Provides for increasing the applicability of brand name and generic prescription drug and other medical services co-payments for medicaid recipients

2 Co-sponsors

• Patrick M. Gallivan
• William J. Larkin Jr.

BILL NUMBER:S1436

Title of bill

An act to amend the social services law, in relation to medicaid co-payments for prescription drugs and other services

Purpose of the bill

This bill provides for increasing brand name and generic prescription drug and other medical services co-payments for Medicaid recipients and requires prepayment.

Summary of specific provisions

Section 1 - Amends paragraph (b) of subdivision 6 of § 367-a of the Social Services Law to redefine those persons not subject to co-payments for services.

Section 2 - Amends the opening paragraph of paragraph (d) of subdivision 6 of § 367-a of the Social Services Law to require that co-payments shall apply to all services covered by the title, except diagnostic services, and to require that co-payments must be pre-paid at the time when services are rendered.

Section 3 - Authorizes the Commissioner of Health to promulgate or adopt any rules or regulations necessary to implement the provisions of this Act.

Section 4 - Effective date.

Justification

The rising cost of the Medicaid program is threatening the ability for the State and its counties to maintain the current program. Just as private health insurance requires co-payments for services in order to rein in costs of health care, New York State should implement the same model to rein in costs and ensure that the cost of the Medicaid program can be sustained. In an effort to modernize the Medicaid program so that it is similar to private health insurance, this legislation institutes co-payments for all services, except diagnostic services. To ensure that co-payments to the providers of the services are received, prepayment of the co-payments must be made when the services are rendered. Currently, the law does not allow for providers to withhold services if the recipient states that he or she can not pay the copayment. However, abuse of this provision has become increasingly apparent, and therefore steps must be taken to ensure that providers receive their payments for the services that they provide to the consumers.

Prior legislative history

2005-2006 - S.3578-B/A.5466-C 2007-08 - S.3292/A.4676 -- HEALTH/Health

2009-10: - S.2990-A/A.6678 -- HEALTH/Health 2011-12 S.3221/A.2339 - HEALTH/Health

Fiscal implications

Yet to be determined. Cost savings to both counties and the state are expected.

Effective date

This act shall take effect immediately.