimbursement  of   and
  coordinate  services  reimbursed  pursuant to title XVIII of the federal
  social security act and all other applicable benefits, with such benefit
  coordination including, but not limited to, measures  to  support  sound
  clinical  decisions, reduce administrative complexity, coordinate access
  to services, maximize benefits available  pursuant  to  such  title  and
  ensure that necessary care is provided;
    (f)  readiness  and  capability to arrange and manage covered services
  and  coordinate  non-covered  services  which  could  include   primary,
  specialty,  and  acute care services reimbursed pursuant to title XIX of
  the federal social security act;
    (g) willingness and capability of taking, or cooperating in, all steps
  necessary to secure and integrate any potential sources of  funding  for
  services provided by the managed long term care plan, including, but not
  limited to, funding available under titles XVI, XVIII, XIX and XX of the
  federal social security act, the federal older Americans act of nineteen
  hundred  sixty-five,  as amended, or any successor provisions subject to
  approval of the director of the state  office  for  aging,  and  through
  financing  options  such  as  those authorized pursuant to section three
  hundred sixty-seven-f of the social services law;
    (h) that the contractual arrangements for providers of health and long
  term care services in the benefit package are sufficient to  ensure  the
  availability and accessibility of such services to the proposed enrolled
  population  consistent  with guidelines established by the commissioner;
  with respect to  individuals  in  receipt  of  such  services  prior  to
  enrollment,  such  guidelines  shall  require the managed long term care
  plan to contract with agencies currently  providing  such  services,  in
  order  to promote continuity of care. In addition, such guidelines shall
  require managed long  term  care  plans  to  offer  and  cover  consumer
  directed personal assistance services for eligible individuals who elect
  such  services  pursuant  to  section  three hundred sixty-five-f of the
  social services law; and
    (i) that the applicant is financially responsible and may be  expected
  to meet its obligations to its enrolled members.
    4. Solvency. (a) The commissioner shall be responsible for evaluating,
  approving  and  regulating  all  matters  relating  to  fiscal solvency,
  including reserves, surplus and provider contracts. The commissioner may
  promulgate regulations to implement this section. The  commissioner,  in
  the administration of this subdivision:
    (i)  shall be guided by the standards which govern the fiscal solvency
  of a  health  maintenance  organization,  provided,  however,  that  the
  commissioner   shall   recognize   the   specific  delivery  components,
  operational capacity and financial capability of the eligible  applicant
  for a certificate of authority;
    (ii)  shall  not  apply financial solvency standards that exceed those
  required for a health maintenance organization; and
    (iii) shall establish reasonable capitalization and contingent reserve
  requirements.
    (b) Standards  established  pursuant  to  this  subdivision  shall  be
  adequate to protect the interests of enrollees in managed long term care
  plans.   The commissioner shall be satisfied that the eligible applicant

  is financially sound, and  has  made  adequate  provisions  to  pay  for
  services.
    4-a.  Role  of  the  superintendent  of  financial  services.  (a) The
  superintendent  of  financial  services  shall  determine  and   approve
  premiums in accordance with the insurance law whenever any population of
  enrollees  not  eligible  under title XIX of the federal social security
  act  is  to  be  covered.  The  determination  and   approval   of   the
  superintendent of financial services shall relate to premiums charged to
  such  enrollees  not  eligible  under  title  XIX  of the federal social
  security act.
    (b) The  superintendent  of  financial  services  shall  evaluate  and
  approve  any  enrollee contracts whenever such enrollee contracts are to
  cover any population of enrollees not eligible under title  XIX  of  the
  federal social security act.
    5. Applicability of other laws. A managed long term care plan shall be
  subject   to  the  provisions  of  the  insurance  law  and  regulations
  applicable  to  health  maintenance  organizations,  this  article   and
  regulations  promulgated  pursuant  thereto.  To  the  extent  that  the
  provisions of this section are inconsistent with the provisions of  this
  chapter  or  the provisions of the insurance law, the provisions of this
  section shall prevail.
