NY State Senate Bill 2019-S7812B

Senate Bill S7812B

2019-2020 Legislative Session

Relates to provisions of health care services under medicaid managed care programs by school-based health centers

download bill text pdf

Archive: Last Bill Status - In Senate Committee Finance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Oct 09, 2020	print number 7812b
Oct 09, 2020	amend and recommit to finance
Jul 17, 2020	print number 7812a
Jul 17, 2020	amend and recommit to finance
Mar 10, 2020	reported and committed to finance
Feb 24, 2020	referred to health

Votes

- Mar 10, 2020 - Health Committee Vote
  S7812B
  
  14
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Mar 10, 2020
      
      aye (14)
      
      Benjamin
      
      Biaggi
      
      Carlucci
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      Little
      
      Metzger
      
      Montgomery
      
      Ortt
      
      Ritchie
      
      Rivera
      
      Salazar
      
      Stavisky
      
      excused (1)
      
      Jacobs

Bill Amendments

Original

B (Active)

co-Sponsors

2019-S7812 - Details

See Assembly Version of this Bill:: A9894
Current Committee:: Senate Finance
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S2127, A1587

2019-S7812 - Summary

Provides for the provision of health care services under medicaid managed care programs by school-based health centers.

2019-S7812 - Sponsor Memo

                                
 
BILL NUMBER: S7812

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to school-based
health centers for purposes of managed care programs under medicaid

 
PURPOSE OR GENERAL IDEA OF BILL:

To permit each school-based health center (SBHC) to choose to remain out
of Medicaid managed care and to guide cooperation between SBHCs and
Medicaid managed care providers.

 
SUMMARY OF SPECIFIC PROVISIONS:

The bill amends Social Services Law § 364-j to define "school-based
health center" and a "sponsoring organization" as providing an array of
primary health care services in elementary, secondary and prekindergar-
ten public school settings, sponsored by general hospitals or health
centers licensed under Public Health Law Article 28.

The bill amends Social Services Law § 364-J to (a) provide SBHCs the
choice of operating under Medicaid fee-for-service, (b) enables them to
choose to participate in Medicaid managed care and (c), to ensure coor-
dinated and quality care as well as participation in quality improvement
initiatives, there shall be a DOH-drafted memorandum between the SBHC
and the Medicaid managed care provider, providing for data sharing, to
which DOH will contribute.

 
JUSTIFICATION:

SBHCs provide comprehensive physical, chronic, mental and dental health
services to over 230,000 underserved youth in rural, urban and suburban
areas of the State, regardless of insurance status or ability to pay.
SBHCs are a proven model for increasing access to health and mental
health services, reducing ethnic and racial disparities in the communi-
ties they serve, and improving school attendance and performance. They
have a proven track record of reducing health care costs including
unnecessary hospitalizations and emergency room visits.

Since 1985, SBHCs have been "carved-out" of the MMC program, being paid
under fee-for-service. However, DOH is now planning to end the carve-out
as of January 1, 2021. SBHCs will be required to negotiate the terms and
conditions of payment by managed care plans. A report by the Children's
Defense Fund found this transition will cost SBHCs over $16 million in
lost revenue. Already, SBHCs have suffered over seven million or nearly
30% in funding cuts since 2008, while their patient population has
grown.

This bill protects the choice of each SBHC to operate either carved-out
from Medicaid managed care or participating in Medicaid managed care.
Where some of a carved-out SBHC's patients are Medicaid managed care
enrollees, the bill provides for the SBHC and the Department to provide
extensive information to the student's managed care plan about the care
provided to the student. This will help the managed care plan to provide
quality care and effective care coordination even though part of the
student's care is not provided by the managed care plan.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

none.

 
EFFECTIVE DATE:
180 days after becoming law.

