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A09544 Summary:

Add §367-w, amd §366-d, Soc Serv L; amd §13-d, Work Comp L
Relates to payment for contingency management programs that provide an incentive structure as a service for the treatment of a substance use disorder.
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A09544 Text:

                STATE OF NEW YORK
                   IN ASSEMBLY
                                     March 16, 2022
        Introduced  by M. of A. CARROLL -- read once and referred to the Commit-
          tee on Health
        AN ACT to amend the social services law and  the  workers'  compensation
          law, in relation to payment for contingency management programs
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. The social services law is amended by adding a new  section
     2  367-w to read as follows:
     3    §  367-w.  Payment  for  contingency  management  programs. 1. For the
     4  purpose of  this  section,  "contingency  management  program"  means  a
     5  substance  use  disorder  treatment  service  that provides an incentive
     6  structure, including scaling rewards for continued evidence of specified
     7  behaviors or adherence to treatment goals, that rewards participants for
     8  specified behaviors, provided the receipt of  any  incentive  or  reward
     9  pursuant  to  such a program shall not be considered income for purposes
    10  of eligibility for public benefits or other  public  assistance  to  the
    11  extent allowed by law.
    12    2.  The  commissioner  may authorize the payment of medical assistance
    13  funds for contingency management programs.  The commissioner  shall,  in
    14  consultation  with  the  AIDS  Institute  and  the  office  of addiction
    15  services and supports:
    16    a. Issue guidance on the use of contingency  management  programs  for
    17  beneficiaries  who  access  substance  use  disorder  services under the
    18  medical assistance program;
    19    b. Establish limits on the number and value of incentives available to
    20  beneficiaries who receive services pursuant to a contingency  management
    21  program; and
    22    c.  Determine  maximum  allowable  rates  for  contingency  management
    23  programs based  upon  the  medical  assistance  program  fee-for-service
    24  outpatient  rates  for  the  same or similar services, or any other data
    25  deemed reliable and relevant by the commissioner.
    26    3. Subdivision two of this section shall be effective if, and as  long
    27  as,  federal financial participation is available for medical assistance
    28  expenditures made pursuant to it.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 9544                             2
     1    4. For the purposes of implementing  this  section,  the  commissioner
     2  shall  seek  any necessary federal approvals, including approvals of any
     3  state plan amendment or federal waivers,  by  the  federal  centers  for
     4  medicare  and Medicaid services no later than December thirty-first, two
     5  thousand twenty-two.
     6    §  2.  Subdivision  2  of  section 366-d of the social services law is
     7  amended by adding a new paragraph (e) to read as follows:
     8    (e)  this  subdivision  shall  not  apply  to  contingency  management
     9  programs  operated  pursuant  to  section three hundred sixty-seven-w of
    10  this title.
    11    § 3. Paragraph (g) of subdivision 2 of section 13-d  of  the  workers'
    12  compensation  law,  as  amended by section 2 of part CC of chapter 55 of
    13  the laws of 2019, is amended to read as follows:
    14    (g) has directly or indirectly requested, received or participated  in
    15  the division, transference, assignment, rebating, splitting or refunding
    16  of a fee for, or has directly or indirectly requested, received or prof-
    17  ited  by  means of a credit or other valuable consideration as a commis-
    18  sion, discount or gratuity in connection with the furnishing of  medical
    19  or  surgical  care,  an  independent  medical  examination, diagnosis or
    20  treatment or service, including X-ray examination and treatment, or  for
    21  or in connection with the sale, rental, supplying or furnishing of clin-
    22  ical  laboratory  services  or  supplies,  X-ray  laboratory services or
    23  supplies, inhalation therapy service or  equipment,  ambulance  service,
    24  hospital or medical supplies, physiotherapy or other therapeutic service
    25  or  equipment,  artificial  limbs, teeth or eyes, orthopedic or surgical
    26  appliances or  supplies,  optical  appliances,  supplies  or  equipment,
    27  devices  for  aid  of hearing, drugs, medication or medical supplies, or
    28  any other goods, services or supplies prescribed for medical  diagnosis,
    29  care  or  treatment, under this chapter; except that reasonable payment,
    30  not exceeding the technical component fee permitted in the  medical  fee
    31  schedule, established under this chapter for X-ray examinations, diagno-
    32  sis  or treatment, may be made by a provider duly authorized as a roent-
    33  genologist to any hospital furnishing facilities and equipment for  such
    34  examination,  diagnosis  or  treatment,  provided such hospital does not
    35  also submit a charge for the same services. Nothing  contained  in  this
    36  paragraph  shall  prohibit  such  providers who practice as partners, in
    37  groups or as a professional corporation or as a university faculty prac-
    38  tice corporation from pooling fees and moneys received,  either  by  the
    39  partnership,   professional  corporation,  university  faculty  practice
    40  corporation or group by the individual members thereof, for professional
    41  services furnished by any individual professional member, or employee of
    42  such partnership, corporation or  group,  nor  shall  the  professionals
    43  constituting  the  partnerships,  corporations,  or groups be prohibited
    44  from sharing, dividing or apportioning the fees and moneys  received  by
    45  them  or  by  the partnership, corporation or group in accordance with a
    46  partnership or other  agreement.  This  paragraph  shall  not  apply  to
    47  contingency  management  programs  operated  pursuant  to  section three
    48  hundred sixty-seven-w of the social services law.
    49    § 4. This act shall take effect immediately.
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