Extends the effectiveness of chapter 631 of the laws of 1997 relating to authorizing certain medical assistance payments

Summary of specific provisions

Extends the sunset date of Chap. 47 of 2005 to July 1, 2011.

Justification

When Social Services Law section 368-d and section 368-e were enacted in 1989, the intent was to increase the potential for Medicaid reimburse- ment, not to limit who could bill Medicaid for IEP-related services. Prior to this law, school districts and municipalities were not billing Medicaid and, therefore, the State and municipalities lost Medicaid revenue for children whose IEP-related services were not billed through a special education program which had an Article 28 clinic.

Currently, certain clinics across the state provide the related services of physical therapy, speech therapy, and occupational therapy to Medi- caid eligible preschoolers who attend their State Education Department (SED) approved programs and bill Medicaid for the services through their Article 28 clinics. SED then offsets the tuition rate for their programs with Medicaid reimbursement. The amount of reimbursement depends on the number of Medicaid children, the number of related services provided based on IEP requirements, and the clinic's Medicaid rate.

In October 1993, the Office of Temporary and Disability Assistance (OTDA), formerly the New York State Department of Social Services (DSS), sent out a Medicaid Update which stated that only municipalities and school districts could bill Medicaid for IEP related services, which it renamed Supportive Health Services. When OTDA and SED studied the fiscal ramifications of not allowing clinics to bill for these services, they revised their policy.

If this interpretation by OTDA were to ever be implemented, New York State would incur additional costs. Clinic rates would increase due to elimination of these services from current clinic reimbursement calcu- lations, and the tuition rates of the preschool programs will increase by the amount that had previously been offset by the Medicaid reimburse- ment. This tuition increase would be for all children, not just the children who are eligible for Medicaid.

Since 1996, enacted legislation has continued the authority for Article 28 clinics to bill Medicaid directly during which time a state evalu- ation would be done. After all these years, no evaluation has taken place. The legislation has also required that both the actual full cost of any IEP related services incurred by any Article 28 clinic directly billing Medicaid and the associated Medicaid revenue be reported on the New York State Consolidated Fiscal Report. Since this reporting requirement was implemented there have been no reports of double billing or other fraud.

This year, Gov. Spitzer's Article VII Education budget bill seeks to create a Temporary Task Force on Preschool Education to study the relationship between early childhood programs, their system of delivery and their funding methodology. While this task force would be a long overdue and welcomed step, this legislation is necessary to continue the authority for certain Article 28 clinics to bill Medicaid for services rendered by them for preschool special education students.

Legislative history

A.5710 was signed into law Chap. 47 of 2007. A.4248 was signed into law Chap. 142 of 2005. A.9869 was signed into law Chap. 99 of 2002

Fiscal implications

To be determined.

Effective date

Immediately.