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Bill

S 9875

Authorizes individuals receiving hospice services to enroll in managed long term care plans

2025 Regular Session Introduced by Lea Webb

Allows hospice patients to enroll in MLTC plans and establishes DOH standards to coordinate care and prevent disruptions between MLTC and hospice services.

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Bill Summary · S 9875

Overview

Bill S. 9875 (2025-2026 Session, New York) would allow individuals who are receiving hospice services to enroll in managed long term care (MLTC) plans and would establish mechanisms to ensure coordinated, continuous care between MLTC plans and hospice providers. It also directs the Department of Health (DOH) to set standards to promote care coordination and to seek any necessary federal approvals to implement Medicaid-related provisions. The act includes guidance requirements for enrollment procedures and coordination, and clarifies protections for individuals who switch between hospice and MLTC.

Objective and Intent

  • Expand access to MLTC for people receiving hospice services.
  • Preserve continuity of care and coordination between hospice services and MLTC plans, even when individuals elect hospice.
  • Establish standards and procedures to minimize delays and disruptions in care for dually served individuals (MLTC enrollees who also receive hospice).

Key Provisions

  1. Enrollment Eligibility (Social Services Law)

    • Adds “individuals receiving hospice services at time of enrollment” to the list of people eligible to enroll in MLTC plans.
    • Protections ensure that individuals already enrolled in MLTC or other care coordination models who later elect hospice are not forced to disenroll solely due to their hospice election.
    • Clarifies that electing hospice benefit under Medicare or Medicaid does not automatically render an individual ineligible for MLTC enrollment.
    • Requires the commissioner to issue guidance on enrollment procedures, continuity of care, and coordination expectations for these individuals.

  2. Enrollment Guidance (Public Health Law)

    • Mirrors the hospice-enrollment protections in the MLTC context within the Public Health Law.
    • Requires guidance to MLTC plans, local social services districts, and hospice programs regarding enrollment, continuity of care, and coordination expectations.

  3. Department of Health Standards (New Subdivision 12-a, Public Health Law)

    • DOH must establish standards to promote coordination of care for MLTC-enrolled individuals who are also receiving hospice.
    • Potential standards (illustrative) include:
      • Shared or coordinated care planning.
      • Interdisciplinary communication protocols.
      • Clear delineation of responsibilities for personal care, transportation, and other community-based services.
      • Procedures to minimize delays or disruptions in service delivery.
    • Requires exchange of information between MLTC plans and hospice programs, consistent with privacy laws.
    • DOH may promulgate regulations and issue guidance to implement these standards.

  4. Federal Medicaid Considerations

    • DOH may seek federal approvals necessary to implement the Medicaid-related provisions of the act.

  5. Effective Date

    • General effective date: 100 days after enactment.
    • Transitional clarifications: certain amendments align with repeal timelines for related laws; immediate authority for rulemaking needed to implement the act on its effective date.

Affected Parties

  • Individuals receiving hospice services who are or may become MLTC enrollees.
  • Managed long term care plans (MLTC plans).
  • Hospice providers and programs.
  • Local social services districts.
  • New York State Department of Health (DOH).
  • Medicaid program administrators and potentially other state agencies involved in care coordination.

Procedural and Timeline Aspects

  • Enactment would require DOH to create standards and guidance, and to pursue any required federal approvals under Medicaid.
  • The act becomes effective 100 days after it becomes law, with immediate authority for necessary regulatory actions to implement on or before that date.
  • The legislation references and harmonizes with existing provisions amended in 2013, maintaining consistency with prior statutory frameworks.

Potential Impacts

  • Improved access to MLTC services for hospice patients, potentially expanding options for home- and community-based care.
  • Enhanced care coordination between MLTC plans and hospice providers, reducing fragmentation and potential gaps in service delivery.
  • Clear procedural guidance may reduce enrollment confusion and ensure patients retain continuity of care during transitions between care models.
  • Operational implications for MLTC plans and hospice programs, including information sharing and adherence to new coordination standards, while respecting privacy laws.
  • Possible need for federal Medicaid approvals to support integrated funding and delivery of these combined services.

Summary

This bill seeks to integrate hospice services with MLTC by permitting Hospice patients to enroll in MLTC plans without being forced to disenroll upon starting hospice, and by establishing DOH-led standards for coordinated care, communications, and service administration across MLTC plans and hospice programs. It emphasizes continuity of care, clear roles and responsibilities, and adherence to privacy requirements, with an eye toward Medicaid-related implementation and federal approvals. The changes would take effect 100 days after enactment, accompanied by regulatory work by state agencies.

Compiled from official sources — confirm details with the bill’s official record.

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