360-10.7 Managed care plan review process.
(a) Each designated social services district must develop and submit a
managed care plan to the commissioner within 180 days of the date on which the department
notifies the district that the district has been selected to develop and submit a managed
care plan unless the district has been granted an exemption from submitting a managed care
plan under subdivision (g) of this section.
(b) The commissioner will review a social services district's managed
care plan and, within 90 days after receipt of the plan from the district, either approve
or disapprove the plan or request that the district modify the plan.
(c) If the commissioner disapproves a managed care plan or requests
modification of such plan, the commissioner will provide written notice to the social
services district that describes the plan's specific deficiencies.
(d) After the social services district receives this notice, the
district will have up to 90 days to submit a modified plan to the department.
(e) If the commissioner determines that the modified plan does not meet
the requirements of section 360-10.8 of this Subpart or if the modified plan is not
submitted within the required period of time, the commissioner will disapprove the plan or
notify the social services district if another modified plan will be considered. The
commissioner will inform the social services district in writing of his or her
determination within 30 days of the date the commissioner receives the district's modified
plan or, if the modified plan is not submitted timely, the date when the modified plan
should have been submitted.
(f) If the commissioner approves a managed care plan, the social
services district is authorized to implement the plan within the social services district.
(g) (1) A social services district may seek an exemption from the
requirement to develop and submit a managed care plan if the district can document that
the following applies:
(i) the social services
district cannot achieve fiscal savings through operation of an MCP; or
(ii) the quality of
care that is provided to MA recipients cannot be maintained through operation of an MCP.
(2) A social services district which seeks an
exemption under this subdivision must make a written request to the department within 60
days of the date on which the department notifies the district that the district has been
designated to develop and submit a managed care plan. The commissioner will either approve
or disapprove the exemption request in writing within 30 days of receipt of the request.
If the exemption request is denied, the social services district will have 180 days from
receipt of the department's disapproval notice to submit a managed care plan in accordance
with the requirements of this Subpart. A social services district which has been granted
an exemption under this subdivision may request renewals of the exemption for successive
two year periods.