2019-S7812 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7812
 
                             I N  S E N A T E
 
                             February 24, 2020
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law,  in  relation  to  school-based
   health centers for purposes of managed care programs under medicaid
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 1 of section 364-j of the social  services  law
 is  amended  by  adding  two  new  paragraphs  (w)  and (w-1) to read as
 follows:
   (W) "SCHOOL-BASED HEALTH CENTER".  A  CLINIC  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW  OR SPONSORED EITHER FULLY OR
 PARTIALLY BY A FACILITY  LICENSED  UNDER  ARTICLE  TWENTY-EIGHT  OF  THE
 PUBLIC  HEALTH  LAW  OR  WHERE  SUCH SPONSORSHIP IS DUALLY SHARED WITH A
 FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF  THE  MENTAL  HYGIENE  LAW
 WHICH  PROVIDES PRIMARY AND PREVENTIVE CARE WHICH MAY INCLUDE BUT IS NOT
 LIMITED TO HEALTH MAINTENANCE, WELL-CHILD CARE, DIAGNOSIS AND  TREATMENT
 OF  INJURY  AND  ACUTE  ILLNESS,  DIAGNOSIS  AND  MANAGEMENT  OF CHRONIC
 DISEASE, BEHAVIORAL SERVICES, VISION CARE, DENTAL CARE, AND  NUTRITIONAL
 OR OTHER ENHANCED SERVICES TO CHILDREN AND ADOLESCENTS, ANY OF WHICH MAY
 BE  PROVIDED  BY REFERRAL, WITHIN AN ELEMENTARY, SECONDARY OR PREKINDER-
 GARTEN PUBLIC SCHOOL SETTING.
   (W-1) "SPONSORING ORGANIZATION". A  FACILITY  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC HEALTH LAW WHICH ACTS AS THE SPONSOR FOR A
 SCHOOL-BASED HEALTH CENTER, WHICH SUCH SPONSORSHIP MAY BE DUALLY  SHARED
 WITH  A FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL HYGIENE
 LAW.
   § 2. Section 364-j of the social services law is amended by  adding  a
 new subdivision 4-a to read as follows:
   4-A.  (A)  MEDICAL  ASSISTANCE  SERVICES  AND  SUPPLIES  PROVIDED BY A
 SCHOOL-BASED HEALTH CENTER MAY BE PROVIDED AND PAID FOR OTHER THAN BY  A
 MANAGED  CARE PROVIDER. IN SUCH CASE, THE SERVICES AND SUPPLIES SHALL BE
 PAID IN ACCORDANCE WITH APPLICABLE  REIMBURSEMENT  METHODOLOGIES,  WHICH
 SHALL MEAN:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD15128-02-0

