N.Y. Social Services Law § 364-g: Medical assistance capitation rate demonstration project

* § 364-g. Medical assistance capitation rate demonstration project.

1. The department and the county of Monroe are authorized to participate

in the "Monroe County Medicap Plan" research and demonstration project,

for the purpose of testing the feasibility of converting from a fee for

service payment system to a capitation payment system as a means of

financing health care services for medicaid recipients residing in

Monroe county.

2. The department shall undertake the research and demonstration

project authorized by this section only if it has determined that there

is a reasonable expectation that the total cost of benefits under such

project would be less than the total cost of benefits if the project was

not in effect.

3. Expenditures made in connection with the research and demonstration

project authorized by this section shall be subject to state

reimbursement in accordance with a schedule of reimbursable amounts

approved by the department, the department of health and the director of

the budget.

4. The department shall, in a manner to be decided upon by the

commissioner, determine what portion of the total expenditures made

under the research and demonstration project authorized by this section

are attributable to the provision of the services specified in paragraph

(g) of subdivision one of section three hundred sixty-eight-a of this

title, and shall ensure that the increased state reimbursement available

for such services shall be provided.

5. Notwithstanding any inconsistent provision of this chapter or any

other law to the contrary, the commissioner may, subject to the approval

of the director of the budget, apply for appropriate waivers of federal

law and regulation, and shall be authorized to waive any provisions of

sections three hundred sixty-six, three hundred sixty-seven-b and three

hundred sixty-eight-a of this title and accompanying regulations of the

department, consistent with waivers approved by the federal department

of health and human services, when such action would be necessary to

assist in promoting the objectives of this section; provided, however,

that in the event that the research and demonstration project authorized

by this section requires a waiver of article twenty-eight or forty-four

of the public health law or accompanying regulations of the department

of health, the project shall be conducted jointly with the department of

health, and the commissioner of health may waive such provisions of the

public health law or department of health regulations with the approval

of the commissioner and the director of the budget.

6. Every person eligible for or receiving medical assistance who

resides in the county of Monroe shall participate in the demonstration

project authorized by this section except for good cause as defined by

the commissioner in regulation.

7. Notwithstanding any inconsistent provisions of this section,

participation in the project authorized by this section shall not affect

a recipient's medical assistance eligibility or the scope of available

medical services to which he or she is entitled.

8. The department and the county of Monroe shall jointly submit to the

governor and the legislature a long term care capitation implementation

plan by March thirty-first, nineteen hundred eighty-five.

9. Providers participating in the research and demonstration project

authorized by this section shall submit reports to the commissioner, at

such times as he may require, evaluating the results of such project.

10. The department shall submit to the governor and the legislature an

interim report and a final report evaluating the project's impact on

medicaid costs, access to services, quality of services rendered and any

other subjects which the commissioner shall deem relevant. The interim

report shall be due January first, nineteen hundred eighty-six and the

final report shall be due at the conclusion of the project.

11. This section shall be effective if, and as long as, federal

financial participation is available for expenditures made for the

project conducted pursuant to the provisions of this section.

* NB Expired March 31, 1988 per sub 11