NY State Senate Bill 2023-S5773

Senate Bill S5773

2023-2024 Legislative Session

Establishes a workgroup to conduct analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health services

download bill text pdf

Current Bill Status - In Senate Committee Mental Health 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

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2024	referred to mental health
Mar 15, 2023	referred to mental health

2023-S5773 (ACTIVE) - Details

See Assembly Version of this Bill:: A4330
Current Committee:: Senate Mental Health
Law Section:: Mental Hygiene Law
Laws Affected:: Amd §7.07, Ment Hyg L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S6694, A7935
2021-2022: S3476, A5878

2023-S5773 (ACTIVE) - Summary

Establishes a workgroup to conduct analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health services.

2023-S5773 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5773

SPONSOR: PARKER
 
TITLE OF BILL:

An act to amend the mental hygiene law, in relation to establishing a
workgroup to conduct analysis on the ambulatory patient group rates and
commercial insurance rates for behavioral health services

 
PURPOSE:

The purpose of this bill is to ensure that mental health and substance
use service providers have fiscally viable programs.

 
SUMMARY OF PROVISIONS:

Section 1: Section 7.07 of the mental hygiene law is amended by adding a
new subdivision (i).

Section 2: This act shall take effect on the ninetieth day after it
shall have become a law.

 
STATEMENT OF SUPPORT:

The enacted budget for state fiscal year 201'2020 extended the legal
authority for the state mandate to provide behavioral health service
providers the APG rate for services rendered until March 31, 2023.
Generally, the APG payment methodology allows for greater payment homo-
geneity for comparable services across all ambulatory care settings.
Most importantly, the APG rate has given behavioral health service
providers assurance that they will receive a rate for service that will
enable such providers to maintain a fiscally viable program. However,
concerns have been raised by the behavioral health advocacy and service
provider community that the APG rates are not keeping pace with the
costs of care. Providers have a ranges of fixed and variable costs which
all continue to rise, such as maintenance of facilities, providing staff
benefits, etc. In addition, commercial insurance rates are far less and
must be brought on par with APG rates to ensure equal access to care for
commercial insurance beneficiaries. This bill would help to ensure that
behavioral health programs can provide quality care and maintain fiscal
viability by requiring the commissioner of OMH in collaboration with the
commissioner of DOH, and the commissioner of OASA S to establish a work-
group that would be tasked with conducting an analysis of the APG and
commercial insurance rates for behavioral health services and make
recommendations that would assist the State in providing an adequate
service rate which reflects the cost of care.

 
PRIOR LEGISLATIVE HISTORY:

2021-22: S3476 - Referred to Mental Health

2019-20: S6694-Passed Senate

 
FISCAL IMPLICATIONS:

Undetermined.

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth after it shall have become a
law.

2023-S5773 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5773
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                              March 15, 2023
                                ___________
 
 Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
   printed to be committed to the Committee on Mental Health
 
 AN ACT to amend the mental hygiene law, in relation  to  establishing  a
   workgroup  to  conduct  analysis on the ambulatory patient group rates
   and commercial insurance rates for behavioral health services