 S. 7812                             2
 
   (I)  FOR A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY A FEDERALLY
 QUALIFIED HEALTH CENTER, RATES  OF  REIMBURSEMENT  AND  REQUIREMENTS  IN
 ACCORDANCE   WITH   THOSE  MANDATED  BY  42  U.S.C.  SECS.    1396A(BB),
 1396B(M)(2)(A)(IX) AND 1936A(A)(13)(C); AND
   (II)  FOR  A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY AN ENTITY
 LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW  THAT
 IS  NOT  A FEDERALLY QUALIFIED HEALTH CENTER OR IS A FEDERALLY QUALIFIED
 HEALTH CENTER THAT CHOOSES NOT  TO  RECEIVE  REIMBURSEMENT  PURSUANT  TO
 SUBPARAGRAPH  (I)  OF  THIS PARAGRAPH, RATES OF REIMBURSEMENT AT THE FEE
 FOR SERVICE RATE FOR SUCH SERVICES AND SUPPLIES IN EFFECT ON THE  EFFEC-
 TIVE DATE OF THIS SUBPARAGRAPH FOR THE AMBULATORY PATIENT GROUP RATE FOR
 THE  APPLICABLE  SERVICE  AND  SUPPLY  AND IN ACCORDANCE WITH ANY FUTURE
 ADJUSTMENTS MADE TO SUCH RATES BY THE DEPARTMENT OF HEALTH.
   (B) THIS SUBDIVISION SHALL NOT PRECLUDE A SCHOOL-BASED  HEALTH  CENTER
 OR  SPONSORING  ORGANIZATION FROM CHOOSING TO PROVIDE MEDICAL ASSISTANCE
 SERVICES AND SUPPLIES THROUGH MANAGED CARE PROVIDERS.
   (C) THE SCHOOL-BASED HEALTH CENTER OR SPONSORING ORGANIZATION AND  THE
 MANAGED  CARE  PROVIDER SHALL ENTER INTO A STANDARD MEMORANDUM OF UNDER-
 STANDING, WHICH SHALL BE DEVELOPED BY THE COMMISSIONER FOR  THE  PURPOSE
 OF  PROMOTING  THE DELIVERY OF COORDINATED HEALTH CARE AND PARTICIPATION
 IN QUALITY IMPROVEMENT INITIATIVES. THE COMMISSIONER SHALL  PERIODICALLY
 SHARE  ENROLLMENT, ENCOUNTER, AND ANY OTHER DATA THE COMMISSIONER DETER-
 MINES NECESSARY WITH EACH ENROLLED PARTICIPANT'S MEDICAID  MANAGED  CARE
 PROVIDER  TO  ALLOW  THE  EXCHANGE OF SUCH DATA BETWEEN MEDICAID MANAGED
 CARE PROVIDERS AND SCHOOL-BASED HEALTH CENTERS FOR THE PURPOSE  OF  THIS
 PARAGRAPH  AND  FACILITATING  ENROLLEE  ACCESS TO SERVICES AND IMPROVING
 COORDINATION AND QUALITY OF CARE.
   § 3. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided  that  the  amendments  to  section
 364-j  of  the  social services law made by sections one and two of this
 act shall not affect the repeal of such section and shall expire and  be
 deemed  repealed therewith.   Effective immediately, the commissioner of
 health shall make regulations and take other actions  reasonably  neces-
 sary to implement this act on its effective date.

co-Sponsors

2019-S7812A - Details

See Assembly Version of this Bill:: A9894
Current Committee:: Senate Finance
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S2127, A1587

2019-S7812A - Summary

Provides for the provision of health care services under medicaid managed care programs by school-based health centers.

2019-S7812A - Sponsor Memo

                                
 
BILL NUMBER: S7812A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to school-based
health centers for purposes of managed care programs under medicaid

 
PURPOSE OR GENERAL IDEA OF BILL:

To permit each school-based health center (SBHC) to choose remain out of
Medicaid managed care and to guide cooperation between SBHCs and Medi-
caid managed care providers.

 
SUMMARY OF SPECIFIC PROVISIONS:.

The bill amends Social Services Law § 364-j to define "school-based
health center" and a "sponsoring organization" as providing an array of
primary health care services in elementary, secondary and prekindergar-
ten public school settings, sponsored by general hospitals or health
centers licensed under Public Health Law Article 28.

The bill amends Social Services Law § 364-J to (a) provide SBHCs the
choice of operating under Medicaid fee-for-service, (b) enables them to
choose to participate in Medicaid managed care and (c), to ensure coor-
dinated and quality care as well as participation in quality improvement
initiatives, there shall be a DOH-drafted memorandum between the SBHC
and the Medicaid managed care provider, providing for data sharing, to
which DOH will contribute.

 
JUSTIFICATION:

SBHCs provide comprehensive physical, chronic, mental and dental health
services to over 230,000 underserved youth in rural, urban and suburban
areas of the State, regardless of insurance status or ability to pay.
SBHCs are a proven model for increasing access to health and mental
health services, reducing ethnic and racial disparities in the communi-
ties they serve, and improving school attendance and performance. They
have a proven track record of reducing health care costs including
unnecessary hospitalizations and emergency room visits.

Since 1985, SBHCs have been "carved-out" of the MMC program, being paid
under fee-for-service. However, DOH is now planning to end the carve-out
as of January 1, 2021. SBHCs will be required to negotiate the terms and
conditions of payment by managed care plans. A report by the Children's
Defense Fund found that this transition will cost SBHCs over sixteen
million in lost revenue. Already, SBHCs have suffered over seven million
or nearly 30% in funding cuts since 2008, while their patient population
has grown.

