Authorizes the commissioner of health to make adjustments to case payment rates for pediatric ventilator services

BILL NUMBER:S5345

Title of bill

An act to amend the public health law, in relation to case payment rates for pediatric ventilator services

Purpose

To enable the Department of Health ("DOH") to establish a discrete Medicaid reimbursement rate for hospital pediatric ventilator services.

Summary of provisions

Section 1 of the bill would amend subparagraph (i) of paragraph (e-2) of subdivision four of section 2807-c of the Public Health Law related to Medicaid reimbursement for physical medical rehabilitation services. The amendment would authorize the Commissioner of Health to make adjustments to such rates for the purpose of reimbursing hospital pediatric ventila- tor services.

Section 2 of the bill would make the bill effective immediately.

Existing law

Paragraph (e-2) of subdivision four of section 2807-c of the Public Health Law governs Medicaid reimbursement for specialty inpa- tient services provided by hospitals.

Justification

Currently, DOH does not have statutory authority to establish a discrete Medicaid rate for pediatric ventilator services provided by hospitals (DOH does have authority to establish such rates for nursing homes). While DOH has authority to establish a rate for physical medical rehabilitation services, the costs to provide pediatric ventilator services are different from, and generally higher than, the costs to provide physical medical rehabilitation services. Thus, given the current reimbursement situation, hospitals have little incentive to provide pediatric ventilator services, even though there is a need for such services. In particular, the addition of such services is in line with the recommendation of the Governor's Medicaid Redesign Team (MRT) to repatriate children needing ventilator care who have been left with no choice but to be placed in out-of-state facilities due to a lack of services in New York State.

Currently, at least one hospital has not opened up its planned pediatric ventilator unit due to concerns about adequate reimbursement. After working with DOH to receive a reimbursement rate that reflects this cost-intensive service, DOH has stated that they do not have statutory authority to establish a discrete rate for this service, but rather only to set a rate for physical medical rehabilitation services. Section 1 of this bill was drafted with input from DOH in order to provide DOH with the authority to establish a discrete rate for this essential service.

Legislative history

New bill.

Fiscal implications

Expected savings. While the bill would provide the Commissioner of Health with the authority to establish a rate for pedia-

tric ventilator services in hospitals the bill does not specify the amount of the rate. However, Medicaid cost savings are expected as currently there are children who require this service who are housed in expensive out-of-state facilities. Some of these children would be able to receive the service in New York State.

Local fiscal implications

None.

Effective date

This bill would take effect immediately.