Relates to medicaid payments to free-standing clinics licensed pursuant to article thirty-one of the mental hygiene law

1 Co-sponsor

• Owen H. Johnson

Title of bill

An act to amend the public health law, in relation to Medicaid payments to free-standing clinics licensed pursuant to article thirty-one of the mental hygiene law

Purpose or general idea of bill

To ensure that people with serious and persistent mental illness (SPMI) have access to outpatient mental health services.

Summary of specific provisions

Section one amends Public Health Law (PHL) Section 2807(2-a) (e) (ii) to provide that payments to outpatient mental health clinics must be based on the methodologies used by the New York State Department of Health for the development of Ambulatory Patient Group (APG) reimbursement, including but not limited to, the diagnosis of the patient and intensity of the services provided.

Justification

In 1991, the Office of Mental Health (OMH) implemented a new Medicaid supplement to the rates for outpatient mental health clinics called Comprehensive Outpatient Programs (COPs). This Medicaid supplement permitted the State to access federal matching dollars thereby reducing the State's funding for the clinics.

The COPs clinics serve a significant number of people with severe and multiple diagnoses such as schizophrenia and drug and alcohol addictions. The children that these clinics care for are in significant distress and are often victims of physical and mental abuse and the juvenile justice system. The COPs clinics are frequently utilized to shorten an inpatient hospital stay or even eliminate the need for a hospitalization.

This enhanced federal payment is now projected to be eliminated over the next four years by the OMH Restructuring Plan. The OMH plan will redistribute current Medicaid payments by taking funds from COPs clinics and giving them to non-Cops clinics. When this plan goes into effect, the financial viability of many clinics will be seriously jeopardized. This change is being implemented by regulation and does not require legislative approval.

This bill requires OMH to consider the severity of a patient's illness when developing the new payment rates under the Restructuring Plan. This will ensure that incentives are built into the rates to provide services to patients who are most in need, and that more costly care such as ER visits and hospitalizations care are avoided.

This is consistent with the Executive's policy for the new APG reimbursement reform with respect to Article 28 clinics regulated by the Department of Health (DOH). APG reimbursement rates for primary care clinics are weighted to take into account the severity of the illness and the resources needed to provide treatment and disease management. There is no rational reason to provide these incentives in one clinic setting but not in another.

Prior legislative history

None.

Fiscal implications

This bill will save the State money by improving the mental health of individuals living with serious and persistent mental illness and preventing hospital stays and emergency visits.

Effective date

Immediate.