Senate Bill S9573

                                 
BILL NUMBER: S9573

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to authorizing the
commissioner of health to establish nursing facility transition and
diversion Medicaid waiting lists per designated waiver region

 
PURPOSE:

This bill ensures transparent, equitable, and regionally based access to
the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver program
by requiring the Department of Health (DOH) to establish and maintain
waiting lists once federally approved waiver capacity is reached, and to
draw individuals from the waiting lists in an orderly and fair manner.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends subdivision 6-a of section 366 of the social services
law, in relation to eligibility for Medicaid, by adding a new paragraph
(i) to require the Commissioner of Health (COH) to establish a waiting
              

list for each designated waiver region once the federally approved
capacity for the NHTD waiver has been reached; require the COH to estab-
lish a waiting list from the applicable regional waiting list as capaci-
ty becomes available; require that individuals are served in the order
they were added to the list, unless the DOH chooses to prioritize
specific populations, such as people transitioning from nursing homes to
the community; and ensure that eligible individuals reside in the region
where the new waiver slot becomes available.

Section 2 provides the effective date.

 
JUSTIFICATION:

The Nursing Home Transition and Diversion (NHTD) Medicaid Program exists
to allow eligible individuals, 65 years and older or those with physical
disabilities, to receive services in a community-based setting. NHTD
provides a variety of home based care services, intended to prolong the
amount of time before a patient goes into a nursing home, or allowing
some individuals to leave a nursing home and return to their communities
while supporting their independence.

The current system is managed as a statewide program with a maximum set
number of participants and once that threshold is reached, enrollment is
either paused or the waiver is amended to increase said threshold if it
is larger than what is approved by the federal Centers for Medicare and
Medicaid Services. This statewide system paired with the enrollment
pause creates a barrier for individuals looking to apply for the waiver
after the threshold is reached. Once an individual applies for the NHTD
waiver after the threshold is reached, a letter will disclose that their
referral to the NHTD waiver program will no longer be considered.

This bill will make the Department of Health (DOH) establish specified
waiver regions and form region-based waitlists for the NHTD program once
the federally approved capacity has been reached. Having a waitlist
divvyed up by region makes this system more seamless and effective for
eligible users; and individuals who apply for the NHTD waiver will have
increased transparency on the status and location of their application.
The bill would also allow DOH to draw from the waitlist out of order to
identify and provide services to eligible individuals and populations
who are the most in need of care.

An additional issue is that the current state of open applications may
have been lost prior to the waiver being capped. Extending the NHTD to
January 1, 2032 will make enough time for these individuals to have
their needs assessed, increasing their accessibility to care and ensur-
ing fairness in the application waiver process.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

Minimal, the Department of Health may incur additional administrative
costs for establishing and regulating the regional waitlists.

 
EFFECTIVE DATE:
This act shall take effect immediately.