N.Y. Social Services Law § 365-n: Department of health assumption of program administration

§ 365-n. Department of health assumption of program administration. 1.

Notwithstanding the provisions of title two of article three of this

chapter or of section three hundred sixty-five of this title or of any

other law to the contrary, the commissioner of health (commissioner) is

authorized to take actions explicitly authorized by this section that

are necessary to transfer responsibility for the administration of the

medical assistance program from local social services districts to the

department of health (department) by March thirty-first, two thousand

eighteen.

2. For purposes of this section, the administration of the medical

assistance program includes: processing applications for benefits and

services available under this title and title eleven-D of this article;

making determinations of initial and ongoing eligibility for such

benefits and services; making coverage determinations with respect to

benefits and services requiring prior authorization; notifying

applicants and recipients of these determinations and of their rights

and responsibilities, authorizing benefits and services for persons

found eligible; exercising subrogation rights with respect to amounts

received from insurance carriers or other liable third parties; imposing

liens and pursuing recoveries; and any other such tasks and functions

identified by the commissioner.

3. Notwithstanding sections sixty-one, sixty-three, seventy,

seventy-eight, seventy-nine, eighty-one and eighty-one-a of the civil

service law or any provisions to the contrary contained in any general,

special, or local laws, all lawful appointees of a county performing the

functions established in subdivision two of this section as of the

effective date of this section or any such appointees who meet the open

competitive qualifications for positions established to perform these

functions will be eligible for voluntary transfer to appropriate

positions, in the department, that are classified to perform such

functions without further examination, qualification, or probationary

period; and, upon such transfer, will have all the rights and privileges

of the jurisdictional classification to which such positions are

allocated in the classified service of the state.

4. Within one hundred twenty days of the effective date of this

section, the department shall develop and implement a local department

of social services statement of interest. The statement of interest will

elicit from local departments of social services their interest in and

capacity to contract with the department to perform the functions

established in subdivision two of this section. To the extent

practicable and in the best interest of the medical assistance program,

the department shall contract with local social services districts to

perform all or a portion of the functions described in subdivision two

of this section. In no event, however, shall the department, by means

of such a contract, delegate its authority to exercise administrative

discretion in the administration or supervision of the state plan for

medical assistance submitted pursuant to section three hundred

sixty-three-a of this title, or to issue policies, rules, and

regulations on program matters nor may any contracted entity be given

the authority to change or disapprove any administrative decision of the

department, or otherwise substitute such entity's judgment for that of

the department with respect to the application of policies, rules, and

regulations issued by the department. Notwithstanding any inconsistent

provision of sections one hundred twelve and one hundred sixty-three of

the state finance law, or sections one hundred forty-two and one hundred

forty-three of the economic development law, or any other contrary

provision of law, the commissioner is authorized to enter into a

contract with local departments of social services without a competitive

bid or request for proposal process.

5-a. (a) The commissioner may take necessary action to review the

accuracy of determinations of initial and ongoing eligibility under the

medical assistance program, and to identify and eliminate inappropriate

instances of concurrent or duplicate benefits and authorizations. The

commissioner is authorized to contract with one or more entities to

assist the state in implementing the provisions of this subdivision.

(b) Notwithstanding the provisions 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 contrary provision of

law, the commissioner is authorized to enter into a contract or

contracts under paragraph (a) of this subdivision without a competitive

bid or request for proposal process, provided, however, that:

(i) The department of health 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;

(ii) All reasonable and responsive submissions that are received from

prospective contractors in timely fashion shall be reviewed by the

commissioner; and

(iii) The commissioner shall select such contractor or contractors

that, in his or her discretion, are best suited to serve the purposes of

this section; and

(iv) No contract entered pursuant to this paragraph shall have a term

that ends later than March thirty-first, two thousand seventeen.

6. The commissioner shall submit an annual report to the governor,

temporary president of the senate, speaker of the assembly, the chair of

the senate health committee and the chair of the assembly health

committee by December thirty-first, beginning in two thousand twelve and

for each year thereafter until the year following full implementation.

The initial report shall consist of modifications to the plan developed

pursuant to section forty-seven-b of part B of chapter fifty-eight of

the laws of two thousand ten, and shall include anticipated

implementation of the revised plan, its elements, a timeline for such

implementation, recommendations for legislative action, and such other

matters as may be pertinent.

The report shall include a plan and timeline for the state to:

(i) assume specific functions related to the administration of the

medical assistance program; (ii) coordinate the implementation of

provisions of federal law with the assumption of the administration of

the medical assistance program; and (iii) address the financing of the

medical assistance program administration and any associated

administrative cost relief to local social services districts. The

report shall also indicate any function that the state intends to enter

into a contract with a public and/or private entity to perform, and the

date in which the state anticipates entering into any such contract. In

addition, reports shall, at a minimum, indicate: (i) any progress the

department has made regarding its proposed timeline, including a summary

of all functions assumed by the state during the previous year; (ii) any

anticipated and/or actual delay from the proposed timeline; (iii) the

reason for any such delay; and (iv) actions the department has

undertaken to mitigate any such delay.

7. The commissioner shall promulgate such regulations that are

necessary to carry out the provisions of this section. In addition, the

commissioner shall make any amendments to the state plan for medical

assistance, or develop and submit an application for any waiver or

approval under the federal social security act, that are necessary and

required to carry out the provisions of this section.