Senate Bill S6861

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6861
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               May 19, 2021
                                ___________
 
 Introduced  by  Sen. MANNION -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend part H of chapter 59 of the laws of 2011,  amending  the
   public  health  law and other laws, relating to general hospital inpa-
   tient reimbursement for annual  rates,  in  relation  to  supplemental
   Medicaid managed care payments
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 26 of part H of chapter 59 of  the  laws  of  2011,
 amending  the  public  health  law  and other laws, relating to targeted
 Medicaid reimbursement rate reductions, is amended to read as follows:
   § 26. Notwithstanding any provision of law to the contrary and subject
 to the availability of federal financial participation, for  periods  on
 and  after  April  1, 2011, clinics certified pursuant to [articles 16,]
 ARTICLE 31 or 32 of the mental hygiene law shall be subject to  targeted
 Medicaid reimbursement rate reductions in accordance with the provisions
 of  this  section. Such reductions shall be based on utilization thresh-
 olds which may be established either as  provider-specific  or  patient-
 specific  thresholds.  Provider-specific  thresholds  shall  be based on
 average patient utilization for a given provider in comparison to a peer
 based standard to be determined for each service.  The commissioners  of
 the  office of mental health[, the office for persons with developmental
 disabilities,]  and  the  office  of  alcoholism  and  substance   abuse
 services,  in  consultation with the commissioner of health, are author-
 ized to waive utilization thresholds for patients of  clinics  certified
 pursuant  to article [16,] 31[,] or 32 of the mental hygiene law who are
 enrolled in specific treatment programs or otherwise  meet  criteria  as
 may  be  specified by such commissioners.  When applying a provider-spe-
 cific threshold, rates will be reduced on a prospective basis  based  on
 the  amount  any  provider  is  over  the  determined  threshold  level.
 Patient-specific thresholds will be based on  annual  thresholds  deter-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11491-01-1

 S. 6861                             2
 
 mined  for  each service over which the per visit payment for each visit
 in excess of the standard during a twelve month period shall be  reduced
 by a pre-determined amount. The thresholds, peer based standards and the
 payment reductions shall be determined by the department of health, with
 the approval of the division of the budget, and in consultation with the
 office of mental health[, the office for people with developmental disa-
 bilities] and the office of alcoholism and substance abuse services, and
 any such resulting rates shall be subject to certification by the appro-
 priate commissioners pursuant to subdivision (a) of section 43.02 of the
 mental  hygiene  law.  The  base period used to establish the thresholds
 shall be the 2009 calendar  year.  The  total  annualized  reduction  in
 payments shall be not more than $10,900,000 for Article 31 clinics[, not
 more  than  $2,400,000  for  Article  16  clinics,]  and  not  more than
 $13,250,000 for Article 32  clinics.  The  commissioner  of  health  may
 promulgate regulations to implement the provisions of this section.
   § 2. This act shall take effect immediately.