    6. Approval authority. (a) An applicant shall be issued a  certificate
  of  authority  as  a managed long term care plan upon a determination by
  the  commissioner  that  the  applicant  complies  with  the   operating
  requirements  for  a managed long term care plan under this section. The
  commissioner shall issue  no  more  than  seventy-five  certificates  of
  authority to managed long term care plans pursuant to this section.
    (b)  An  operating  demonstration  shall  be  issued  a certificate of
  authority as a managed long term care plan upon a determination  by  the
  commissioner   that  such  demonstration  complies  with  the  operating
  requirements for a managed long  term  care  plan  under  this  section.
  Nothing in this section shall be construed to affect the continued legal
  authority  of  an  operating  demonstration  to  operate  its previously
  approved program.
    (c) For the period beginning April  first,  two  thousand  twelve  and
  ending  March thirty-first, two thousand fifteen, the majority leader of
  the senate and the speaker of the assembly may  each  recommend  to  the
  commissioner,  in  writing, up to four eligible applicants to convert to
  be approved managed long term care plans. An  applicant  shall  only  be
  approved  and  issued  a  certificate  of  authority if the commissioner
  determines that the applicant  meets  the  requirements  of  subdivision
  three  of this section. The majority leader of the senate or the speaker
  of the assembly may assign their authority  to  recommend  one  or  more
  applicants under this section to the commissioner.
    7. Program oversight and administration. (a)(i) The commissioner shall
  promulgate  regulations  to  implement  this  section  and to ensure the
  quality, appropriateness and cost-effectiveness of the services provided
  by managed long term care plans. The commissioner may  waive  rules  and
  regulations  of  the  department,  including  but  not limited to, those
  pertaining to duplicative requirements concerning record keeping, boards
  of directors, staffing and reporting, when such waiver will promote  the
  efficient  delivery of appropriate, quality, cost-effective services and
  when the health, safety and general welfare of  enrollees  will  not  be
  impaired  as  a  result of such waiver. In order to achieve managed long
  term care plan system efficiencies and coordination and to  promote  the
  objectives  of  high  quality,  integrated  and cost effective care, the
  commissioner may establish a single  coordinated  surveillance  process,
  allow for a comprehensive quality improvement and review process to meet

  component  quality  requirements, and require a uniform cost report. The
  commissioner shall require managed  long  term  care  plans  to  utilize
  quality  improvement  measures,  based  on  health  outcomes  data,  for
  internal  quality  assessment processes and may utilize such measures as
  part of the single coordinated surveillance process.
    (ii) Notwithstanding any inconsistent provision of the social services
  law to the contrary, the commissioner  shall,  pursuant  to  regulation,
  determine  whether  and the extent to which the applicable provisions of
  the social  services  law  or  regulations  relating  to  approvals  and
  authorizations  of, and utilization limitations on, health and long term
  care services reimbursed pursuant to title XIX  of  the  federal  social
  security   act,   including,  but  not  limited  to,  fiscal  assessment
  requirements, are inconsistent with the flexibility  necessary  for  the
  efficient  administration  of  managed  long  term  care  plans and such
  regulations shall provide that such provisions shall not  be  applicable
  to  enrollees  or  managed  long  term  care  plans,  provided that such
  determinations  are  consistent  with   applicable   federal   law   and
  regulation.
    * (b)  (i) The commissioner shall, to the extent necessary, submit the
  appropriate waivers, including, but not  limited  to,  those  authorized
  pursuant to sections eleven hundred fifteen and nineteen hundred fifteen
  of  the  federal  social  security act, or successor provisions, and any
  other waivers  necessary  to  achieve  the  purposes  of  high  quality,
  integrated, and cost effective care and integrated financial eligibility
  policies under the medical assistance program or pursuant to title XVIII
  of  the  federal  social  security act. In addition, the commissioner is
  authorized to submit the appropriate waivers, including but not  limited
  to  those  authorized  pursuant  to  sections eleven hundred fifteen and
  nineteen hundred fifteen of the federal social security act or successor
  provisions, and any other waivers necessary to require on or after April
  first, two  thousand  twelve,  medical  assistance  recipients  who  are
  twenty-one  years  of  age or older and who require community-based long
  term care services, as specified by the commissioner, for more than  one
  hundred  and  twenty days, to receive such services through an available
  plan certified pursuant to this section  or  other  program  model  that
  meets guidelines specified by the commissioner that support coordination
  and   integration   of  services.  Such  guidelines  shall  address  the
  requirements of paragraphs (a), (b), (c), (d), (e), (f), (g),  (h),  and
  (i) of subdivision three of this section as well as payment methods that
  ensure provider accountability for cost effective quality outcomes. Such
  other  program  models  may  include long term home health care programs
  that comply  with  such  guidelines.  Copies  of  such  original  waiver
  applications  and  amendments thereto shall be provided to the chairs of
  the senate finance committee, the assembly ways and means committee  and
  the  senate  and  assembly  health  committees simultaneously with their
  submission to the federal government.