This bill protects the choice of each SBHC to operate either carved-out
from Medicaid managed care or participating in Medicaid managed care.
Where some of a carved-out SBHC's patients are Medicaid managed care
enrollees, the bill provides for the SBHC and the Department to provide
extensive information to the student's managed care plan about the care
provided to the student. This will help the managed care plan to provide
quality care and effective care coordination even though part of the
student's care is not provided by the managed care plan.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:  none.

 
EFFECTIVE DATE:.
180 days after becoming law.

2019-S7812A - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7812--A
 
                             I N  S E N A T E
 
                             February 24, 2020
                                ___________
 
 Introduced  by Sens. RIVERA, MONTGOMERY -- read twice and ordered print-
   ed, and when printed to be committed to the  Committee  on  Health  --
   reported  favorably from said committee and committed to the Committee
   on Finance -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee
 
 AN ACT to amend the social services law,  in  relation  to  school-based
   health centers for purposes of managed care programs under medicaid
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 1 of section 364-j of the social  services  law
 is  amended  by  adding  two  new  paragraphs  (w)  and (w-1) to read as
 follows:
   (W) "SCHOOL-BASED HEALTH CENTER".  A  CLINIC  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW  OR SPONSORED EITHER FULLY OR
 PARTIALLY BY A FACILITY  LICENSED  UNDER  ARTICLE  TWENTY-EIGHT  OF  THE
 PUBLIC  HEALTH  LAW  OR  WHERE  SUCH SPONSORSHIP IS DUALLY SHARED WITH A
 FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF  THE  MENTAL  HYGIENE  LAW
 WHICH  PROVIDES PRIMARY AND PREVENTIVE CARE WHICH MAY INCLUDE BUT IS NOT
 LIMITED TO HEALTH MAINTENANCE, WELL-CHILD CARE, DIAGNOSIS AND  TREATMENT
 OF  INJURY  AND  ACUTE  ILLNESS,  DIAGNOSIS  AND  MANAGEMENT  OF CHRONIC
 DISEASE, BEHAVIORAL SERVICES, VISION CARE, DENTAL CARE, AND  NUTRITIONAL
 OR OTHER ENHANCED SERVICES TO CHILDREN AND ADOLESCENTS, ANY OF WHICH MAY
 BE  PROVIDED  BY REFERRAL, WITHIN AN ELEMENTARY, SECONDARY OR PREKINDER-
 GARTEN PUBLIC SCHOOL SETTING.
   (W-1) "SPONSORING ORGANIZATION". A  FACILITY  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC HEALTH LAW WHICH ACTS AS THE SPONSOR FOR A
 SCHOOL-BASED HEALTH CENTER, WHICH SUCH SPONSORSHIP MAY BE DUALLY  SHARED
 WITH  A FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL HYGIENE
 LAW.
   § 2. Section 364-j of the social services law is amended by  adding  a
 new subdivision 4-a to read as follows:
   4-A.  (A)  MEDICAL  ASSISTANCE  SERVICES  AND  SUPPLIES  PROVIDED BY A
 SCHOOL-BASED HEALTH CENTER MAY BE PROVIDED AND PAID FOR OTHER THAN BY  A
 MANAGED  CARE PROVIDER. IN SUCH CASE, THE SERVICES AND SUPPLIES SHALL BE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD15128-04-0

