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A08011 Summary:

BILL NOA08011
 
SAME ASSAME AS S06219-A
 
SPONSORGottfried
 
COSPNSR
 
MLTSPNSR
 
Amd 364-j, Soc Serv L; amd 2511 & 4403-f, Pub Health L
 
Provides that increased rates of payment for behavioral health services shall be deemed to be effective on the date of the law, rule or regulation under which the change or increase is required.
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A08011 Actions:

BILL NOA08011
 
05/25/2017referred to health
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A08011 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8011
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the social services law and the public health law, in relation to payments for behavioral health services   PURPOSE OR GENERAL IDEA OF BILL: To require Medicaid managed care plans, managed long term care plans, and plans under Child Health Plus to implement required changes in rates, coverage or payments for behavioral health providers on the same date as the change takes effect for Medicaid non-managed care, or to make updated payments retroactively to that date.   SUMMARY OF PROVISIONS: Section 1 amends section 364-j of the social services law by adding a new paragraph (e) to subdivision 18, providing that Medicaid managed care plans shall adjust payments to behavioral health providers required by law, regulations or guidelines, on the same date as changes in rates, coverage or other areas take effect for non-managed care. If such plans require additional time to make technical or other system updates, they shall make retroactive payments to the providers. Sections 2 and 3 amend sections 2511 and 4403-f of the public health law respectively, to make the same change for Child Health Plus and managed long-term care plans. Section 4 makes the bill effective immediately.   JUSTIFICATION: Medicaid managed care plans, managed long term care plans, and Child Health Plus organizations pay behavioral health providers using ambula- tory patient group (APG) rates, which are occasionally adjusted by the state due to statutory or budgetary changes, rebasing workforce increases, and market forces. When rates are adjusted upward, the state increases payments to managed care plans and Child Health Plus organiza- tions accordingly, and the plans are supposed to pass the payment increase through to providers. Under current law, however, plans can delay making the necessary system updates to new provider payment rates and are not required to make retroactive payment adjustments, despite receiving increased payments from the state for that purpose. The bill will ensure that state payments intended to reimburse behav- ioral health providers distributed appropriately. and will improve the viability of community health care providers that New Yorkers rely on.   PRIOR LEGISLATIVE HISTORY: New bill   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None   EFFECTIVE DATE: Immediate
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A08011 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          8011
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 25, 2017
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health
 
        AN ACT to amend the social services law and the public  health  law,  in
          relation to payments for behavioral health services
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 18 of section 364-j of the social services  law
     2  is amended by adding a new paragraph (e) to read as follows:
     3    (e)  Increased  rates, terms or scope of payment for behavioral health
     4  services under this title, where payment  is  made  by  a  managed  care
     5  provider  under  this  section, as a result of a rate, coverage or other
     6  change made pursuant to a law, regulation, rule  or  official  guidance,
     7  shall  be  deemed in effect on the same date that such change would have
     8  taken effect if payment were made other than by the managed care provid-
     9  er. Where payment is not made as of the effective date, the managed care
    10  provider shall make retroactive  payments  to  the  appropriate  service
    11  providers.
    12    §  2. Section 2511 of the public health law is amended by adding a new
    13  subdivision 22 to read as follows:
    14    22. Increased rates, terms or scope of payment for  behavioral  health
    15  services  under  this title, where payment is made by an approved organ-
    16  ization, as a result of a rate, coverage or other change  made  pursuant
    17  to  a  law,  regulation,  rule  or  official guidance shall be deemed in
    18  effect on the same date that such change  would  have  taken  effect  if
    19  payment were made other than by the approved organization. Where payment
    20  is  not  made  as of the effective date, the approved organization shall
    21  make retroactive payments to the appropriate service providers.
    22    § 3. Subdivision 7 of section 4403-f  of  the  public  health  law  is
    23  amended by adding a new paragraph (i) to read as follows:
    24    (i)  Increased  rates, terms or scope of payment for behavioral health
    25  services under this section, where payment is made by  an  entity  under
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11787-03-7

        A. 8011                             2
 
     1  this  section,  as  a  result  of  a rate, coverage or other change made
     2  pursuant to a law, regulation,  rule  or  official  guidance,  shall  be
     3  deemed  in  effect  on  the  same date that such change would have taken
     4  effect  if  payment were made other than by the entity. Where payment is
     5  not made as of the effective date, the  entity  shall  make  retroactive
     6  payments to the appropriate service providers.
     7    §  4.  This act shall take effect immediately; provided, however, that
     8  the amendments to section 364-j of the social services law  and  section
     9  4403-f  of  the public health law made by sections one and three of this
    10  act, respectively, shall not affect the  repeal  of  such  sections  and
    11  shall be deemed repealed therewith.
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