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 7.07 of the mental hygiene law is amended by adding
 a new subdivision (i) to read as follows:
   (I)  1.  THE  COMMISSIONER  OF THE OFFICE OF MENTAL HEALTH, IN COLLAB-
 ORATION WITH THE COMMISSIONER  OF  THE  DEPARTMENT  OF  HEALTH  AND  THE
 COMMISSIONER  OF  THE  OFFICE  OF  ADDICTION  SERVICES  AND SUPPORTS ARE
 DIRECTED TO CONVENE AND JOINTLY CHAIR,  EITHER  DIRECTLY  OR  THROUGH  A
 DESIGNEE  OR DESIGNEES, A WORKGROUP, WHICH SHALL INCLUDE MEMBERSHIP THAT
 ENSURES ADEQUATE STATEWIDE GEOGRAPHIC REPRESENTATION SELECTED WITH EQUAL
 CONTRIBUTIONS ON SUCH SELECTION FROM THE GOVERNOR, THE  SPEAKER  OF  THE
 ASSEMBLY  AND  TEMPORARY PRESIDENT OF THE SENATE AND BE COMPRISED OF THE
 FOLLOWING MEMBERS: (I) PROFESSIONAL ASSOCIATIONS REPRESENTING  SUBSTANCE
 USE,  MENTAL  HEALTH, AND/OR BEHAVIORAL HEALTH PROVIDERS; (II) REPRESEN-
 TATIVES FROM PROFESSIONAL ASSOCIATIONS REPRESENTING  PROVIDERS  OF  PEER
 AND  RECOVERY-BASED  PROGRAMS  AND  SERVICES; (III) REPRESENTATIVES FROM
 PROFESSIONAL  ASSOCIATIONS  REPRESENTING  MEDICATED  ASSISTED  TREATMENT
 PROVIDERS;  (IV)  REPRESENTATIVES FROM PROFESSIONAL ASSOCIATIONS REPRES-
 ENTING CHILDREN'S BEHAVIORAL HEALTH PROVIDERS; (V) REPRESENTATIVES  FROM
 HOSPITAL ASSOCIATIONS; (VI) REPRESENTATIVES FROM ASSOCIATIONS REPRESENT-
 ING  BEHAVIORAL HEALTH CONSUMERS AND FAMILY MEMBERS; AND (VII) ANY ADDI-
 TIONAL STAKEHOLDER OR EXPERT  THAT  THE  COMMISSIONERS  DEEM  NECESSARY.
 MEMBERS  OF  THE  WORKGROUP SHALL SERVE WITHOUT COMPENSATION, BUT MAY BE
 REIMBURSED FOR ACTUAL COSTS INCURRED FOR  PARTICIPATION  ON  SUCH  WORK-
 GROUP.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06022-01-3
 S. 5773                             2

 
   2.  THE  WORKGROUP SHALL CONDUCT AN ANALYSIS ON THE AMBULATORY PATIENT
 GROUP  RATES  AND  COMMERCIAL  INSURANCE  RATES  FOR  BEHAVIORAL  HEALTH
 SERVICES  FOR  THE  PURPOSE  OF  DEVELOPING  A REPORT THAT SHALL PROVIDE
 RECOMMENDATIONS ON THE FOLLOWING:  (I)  RATE  ADEQUACY  RELATED  TO  THE
 EXISTING  AMBULATORY  PATIENT  GROUP-BASED  REIMBURSEMENT PROVIDED UNDER
 MEDICAID MANAGED CARE, AS WELL AS FOR COMMERCIAL  INSURANCE  RATES  WITH
 REGARDS  TO  SERVICES  RENDERED UNDER CHILD HEALTH PLUS, OR FOR SERVICES
 PROVIDED BY CLINICS LICENSED OR CERTIFIED PURSUANT TO ARTICLE THIRTY-ONE
 OR THIRTY-TWO OF THIS CHAPTER OR  DUALLY  LICENSED  OR  CERTIFIED  UNDER
 ARTICLE  THIRTY-ONE  OR  THIRTY-TWO  OF THIS CHAPTER AND ARTICLE TWENTY-
 EIGHT OF THE PUBLIC HEALTH LAW; (II) THE ACTUAL COSTS OF CARE ASSOCIATED
 WITH THE DELIVERY OF BEHAVIORAL  HEALTH  SERVICES;  (III)  ONE  OR  MORE
 ALTERNATIVE  REIMBURSEMENT MODELS THAT WOULD ADEQUATELY COMPENSATE CLIN-
 ICS LICENSED OR HOLDING AN OPERATING CERTIFICATE UNDER  ARTICLE  THIRTY-
 ONE OR THIRTY-TWO OF THIS CHAPTER OR DUALLY LICENSED UNDER ARTICLE THIR-
 TY-ONE  OR  THIRTY-TWO  OF  THIS CHAPTER AND ARTICLE TWENTY-EIGHT OF THE
 PUBLIC HEALTH LAW FOR THEIR COSTS OF CARE UNDER  MEDICAID  MANAGED  CARE
 AND CHILD HEALTH PLUS; AND (IV) ANY POLICY OR FISCAL RESOURCES NECESSARY
 TO  CARRY  OUT  THE  RECOMMENDATIONS OF THE REPORT DEVELOPED PURSUANT TO
 THIS SECTION. THE REPORT SHALL BE SUBMITTED TO THE GOVERNOR, THE SPEAKER
 OF THE ASSEMBLY AND THE TEMPORARY PRESIDENT OF THE SENATE NO LATER  THAN
 OCTOBER FIRST, TWO THOUSAND TWENTY-FIVE.
   §  2.  This  act shall take effect on the ninetieth day after it shall
 have become a law.

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