    (ii) The commissioner, shall seek input from representatives  of  home
  and  community-based  long term care services providers, recipients, and
  the Medicaid managed  care  advisory  review  panel,  among  others,  to
  further  evaluate  and  promote  the transition of persons in receipt of
  home and community-based long term care services into managed long  term
  care  plans and other care coordination models and to develop guidelines
  for such care coordination models. The guidelines shall be finalized and
  posted on the department's website no later than November  fifteen,  two
  thousand eleven.
    (iii) Medical assistance recipients who are Native Americans shall not
  be  required  to  enroll  in a managed long term care plan or other care
  coordination model pursuant to this paragraph.

    (iv) The following medical assistance recipients shall not be eligible
  to participate in a  managed  long  term  care  program  or  other  care
  coordination model established pursuant to this paragraph:
    (1) a person who is expected to be eligible for medical assistance for
  less  than  six  months,  for  a  reason  other  than that the person is
  eligible for medical assistance only through the application  of  excess
  income toward the cost of medical care and services;
    (2) a person who is eligible for medical assistance benefits only with
  respect to tuberculosis-related services;
    (3) a person receiving hospice services at time of enrollment;
    (4) a person who has primary medical or health care coverage available
  from or under a third-party payor which may be maintained by payment, or
  part  payment,  of  the premium or cost sharing amounts, when payment of
  such premium  or  cost  sharing  amounts  would  be  cost-effective,  as
  determined by the social services district;
    (5)   a   person   receiving  family  planning  services  pursuant  to
  subparagraph eleven of paragraph (a) of subdivision one of section three
  hundred sixty-six of the social services law;
    (6) a person who  is  eligible  for  medical  assistance  pursuant  to
  paragraph  (v) of subdivision four of section three hundred sixty-six of
  the social services law.
    (v) The following medical assistance recipients shall not be  eligible
  to  participate  in  a  managed  long  term  care  program or other care
  coordination model established pursuant to this paragraph until  program
  features  and  reimbursement rates are approved by the commissioner and,
  as applicable, the commissioner of developmental disabilities:
    (1) a person enrolled in a managed care plan pursuant to section three
  hundred sixty-four-j of the social services law;
    (2) a participant in the traumatic brain injury waiver program;
    (3) a participant in the nursing home transition and diversion  waiver
  program;
    (4) a person enrolled in the assisted living program;
    (5)  a  person  enrolled  in  home and community based waiver programs
  administered by the office for people with developmental disabilities.
    (vi) persons required to enroll in the managed long term care  program
  or  other care coordination model established pursuant to this paragraph
  shall have no less than thirty days to select a managed long  term  care
  provider,  and  shall  be  provided with information to make an informed
  choice. Where a participant  has  not  selected  such  a  provider,  the
  commissioner  shall  assign such participant to a managed long term care
  provider,  taking  into  account  quality,   capacity   and   geographic
  accessibility.
    (vii)  Managed  long  term  care provided and plans certified or other
  care coordination model established pursuant  to  this  paragraph  shall
  comply  with  the  provisions  of  paragraphs (d), (i), (t), and (u) and
  subparagraph (iii) of paragraph (a) and subparagraph (iv)  of  paragraph
  (e)  of  subdivision  four  of section three hundred sixty-four-j of the
  social services law.