 S. 7812--A                          2
 
 PAID IN ACCORDANCE WITH APPLICABLE  REIMBURSEMENT  METHODOLOGIES,  WHICH
 SHALL MEAN:
   (I)  FOR A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY A FEDERALLY
 QUALIFIED HEALTH CENTER, RATES  OF  REIMBURSEMENT  AND  REQUIREMENTS  IN
 ACCORDANCE   WITH   THOSE  MANDATED  BY  42  U.S.C.  SECS.    1396A(BB),
 1396B(M)(2)(A)(IX) AND 1396A(A)(13)(C); AND
   (II) FOR A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY  AN  ENTITY
 LICENSED  PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW THAT
 IS NOT A FEDERALLY QUALIFIED HEALTH CENTER OR IS A  FEDERALLY  QUALIFIED
 HEALTH  CENTER  THAT  CHOOSES  NOT  TO RECEIVE REIMBURSEMENT PURSUANT TO
 SUBPARAGRAPH (I) OF THIS PARAGRAPH, RATES OF REIMBURSEMENT  AT  THE  FEE
 FOR  SERVICE RATE FOR SUCH SERVICES AND SUPPLIES IN EFFECT ON THE EFFEC-
 TIVE DATE OF THIS SUBPARAGRAPH FOR THE AMBULATORY PATIENT GROUP RATE FOR
 THE APPLICABLE SERVICE AND SUPPLY AND  IN  ACCORDANCE  WITH  ANY  FUTURE
 ADJUSTMENTS MADE TO SUCH RATES BY THE DEPARTMENT OF HEALTH.
   (B)  THIS  SUBDIVISION SHALL NOT PRECLUDE A SCHOOL-BASED HEALTH CENTER
 OR SPONSORING ORGANIZATION FROM CHOOSING TO PROVIDE  MEDICAL  ASSISTANCE
 SERVICES AND SUPPLIES THROUGH MANAGED CARE PROVIDERS.
   (C)  THE SCHOOL-BASED HEALTH CENTER OR SPONSORING ORGANIZATION AND THE
 MANAGED CARE PROVIDER SHALL ENTER INTO A STANDARD MEMORANDUM  OF  UNDER-
 STANDING,  WHICH  SHALL BE DEVELOPED BY THE COMMISSIONER FOR THE PURPOSE
 OF PROMOTING THE DELIVERY OF COORDINATED HEALTH CARE  AND  PARTICIPATION
 IN  QUALITY IMPROVEMENT INITIATIVES. THE COMMISSIONER SHALL PERIODICALLY
 SHARE ENROLLMENT, ENCOUNTER, AND ANY OTHER DATA THE COMMISSIONER  DETER-
 MINES  NECESSARY  WITH EACH ENROLLED PARTICIPANT'S MEDICAID MANAGED CARE
 PROVIDER TO ALLOW THE EXCHANGE OF SUCH  DATA  BETWEEN  MEDICAID  MANAGED
 CARE  PROVIDERS  AND SCHOOL-BASED HEALTH CENTERS FOR THE PURPOSE OF THIS
 PARAGRAPH AND FACILITATING ENROLLEE ACCESS  TO  SERVICES  AND  IMPROVING
 COORDINATION AND QUALITY OF CARE.
   § 3. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become  a  law; provided that the amendments to section
 364-j of the social services law made by sections one and  two  of  this
 act  shall not affect the repeal of such section and shall expire and be
 deemed repealed therewith.  Effective immediately, the  commissioner  of
 health  shall  make regulations and take other actions reasonably neces-
 sary to implement this act on its effective date.

co-Sponsors

2019-S7812B (ACTIVE) - Details

See Assembly Version of this Bill:: A9894
Current Committee:: Senate Finance
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S2127, A1587

2019-S7812B (ACTIVE) - Summary

Provides for the provision of health care services under medicaid managed care programs by school-based health centers.

2019-S7812B (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S7812B

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to school-based
health centers for purposes of managed care programs under medicaid

 
PURPOSE OR GENERAL IDEA OF BILL:

To permit each school-based health center (SBHC) to choose remain out of
Medicaid managed care and to guide cooperation between SBHCs and Medi-
caid managed care providers.

 
SUMMARY PROVISIONS:

THE BILL AMENDS SOCIAL SERVICES LAW § 364-J TO DEFINE "SCHOOL-BASED
HEALTH CENTER" AND A "SPONSORING ORGANIZATION" AS PROVIDING AN ARRAY OF
PRIMARY HEALTH CARE SERVICES IN ELEMENTARY, SECONDARY AND PREKINDERGAR-
TEN PUBLIC SCHOOL SETTINGS, SPONSORED BY GENERAL HOSPITALS OR HEALTH
CENTERS LICENSED UNDER PUBLIC HEALTH LAW ARTICLE 28.

