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Sponsors
12 Co-sponsors
History
- Held for consideration in ways and means
- Reported referred to ways and means
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to medical home multipayor programs
In Senate Committee · Health · Sponsor Thomas K. Duane
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:A9917
Title of bill
An act to amend the public health law, in relation to medical home multipayor programs
Purpose or general idea of bill
To help primary care providers meet "medical home" standards to improve outcomes and contain costs, by encouraging all third-party payers to adequately reimburse primary care. providers who meet those standards.
Summary of specific provisions
Enacts a new Public Health Law § 2799-t, to authorize the Dept. of Health (DOH) to establish medical home multi- payor programs, modeled on the Adirondack demonstration program. A program would bring together health care payors (including Medicaid and, if possible, Medicare) and providers in an area, under DOH supervision, to set medical home standards and payment levels to enable primary care providers to meet those standards.
The program would include alternative payment methodologies and levels. Payments could also be made to non-profit entities that assist primary care providers with care management and other services. For Medicaid, these payments would be in place of previously authorized Medicaid medical home payments.
To enable entities that are competitors to work together without violat- ing anti-trust laws, the bill would provide a "state action" exemption from anti-trust laws for participants in a program under this section.
As in the Adirondack program, payors and providers would be encouraged to contribute to the administrative costs of running the program.
DOH would have authority to provide technical assistance to health care providers and consumer assistance in a program, and to provide assist- ance to the establishment of programs.
Justification
It is widely recognized that having primary care provid- ers meet "medical home" standards will significantly improve the quality of care, prevent conditions from developing or worsening, manage care -especially for chronic conditions - more effectively, avoid unnecessary hospitalizations, and reduce health care costs, However, this requires health care third party payors to have payment methodologies and levels of payment that support "medical home" providers,
In New York, the Medicaid program is moving towards supporting "medical home" models of care. In the Adirondacks, a state-promoted regional demonstration project has brought all payors into a system to support medical homes.
Bringing all payors and providers together for this purpose requires leadership and effort by DOH, as well as an exemption from anti-trust laws to enable these parties to work together legally. Under federal and state antitrust law, the state can provide a "state action" exemption
from anti-trust laws for an activity in the public interest that is supervised and regulated by the state. This bill would provide that leadership, effort and legal protection.
Alternative payment methodologies and other provisions of a program could also promote the development of integrated health care delivery systems.
Under the bill, the Adirondack demonstration program would be continued as a program under this legislation..
Prior legislative history
new
Fiscal implications
The bill would authorize administrative and grant expenditures, subject to appropriation. The bill would authorize alter- native payment methodologies for Medicaid (in place of previously-au- thorized Medicaid medical home payments), which would help reduce over- all Medicaid costs.
Effective date
Effective immediately. New programs could not be author- ized after April 1, 2016, although programs already established would continue. The Adirondack demonstration program would become permanent under the new law, despite its April 2014 statutory sunset.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.