    (viii)  (1)  The  commissioner  shall   report   biannually   on   the
  implementation  of  this subdivision. The reports shall include, but not
  be limited to:
    (A) satisfaction of enrollees with care coordination/case  management;
  timeliness of care;
    (B)  service  utilization  data including changes in the level, hours,
  frequency, and types of services and providers;
    (C) enrollment data, including auto-assignment rates by plan;
    (D) quality data; and

    (E) continuity of care for participants as they move to  managed  long
  term care, with respect to community based and nursing home populations,
  including  pediatric  nursing  home  populations,  and medically fragile
  children being served by home care agencies  affiliated  with  pediatric
  nursing  homes  and  diagnostic  and treatment centers primarily serving
  medically fragile children.
    (2) The commissioner shall publish  the  report  on  the  department's
  website and provide notice to the temporary president of the senate, the
  speaker  of  the assembly, the chair of the senate standing committee on
  health, the chair of the assembly  health  committee  and  the  Medicaid
  Managed  Care Advisory Review Panel upon availability of the report. The
  initial report shall  be  provided  by  September  first,  two  thousand
  twelve.  The reports shall be made available by each February first, and
  September first thereafter. Such reports shall  be  formatted  to  allow
  comparisons between plans.
    * NB Effective until April 1, 2015
    * (b)  The  commissioner  shall,  to  the extent necessary, submit the
  appropriate waivers, including, but not  limited  to,  those  authorized
  pursuant to sections eleven hundred fifteen and nineteen hundred fifteen
  of  the  federal  social  security act, or successor provisions, and any
  other waivers  necessary  to  achieve  the  purposes  of  high  quality,
  integrated, and cost effective care and integrated financial eligibility
  policies under the medical assistance program or pursuant to title XVIII
  of  the  federal  social  security  act.  Copies of such original waiver
  applications shall be provided to the chairman  of  the  senate  finance
  committee  and  the  chairman  of  the assembly ways and means committee
  simultaneously with their submission to the federal government.
    * NB Effective April 1, 2015
    (c)(i) A managed long term  care  plan  shall  not  use  deceptive  or
  coercive  marketing  methods  to  encourage  participants  to  enroll. A
  managed long term care plan shall not distribute marketing materials  to
  potential  enrollees  before  such  materials  have been approved by the
  commissioner.
    (ii) The  commissioner  shall  ensure,  through  periodic  reviews  of
  managed  long  term  care plans, that enrollment was an informed choice;
  such plan has only enrolled persons whom it is authorized to enroll, and
  plan services are promptly available to enrollees when appropriate. Such
  periodic reviews shall be made according to standards as  determined  by
  the commissioner in regulations.
    (d)  Notwithstanding  any  provision of law, rule or regulation to the
  contrary, the commissioner may issue a request for  proposals  to  carry
  out reviews of enrollment and assessment activities in managed long term
  care  plans  and  operating  demonstrations  with  respect  to enrollees
  eligible to receive services under  title  XIX  of  the  federal  social
  security  act  to  determine  if  enrollment  meets  the requirements of
  subparagraph (ii)  of  paragraph  (c)  of  this  subdivision;  and  that
  assessments  of such enrollees' health, functional and other status, for
  the purpose of adjusting premiums, were accurate.
    (e) The commissioner may, in his or her discretion for the purpose  of
  protection  of enrollees, impose measures including, but not limited to,
  bans on further enrollments  and  requirements  for  use  of  enrollment
  brokers  until  any identified problems are resolved to the satisfaction
  of the commissioner.
    (f) Continuation of a  certificate  of  authority  issued  under  this
  section shall be contingent upon satisfactory performance by the managed
  long  term  care  plan  in the delivery, continuity, accessibility, cost
  effectiveness  and  quality  of  the  services  to   enrolled   members;
  compliance  with  applicable  provisions  of  this section and rules and

  regulations promulgated thereunder; the continuing  fiscal  solvency  of
  the  organization;  and,  federal financial participation in payments on
  behalf of enrollees who are eligible to receive services under title XIX
  of the federal social security act.