THE BILL AMENDS SOCIAL SERVICES LAW § 364-J TO (A) PROVIDE SBHCS THE
CHOICE OF OPERATING UNDER MEDICAID FEE-FOR-SERVICE, (B) ENABLES THEM TO
CHOOSE TO PARTICIPATE IN MEDICAID MANAGED CARE AND (C), TO ENSURE COOR-
DINATED AND QUALITY CARE AS WELL AS PARTICIPATION IN QUALITY IMPROVEMENT
INITIATIVES, THERE SHALL BE A DOH-DRAFTED MEMORANDUM BETWEEN THE SBHC
AND THE MEDICAID MANAGED CARE PROVIDER, PROVIDING FOR DATA SHARING, TO
WHICH DOH WILL CONTRIBUTE.

 
JUSTIFICATION:

SBHCS PROVIDE COMPREHENSIVE PHYSICAL, CHRONIC, MENTAL AND DENTAL HEALTH
SERVICES TO OVER 230,000 UNDERSERVED YOUTH IN RURAL, URBAN AND SUBURBAN
AREAS OF THE STATE, REGARDLESS OF INSURANCE STATUS OR ABILITY TO PAY.
SBHCS ARE A PROVEN MODEL FOR INCREASING ACCESS TO HEALTH AND MENTAL
HEALTH SERVICES, REDUCING ETHNIC AND RACIAL DISPARITIES IN THE COMMUNI-
TIES THEY SERVE, AND IMPROVING SCHOOL ATTENDANCE AND PERFORMANCE. THEY
HAVE A PROVEN TRACK RECORD OF REDUCING HEALTH CARE COSTS INCLUDING
UNNECESSARY HOSPITALIZATIONS AND EMERGENCY ROOM VISITS.

SINCE 1985, SBHCS HAVE BEEN "CARVED-OUT" OF THE MMC PROGRAM, BEING PAID
UNDER FEE-FOR-SERVICE. HOWEVER, DOH IS NOW PLANNING TO END THE CARVE-OUT
AS OF JANUARY 1, 2021. SBHCS WILL BE REQUIRED TO NEGOTIATE THE TERMS AND
CONDITIONS OF PAYMENT BY MANAGED CARE PLANS. A REPORT BY THE CHILDREN'S
DEFENSE FUND FOUND THAT THIS TRANSITION WILL COST SBHCS OVER SIXTEEN
MILLION IN LOST REVENUE. ALREADY, SBHCS HAVE SUFFERED OVER SEVEN MILLION
OR NEARLY 30% IN FUNDING CUTS SINCE 2008, WHILE THEIR PATIENT POPULATION
HAS GROWN.

THIS BILL PROTECTS THE CHOICE OF EACH SBHC TO OPERATE EITHER CARVED-OUT
FROM MEDICAID MANAGED CARE OR PARTICIPATING IN MEDICAID MANAGED CARE.
WHERE SOME OF A CARVED-OUT SBHC'S PATIENTS ARE MEDICAID MANAGED CARE
ENROLLEES, THE BILL PROVIDES FOR THE SBHC AND THE DEPARTMENT TO PROVIDE
EXTENSIVE INFORMATION TO THE STUDENT'S MANAGED CARE PLAN ABOUT THE CARE
PROVIDED TO THE STUDENT. THIS WILL HELP THE MANAGED CARE PLAN TO PROVIDE
QUALITY CARE AND EFFECTIVE CARE COORDINATION EVEN THOUGH PART OF THE
STUDENT'S CARE IS NOT PROVIDED BY THE MANAGED CARE PLAN.

 
PRIOR LEGISLATIVE HISTORY:

NEW BILL.

 
FISCAL IMPLICATIONS:

NONE.

 
EFFECTIVE DATE:
180 DAYS AFTER BECOMING LAW.

