Adds certain school based health services to list of services which need not be provided by a managed care program

2 Co-sponsors

• Leroy Comrie
• Timothy M. Kennedy

BILL NUMBER:S1061

Title of bill

An act to amend the social services law, in relation to school-based health services under managed care programs

Purpose or general idea of bill

To assure that Medicaid managed care enrollees have continued access to school-based health services.

Summary of specific provisions

Section 1 amends section 364-j(3)(e) of the Social Services Law by adding a new subparagraph (x) adding school-based health services to the list of services which need not be provided by a managed care program.

Section 2 provides for an immediate effective date.

Justification

School-based health centers are recognized as a highly effective vehicle for delivering crucially needed, timely health care services to the most vulnerable underserved and uninsured school-age children. The Department of Health has on several occasions delayed a requirement that managed care programs contract with school-based health centers. Managed care programs require each enrollee to choose a primary care practitioner. But they generally will only contract with physicians as primary care practitioners. Since school-based health centers use mostly nurse practitioners, physician's assistants and certified social workers with back up of physicians and psychologists or psychiatrists, managed care programs are unlikely to contract with school-based health centers as primary care providers for eligible students who are enrolled in managed care. School-based health centers have become an integral part of the fabric of the communities where they are located. Often, they are the only accessible primary care and mental health providers for the most high-risk children and youth. While this bill would eliminate the requirement that managed care providers offer school based health services, it would allow for the establish ment of procedures and linkages which assure that the care of children enrolled in Medicaid managed care programs is coordinated. This bill maintains a reasonable balance between the development of managed care programs and the need to assure continued access to school based health services.

Prior legislative history

Senate: 2011-2012: Died in Committee; 2013-2014: S.4253-A - Died in Committee. Assembly: 1999-00:A.8634 passed the Assembly; 2001-02: A.2531 passed the Assembly; 2003-04: A.3503 passed the Assembly; 2005-06: A.3270 passed the Assembly; 2007: A.3600 referred to Social Services; 2008: A.3600 passed Assembly; 2009-10: A.1022 passed the Assembly; 2011-12: A.1444 referred to Social Services Committee.

Fiscal implications

None. The Department of Health has been unable to develop a model for the incorporation of school-based health services into managed care programs.

Effective date

Immediate.