    (g)  * (i)  Managed long term care plans and demonstrations may enroll
  eligible persons in the plan or demonstration upon the completion  of  a
  comprehensive  assessment  that shall include, but not be limited to, an
  evaluation of the  medical,  social  and  environmental  needs  of  each
  prospective  enrollee  in such program. This assessment shall also serve
  as the basis for the development and provision of an appropriate plan of
  care for the enrollee. Upon approval  of  federal  waivers  pursuant  to
  paragraph  (b)  of  this  subdivision  which  require medical assistance
  recipients who require community-based long term care services to enroll
  in a plan, and upon approval of the commissioner, a plan may  enroll  an
  applicant  who  is currently receiving home and community-based services
  and  complete  the  comprehensive  assessment  within  thirty  days   of
  enrollment  provided  that the plan continues to cover transitional care
  until such time as the assessment is completed.
    * NB Effective until April 1, 2015
    * (i) Managed long term  care  plans  and  demonstrations  may  enroll
  eligible  persons  in the plan or demonstration upon the completion of a
  comprehensive assessment that shall include, but not be limited  to,  an
  evaluation  of  the  medical,  social  and  environmental  needs of each
  prospective enrollee in such program. This assessment shall  also  serve
  as the basis for the development and provision of an appropriate plan of
  care for the prospective enrollee.
    * NB Effective April 1, 2015
    (ii)  The  assessment  shall  be  completed by a representative of the
  managed long term care plan or demonstration, in consultation  with  the
  prospective  enrollee's  health  care  practitioner  as  necessary.  The
  commissioner shall prescribe the forms on which the assessment shall  be
  made.
    (iii)  The  enrollment  application  shall be submitted by the managed
  long term care plan or demonstration to the  entity  designated  by  the
  department  prior to the commencement of services under the managed long
  term care plan or demonstration. For purposes of  reimbursement  of  the
  managed  long  term  care  plan  or  demonstration,  if  the  enrollment
  application is submitted on or before the twentieth day  of  the  month,
  the  enrollment  shall  commence on the first day of the month following
  the completion and submission  and  if  the  enrollment  application  is
  submitted  after  the  twentieth  day of the month, the enrollment shall
  commence on the first day of  the  second  month  following  submission.
  Enrollments  conducted  by  a  plan or demonstration shall be subject to
  review and audit by the department or a contractor selected pursuant  to
  paragraph (d) of this subdivision.
    (iv)  Continued  enrollment  in  a  managed  long  term  care  plan or
  demonstration paid for  by  government  funds  shall  be  based  upon  a
  comprehensive  assessment of the medical, social and environmental needs
  of the recipient of the services. Such assessment shall be performed  at
  least  every  six  months by the managed long term care plan serving the
  enrollee. The commissioner  shall  prescribe  the  forms  on  which  the
  assessment will be made.
    (h)  The  commissioner shall, upon request by a managed long term care
  plan or operating demonstration, and consistent with federal regulations
  promulgated  pursuant  to   the   Health   Insurance   Portability   and
  Accountability  Act, share with such plan or demonstration the following
  data if it is available:

    (i) information concerning utilization of services  and  providers  by
  each  of its enrollees prior to and during enrollment, including but not
  limited to utilization of emergency  department  services,  prescription
  drugs, and hospital and nursing facility admissions.
    (ii) aggregate data concerning utilization and costs for enrollees and
  for  comparable  cohorts  served  through  the  Medicaid fee-for-service
  program.
    8. Payment rates for managed long term care  plan  enrollees  eligible
  for  medical  assistance. The commissioner shall establish payment rates
  for services provided to enrollees  eligible  under  title  XIX  of  the
  federal  social  security  act.  Such  payment rates shall be subject to
  approval by the director of the division of the budget and shall reflect
  savings to both state and local governments when compared to costs which
  would  be  incurred  by  such  program  if  enrollees  were  to  receive
  comparable health and long term care services on a fee-for-service basis
  in  the  geographic  region  in  which  such services are proposed to be
  provided. Payment rates shall be risk-adjusted to take into account  the
  characteristics  of enrollees, or proposed enrollees, including, but not
  limited to:  frailty, disability level, health  and  functional  status,
  age,  gender,  the  nature  of  services provided to such enrollees, and
  other factors as determined  by  the  commissioner.  The  risk  adjusted
  premiums  may  also  be  combined  with  disincentives  or  requirements
  designed to mitigate any incentives to obtain higher payment categories.