2019-S7812B (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7812--B
 
                             I N  S E N A T E
 
                             February 24, 2020
                                ___________
 
 Introduced  by  Sens.  RIVERA,  KENNEDY,  MONTGOMERY  --  read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Health  -- reported favorably from said committee and committed to the
   Committee on Finance -- committee discharged,  bill  amended,  ordered
   reprinted  as  amended  and recommitted to said committee -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the social services law,  in  relation  to  school-based
   health centers for purposes of managed care programs under medicaid
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 1 of section 364-j of the social  services  law
 is  amended  by  adding  two  new  paragraphs  (w)  and (w-1) to read as
 follows:
   (W) "SCHOOL-BASED HEALTH CENTER".  A  CLINIC  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW  OR SPONSORED EITHER FULLY OR
 PARTIALLY BY A FACILITY  LICENSED  UNDER  ARTICLE  TWENTY-EIGHT  OF  THE
 PUBLIC  HEALTH  LAW  OR  WHERE  SUCH SPONSORSHIP IS DUALLY SHARED WITH A
 FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF  THE  MENTAL  HYGIENE  LAW
 WHICH  PROVIDES PRIMARY AND PREVENTIVE CARE WHICH MAY INCLUDE BUT IS NOT
 LIMITED TO HEALTH MAINTENANCE, WELL-CHILD CARE, DIAGNOSIS AND  TREATMENT
 OF  INJURY  AND  ACUTE  ILLNESS,  DIAGNOSIS  AND  MANAGEMENT  OF CHRONIC
 DISEASE, BEHAVIORAL SERVICES, VISION CARE, DENTAL CARE, AND  NUTRITIONAL
 OR OTHER ENHANCED SERVICES TO CHILDREN AND ADOLESCENTS, ANY OF WHICH MAY
 BE  PROVIDED  BY REFERRAL, WITHIN AN ELEMENTARY, SECONDARY OR PREKINDER-
 GARTEN PUBLIC SCHOOL SETTING.
   (W-1) "SPONSORING ORGANIZATION". A  FACILITY  LICENSED  UNDER  ARTICLE
 TWENTY-EIGHT  OF  THE  PUBLIC HEALTH LAW WHICH ACTS AS THE SPONSOR FOR A
 SCHOOL-BASED HEALTH CENTER, WHICH SUCH SPONSORSHIP MAY BE DUALLY  SHARED
 WITH  A FACILITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL HYGIENE
 LAW.
   § 2. Section 364-j of the social services law is amended by  adding  a
 new subdivision 4-a to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD15128-06-0

