BILL NUMBER: S6663

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the social services law, in relation to directing the
commissioner of health to authorize additional reimbursement to provid-
ers of health and dental care primarily serving individuals with intel-
lectual and developmental disabilities for certain services

 
PURPOSE:

This bill would require the commissioner of the department of health to
authorize additional medicaid reimbursement to providers of health and
dental care primarily serving individuals with intellectual and develop-
mental disabilities for uncompensated time, use of staff, and services
that are necessary to support treatment of a patient as a result of the
patient's physical, intellectual, or developmental disability and
require that such additional reimbursement be sufficient to cover the
actual cost of providing such necessary support services associated with
treatment.

 
              

SUMMARY OF SPECIFIC PROVISIONS:

Section one amends the social services law by adding a new section
365-P. Section two establishes the effective date.

 
JUSTIFICATION:

Historically, little consideration has been given to the barriers that
exist for Individuals with Intellectual and Developmental Disabilities
(IDD) when seeking health and dental care. Very few providers in the
community are equipped to serve this population, lacking accessible
buildings and clinic space.

In order to serve an individual with IDD in a wheelchair; for example,
that patient must be transferred from. the wheelchair to an exam table.
This generally requires the use of a Boyer lift and two staff members
for safe transfer, and can take as long as 15 minutes of an appointment.
After an examination or treatment, the patient must be transferred back
into the wheelchair, adding up to another 15 minutes to an appointment
and, again, use of two staff members. Additionally, in many cases,
patients are unable to undress or re-dress themselves, requiring addi-
tional time and staff to accomplish this both before and after treat-
ment. Another example would include needing four staff for a woman with
IDD to get a pap smear, two stabilizing the legs, and two stabilifing
the head and upper body, plus the clinician.

Many patients have behavioral issues which can disrupt a medical or
dental exam or treatment, and which need to be addressed, requiring more
staff than would be necessary for a typical patient, who can cognitively
understand what is happening and why. This is particularly true with
respect to dental work, where patient stabilization methods, such as
sedation and physical restraints, are often necessary to limit a
patient's freedom of movement to decrease the risk of injury and permit,
the safe completion of treatment. This can be as simple as having staff
hold a patient's hand to prevent the patient from swatting away a
professional trying to conduct treatment or even to provide comfort and

reassurance to calm a patient with a disability. Again, even the
simplest methods require additional staff.

Moreover, many individuals with IDD are on a higher number of medica-
tions due to co-morbidity issues or seizure activity, and the State of
New York requires more frequent medication reviews for individuals with
IDD that also require additional unreimbursed physician and nursing
staff time. These are only a few examples of the services necessary to
support patients with IDD.

As a result of the need for additional time, use of staff, and services
that are necessary to support treatment of a patient as a result of the
patient's physical, intellectual, or developmental disability, which is
currently uncompensated by Medicaid, additional Medicaid reimbursement
is needed for providers serving this population. Clinics serving the IDD
population are struggling financially and many are in jeopardy of ceas-
ing operations, which would leave this population without appropriate
access to primary care.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This bill shall take effect immediately.