Relates to Medicaid reimbursement rates for facilities operating pursuant to article 16 of the mental hygiene law

BILL NUMBER:S4974A

Title of bill

An act to amend part H of chapter 59 of the laws of 2011, amending the public health law and other laws, relating to general hospital inpatient reimbursement for annual rates, in relation to supplemental Medicaid managed care payments

Purpose

Restores the MRT 26 cut to article 16 clinics.

Summary of provisions

Section 1 amends public health law to provide that after April 1, 2015 paragraph (a) of section 90 of part H of chapter 59 of the laws of 2011 relating to general hospital inpatient reimbursement for annual rates as amended by section 38 of part C of chapter 60 of the laws of 2014 shall not apply to facilities operating pursuant to article 16 of the mental hygiene law.

Section 2 is the effective date.

Justification

Article 16 clinics are under the Office for People With Developmental Disabilities (OPWDD) and can only serve individuals designated by OPWDD. Article 16 clinics provide health care for individuals with disabilities because other health care providers cannot or will not serve them. Many individuals used to receive their therapies from Department of Health (DOH) Article 28 Clinics. But, beginning in 2009, DOH required that Article 16 clinics be established and that all long term therapies be moved from the Article 28 clinics to OPWDD Article 16 clinics Although OPWDD supports and services were not supposed to be included in the 2011 Medicaid Redesign Team (MRT) discussion or cuts, Article 16 clinics were included in the MRT # 26 cut.

Rather than a 2% across the board cut, the MRT # 26 cut reduces overall payment levels to those Article 16 clinics with higher visits per patient in comparison to their peers, in essence penalizing individuals and the clinics who serve those with more severe physical disabilities. The more significant the physical disability of the patients served, the deeper the cut to the Article 16 rate. Individuals with severe physical disabilities require more frequent and intensive therapy services, and by implementing a cut based on the average number of services provided per month, DOH is discriminating against individuals with severe physical disabilities.

Additionally, this cut is based on utilization; however, Article 16 clinics already had utilization controls in place. Each Article 16 clinic is provided with a service authorization based on the population they serve. The service authorization is the total number of services the clinic may bill for in a given year. If an agency wants to provide and bill for services above the utilization assigned to their clinic, they must submit a CON to OPWDD.

The State fiscal plan savings for all of the MRT cuts, including # 26, ended as of 4-1-15. The 2014-2015 Budget restored all of the MRT 2%

across the board cuts one year early but included language to continue this discriminatory Article 16 cut except that the Commissioner of Health, in consultation with the Director of the Division of the Budget, has the authority to terminate this cut "upon a finding that they are no longer necessary to maintain essential cost savings." Therefore, because this cut is unnecessary and discriminates against individuals with the most severe disabilities and the clinics that serve them, MRT # 26 must be restored for Article 16 clinics

Legislative history

New Bill

Fiscal impact on the state

None.

Effective date

This act shall take immediately.