 S. 7812--B                          2
 
   4-A.  (A)  MEDICAL  ASSISTANCE  SERVICES  AND  SUPPLIES  PROVIDED BY A
 SCHOOL-BASED HEALTH CENTER MAY BE PROVIDED AND PAID FOR OTHER THAN BY  A
 MANAGED  CARE PROVIDER. IN SUCH CASE, THE SERVICES AND SUPPLIES SHALL BE
 PAID IN ACCORDANCE WITH APPLICABLE  REIMBURSEMENT  METHODOLOGIES,  WHICH
 SHALL MEAN:
   (I)  FOR A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY A FEDERALLY
 QUALIFIED HEALTH CENTER, RATES  OF  REIMBURSEMENT  AND  REQUIREMENTS  IN
 ACCORDANCE   WITH   THOSE  MANDATED  BY  42  U.S.C.  SECS.    1396A(BB),
 1396B(M)(2)(A)(IX) AND 1396A(A)(13)(C); AND
   (II) FOR A SCHOOL-BASED HEALTH CENTER THAT IS SPONSORED BY  AN  ENTITY
 LICENSED  PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW THAT
 IS NOT A FEDERALLY QUALIFIED HEALTH CENTER OR IS A  FEDERALLY  QUALIFIED
 HEALTH  CENTER  THAT  CHOOSES  NOT  TO RECEIVE REIMBURSEMENT PURSUANT TO
 SUBPARAGRAPH (I) OF THIS PARAGRAPH, RATES OF REIMBURSEMENT  AT  THE  FEE
 FOR  SERVICE RATE FOR SUCH SERVICES AND SUPPLIES IN EFFECT ON THE EFFEC-
 TIVE DATE OF THIS SUBPARAGRAPH FOR THE AMBULATORY PATIENT GROUP RATE FOR
 THE APPLICABLE SERVICE AND SUPPLY AND  IN  ACCORDANCE  WITH  ANY  FUTURE
 ADJUSTMENTS MADE TO SUCH RATES BY THE DEPARTMENT OF HEALTH.
   (B)  THIS  SUBDIVISION SHALL NOT PRECLUDE A SCHOOL-BASED HEALTH CENTER
 OR SPONSORING ORGANIZATION FROM CHOOSING TO PROVIDE  MEDICAL  ASSISTANCE
 SERVICES AND SUPPLIES THROUGH MANAGED CARE PROVIDERS.
   (C)  THIS  PARAGRAPH APPLIES WHERE A MANAGED CARE PROVIDER INCLUDES AS
 AN ENROLLEE A STUDENT WHO IS ELIGIBLE TO BE  SERVED  BY  A  SCHOOL-BASED
 HEALTH  CENTER,  REGARDLESS OF WHETHER THE SCHOOL-BASED HEALTH CENTER OR
 SPONSORING ORGANIZATION CHOOSES TO PROVIDE MEDICAL  ASSISTANCE  SERVICES
 AND  SUPPLIES THROUGH THE MANAGED CARE PROVIDER. THE SCHOOL-BASED HEALTH
 CENTER OR SPONSORING ORGANIZATION AND THE MANAGED  CARE  PROVIDER  SHALL
 ENTER INTO A STANDARD MEMORANDUM OF UNDERSTANDING, WHICH SHALL BE DEVEL-
 OPED  BY  THE  COMMISSIONER FOR THE PURPOSE OF PROMOTING THE DELIVERY OF
 COORDINATED HEALTH CARE AND PARTICIPATION IN QUALITY IMPROVEMENT  INITI-
 ATIVES. THE COMMISSIONER SHALL PERIODICALLY SHARE ENROLLMENT, ENCOUNTER,
 AND  ANY  OTHER  DATA  THE  COMMISSIONER  DETERMINES NECESSARY WITH EACH
 ENROLLED PARTICIPANT'S MEDICAID  MANAGED  CARE  PROVIDER  TO  ALLOW  THE
 EXCHANGE  OF  SUCH  DATA  BETWEEN  MEDICAID  MANAGED  CARE PROVIDERS AND
 SCHOOL-BASED HEALTH CENTERS FOR THE PURPOSE OF THIS PARAGRAPH AND FACIL-
 ITATING ENROLLEE ACCESS TO SERVICES AND IMPROVING COORDINATION AND QUAL-
 ITY OF CARE.
   § 3. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided  that  the  amendments  to  section
 364-j  of  the  social services law made by sections one and two of this
 act shall not affect the repeal of such section and shall expire and  be
 deemed  repealed therewith.   Effective immediately, the commissioner of
 health shall make regulations and take other actions  reasonably  neces-
 sary to implement this act on its effective date.

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Senate Bill S7812B

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Sponsored By

Gustavo Rivera

Archive: Last Bill Status - In Senate Committee Finance Committee

Bill Amendments

co-Sponsors

Velmanette Montgomery

2019-S7812 - Details

2019-S7812 - Summary

2019-S7812 - Sponsor Memo

2019-S7812 - Bill Text download pdf

co-Sponsors

Timothy M. Kennedy

Velmanette Montgomery

2019-S7812A - Details

2019-S7812A - Summary

2019-S7812A - Sponsor Memo

2019-S7812A - Bill Text download pdf

co-Sponsors

Timothy M. Kennedy

Velmanette Montgomery

2019-S7812B (ACTIVE) - Details

2019-S7812B (ACTIVE) - Summary

2019-S7812B (ACTIVE) - Sponsor Memo

2019-S7812B (ACTIVE) - Bill Text download pdf

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