    9. Reports. The department shall provide  an  interim  report  to  the
  governor,  temporary  president  of  the  senate  and the speaker of the
  assembly on or before April first, two thousand three and a final report
  on or before April first, two thousand six on the results of the managed
  long term care plans under this section. Such results shall be based  on
  data  provided by the managed long term care plans and shall include but
  not be limited to the  quality,  accessibility  and  appropriateness  of
  services; consumer satisfaction; the mean and distribution of impairment
  measures  of the enrollees by payor for each plan; the current method of
  calculating premiums and the cost of comparable  health  and  long  term
  care services provided on a fee-for-service basis for enrollees eligible
  for services under title XIX of the federal social security act; and the
  results  of  periodic  reviews  of enrollment levels and practices. Such
  reports  shall  provide   data   on   the   demographic   and   clinical
  characteristics  of  enrollees, voluntary and involuntary disenrollments
  from  plans,  and  utilization  of  services  and  shall   examine   the
  feasibility of increasing the number of plans that may be approved. Data
  collected  pursuant  to this section shall be available to the public in
  an aggregated format  to  protect  individual  confidentiality,  however
  under  no  circumstance  will  data be released on items with cells with
  smaller than statistically acceptable standards.
    10. Notwithstanding any inconsistent provision to  the  contrary,  the
  enrollment  and  disenrollment process and services provided or arranged
  by all operating demonstrations or any program that receives designation
  as a Program of All-Inclusive Care for the Elderly (PACE) as  authorized
  by  federal  public  law  105-33, subtitle I of title IV of the Balanced
  Budget Act of 1997,  must  meet  all  applicable  federal  requirements.
  Services may include, but need not be limited to, housing, inpatient and
  outpatient hospital services, nursing home care, home health care, adult
  day  care,  assisted living services provided in accordance with article
  forty-six-B of this chapter,  adult  care  facility  services,  enriched
  housing  program  services,  hospice  care, respite care, personal care,
  homemaker services,  diagnostic  laboratory  services,  therapeutic  and
  diagnostic  radiologic  services,  emergency  services,  emergency alarm
  systems, home delivered meals,  physical  adaptations  to  the  client's

  home,  physician  care  (including  consultant  and  referral services),
  ancillary  services,  case  management  services,  transportation,   and
  related medical services.
    11.  The  department  shall  develop transition and continuity of care
  policies for participants in home and community based  long  term  care,
  including  the  long  term  home  health  care  program, as they move to
  managed long term care plans addressing:
    (a)  a  timetable  and  plan  for  implementation  and  transition  by
  participants, plans and providers;
    (b)  informative  disclosure  of participants' options as to impending
  actions affecting or relating to the home care services they receive;
    (c) reasonable  opportunity  for  plans'  and  providers'  good  faith
  pursuit  of  contracts,  program  changes or state approvals relevant to
  plan implementation;
    (d) notice that a participant with a previously  established  plan  of
  care provided by a certified home health agency or long term home health
  care  program,  or  provided  pursuant  to the personal care or consumer
  directed personal assistance service programs, may elect  to  have  such
  care  plan  continued  subject  to  the participant's next comprehensive
  assessment; and
    (e) delineation of responsibilities  for  service  delivery  and  care
  coordination,  so  as  to  avoid  conflict,  duplication and unnecessary
  disruption of  direct  care  staffing  for  the  patient,  and  maintain
  compliance  with state and federal statute and regulation, including the
  provisions of this section,  article  thirty-six  of  this  chapter  and
  section three hundred sixty-five-f of the social services law.
    In addition, the department shall provide technical assistance to long
  term  home  health  care  providers  with contracting options under this
  section. The department shall work with  affected  stakeholders  in  the
  development of these policies.
    * NB Repealed December 31, 2015