§ 13.40 People first waiver program.\n (a) The commissioner and the commissioner of health shall jointly\nestablish a people first waiver program for purposes of developing a\ncare coordination model that integrates various long-term habilitation\nsupports and/or health care. The people first waiver program shall\ninclude the use of developmental disability individual support and care\ncoordination organizations, herein referred to as DISCOs, pursuant to\nsection forty-four hundred three-g of the public health law, health\nmaintenance organizations, herein referred to as HMOs, providing\nservices under subdivision eight of section forty-four hundred three of\nthe public health law, and managed long term care plans, herein referred\nto as MLTCs, providing services under subdivisions twelve, thirteen and\nfourteen of section forty-four hundred three-f of the public health law.\nServices shall be provided as described in section forty-four hundred\nthree-g of the public health law, subdivision eight of section\nforty-four hundred three of the public health law, and subdivisions\ntwelve, thirteen and fourteen of section forty-four hundred three-f of\nthe public health law.\n (b) Entities providing services pursuant to this section shall provide\nhealth and long term care services as the term is defined in section\nforty-four hundred three-g of the public health law.\n (c) No person with a developmental disability who is receiving or\napplying for medical assistance and who is receiving, or eligible to\nreceive, services operated, funded, certified, authorized or approved by\nthe office, shall be required to enroll in a DISCO, HMO or MLTC in order\nto receive such services until program features and reimbursement rates\nare approved by the commissioner and the commissioner of health, and\nuntil such commissioners determine that a sufficient number of plans\nthat are authorized to coordinate care for individuals pursuant to this\nsection or that are authorized to operate and to exclusively enroll\npersons with developmental disabilities pursuant to subdivision\ntwenty-seven of section three hundred sixty-four-j of the social\nservices law are operating in such person's county of residence to meet\nthe needs of persons with developmental disabilities, and that such\nentities meet the standards of this section. No person shall be required\nto enroll in a DISCO, HMO or MLTC in order to receive services operated,\nfunded, certified, authorized or approved by the office until there are\nat least two entities operating under this section in such person's\ncounty of residence, unless federal approval is secured to require\nenrollment when there are less than two such entities operating in such\ncounty. Notwithstanding the foregoing or any other law to the contrary,\nany health care provider: (i) enrolled in the Medicaid program and (ii)\nrendering hospital services, as such term is defined in section\ntwenty-eight hundred one of the public health law, to an individual with\na developmental disability who is enrolled in a DISCO, HMO or MLTC, or a\nprepaid health services plan operating pursuant to section forty-four\nhundred three-a of the public health law, including, but not limited to,\nan individual who is enrolled in a plan authorized by section three\nhundred sixty-four-j or the social services law, shall accept as full\nreimbursement the negotiated rate or, in the event that there is no\nnegotiated rate, the rate of payment that the applicable government\nagency would otherwise pay for such rendered hospital services.\n (d) DISCOs, HMOs and MLTCs operating under this section shall ensure,\nto the greatest extent practicable, that their assessment, services, and\nthe grievance and appeals processes are culturally and linguistically\ncompetent.\n (e) 1. The commissioner and the commissioner of health shall identify\none or more valid and reliable quality assurance instruments that\ninclude assessments of individual and family sati
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