NY State Senate Bill 2021-S6861

Senate Bill S6861

2021-2022 Legislative Session

Relates to Medicaid reimbursement rates for facilities operating pursuant to article 16 of the mental hygiene law

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
Mar 15, 2022	reported and committed to finance
Jan 05, 2022	referred to health
May 19, 2021	referred to health

Votes

- Mar 15, 2022 - Health Committee Vote
  S6861
  
  15
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Mar 15, 2022
      
      aye (15)
      
      Biaggi
      
      Boyle
      
      Brouk
      
      Cleare
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      May
      
      Oberacker
      
      Rath III
      
      Rivera
      
      Ryan
      
      Salazar
      
      Stec
      
      Thomas

2021-S6861 (ACTIVE) - Details

See Assembly Version of this Bill:: A8001
Current Committee:: Senate Finance
Law Section:: Public Health
Laws Affected:: Amd Part H §26, Chap 59 of 2011

2021-S6861 (ACTIVE) - Summary

Relates to Medicaid reimbursement rates for facilities operating pursuant to article 16 of the mental hygiene law.

2021-S6861 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S6861

SPONSOR: MANNION
 
TITLE OF BILL:

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 inpatient
reimbursement for annual rates, in relation to supplemental Medicaid
managed care payments

 
PURPOSE OR GENERAL IDEA OF BILL:

This legislation would restore the inpatient reimbursement rate for
Article 16 clinics who solely service individuals with developmental
disabilities

 
SUMMARY OF PROVISIONS:

Section 1. Repeals a targeted Medicaid reimbursement rate reduction
based on utilization thresholds for article 16 clinics.

Section 2. Effective Date

 
JUSTIFICATION:

In 2009, the Department of Health established Article 16 clinics which
are overseen by OPWDD and serve only individuals with developmental
disabilities. Article 16 clinics take care of all health care needs
including typical primary care - such as addressing a cold or sinus
infection, as well as ongoing care such as dental work, physical therapy
and occupational therapy. OPWDD provides Article 16 clinics with a
service authorization, the number of services eligible to be billed,
based on the population they serve. When a clinic would like to provide
additional services, OPWDD must approve such services.

The Medicaid Redesign Team Phase 1 (MRT) proposed hundreds of projects
to reduce the medicaid spending within the state. Many reimbursement
rates faced a 2% across the board cut. However under MRT Project 26,
behavioral health clinics, including Article 16 clinics, instead of a 2%
across the board cut, limited general hospital inpatient reimbursement
for annual rates based on utilization controls. This utilization control
is provider specific, the more visits that a clinic has on average per
patient, the lower their reimbursement rate.

In the Adopted Budget of FY 2014-2015, the 2% across the board cuts were
restored one year early. However, the Article 16 utilization controls
are still in place, despite the equivalent 2% cuts being restored.

Ultimately, these utilization controls deincentivize the care of indi-
viduals with significant physical or behavioral health needs.  OPWDD
already oversees and authorizes the administration of clinic services.
These utilization controls are duplicative and only harm the ability of
patients to receive quality care.

 
LEGISLATIVE HISTORY:

S4974A/A7327A of 2015- vetoed

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
$2,400,000.

 
EFFECTIVE DATE:
Immediately.

2021-S6861 (ACTIVE) - Bill Text download pdf

                            
 
                     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.

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