S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1587
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2021
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED,  CARROLL,  RAMOS,  PAULIN, SIMON,
   SEAWRIGHT, DICKENS, CAHILL, ABINANTI -- read once and referred 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00563-01-1

 A. 1587                             2
 
 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.