What's happening
This bill updates social services law to expand medical assistance coverage for Medicare beneficiaries, including those under Medicare Part C.
Why it matters
Expands Medicaid coverage. to include not just Medicare Part A and B beneficiaries, but also those enrolled in Medicare Part C (Medicare Advantage), meaning more seniors and disabled individuals could have their out-of-pocket costs covered.
Simplifies and standardizes payment rules. for deductibles and co-insurance across all Medicare parts (A, B, and C), reducing confusion and administrative barriers for both beneficiaries and providers.
May reduce financial hardship. for low-income Medicare beneficiaries, as Medicaid would pick up more costs that would otherwise be the responsibility of individuals, especially those enrolled in Medicare Advantage plans.
Could improve provider compensation reliability. for services delivered to dual-eligible patients (those with both Medicare and Medicaid), potentially increasing provider willingness to serve this population and improving access to care.
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Who cares
Headline styles
Expand Medicaid Payment Coverage
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1435
2017-2018 Regular Sessions
IN ASSEMBLY
January 12, 2017
Introduced by M. of A. CAHILL -- Multi-Sponsored by -- M. of A. CYMBROW- ITZ, ENGLEBRIGHT, PEOPLES-STOKES, RIVERA -- read once and referred to the Committee on Health
AN ACT to amend the social services law, in relation to amounts payable under medical assistance
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (d) of subdivision 1 of section 367-a of the social services law, as amended by section 1 of part J1 of chapter 63 of the laws of 2003, subparagraph (iii) as amended by section 31 of part B of chapter 57 of the laws of 2015, subparagraph (iv) as added by section 16 of part B of chapter 59 of the laws of 2016, is amended to read as follows:
(d) [(i)] Amounts payable under this title for medical assistance for items and services provided to eligible persons who are also beneficiaries under part A and/or part B and/or part C of title XVIII of the federal social security act and items and services provided to qualified medicare beneficiaries under part A and/or part B and/or part C of title XVIII of the federal social security act shall not be less than the amount of any deductible and co-insurance liability of such eligible persons or for which such eligible persons or such qualified medicare beneficiaries would be liable under federal law were they not eligible for medical assistance or were they not qualified medicare beneficiaries with respect to such benefits under such part A and/or such part B and/or part C.
[(ii) Amounts payable under this title for medical assistance for items and services provided to eligible persons who are also beneficiaries under part B of title XVIII of the federal social security act and items and services provided to qualified medicare beneficiaries under part B of title XVIII of the federal social security act shall not be less than the amount of any deductible liability of such eligible
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01416-01-7
A. 1435 2
persons or for which such eligible persons or such qualified medicare beneficiaries would be liable under federal law were they not eligible for medical assistance or were they not qualified medicare beneficiaries with respect to such benefits under such part B.
(iii) With respect to items and services provided to eligible persons who are also beneficiaries under part B of title XVIII of the federal social security act and items and services provided to qualified medicare beneficiaries under part B of title XVIII of the federal social security act, the amount payable for services covered under this title shall be the amount of any co-insurance liability of such eligible persons pursuant to federal law were they not eligible for medical assistance or were they not qualified medicare beneficiaries with respect to such benefits under such part B, but shall not exceed the amount that otherwise would be made under this title if provided to an eligible person other than a person who is also a beneficiary under part B or is a qualified medicare beneficiary minus the amount payable under part B; provided, however, amounts payable under this title for items and services provided to eligible persons who are also beneficiaries under part B or to qualified medicare beneficiaries by an ambulance service under the authority of an operating certificate issued pursuant to article thirty of the public health law, a psychologist licensed under article one hundred fifty-three of the education law, or a facility under the authority of an operating certificate issued pursuant to article sixteen, thirty-one or thirty-two of the mental hygiene law and with respect to outpatient hospital and clinic items and services provided by a facility under the authority of an operating certificate issued pursuant to article twenty-eight of the public health law, shall not be less than the amount of any co-insurance liability of such eligible persons or such qualified medicare beneficiaries, or for which such eligible persons or such qualified medicare beneficiaries would be liable under federal law were they not eligible for medical assistance or were they not qualified medicare beneficiaries with respect to such benefits under part B.
(iv) If a health plan participating in part C of title XVIII of the federal social security act pays for items and services provided to eligible persons who are also beneficiaries under part B of title XVIII of the federal social security act or to qualified medicare beneficiaries, the amount payable for services under this title shall be eighty-five percent of the amount of any co-insurance liability of such eligible persons pursuant to federal law if they were not eligible for medical assistance or were not qualified medicare beneficiaries with respect to such benefits under such part B; provided, however, amounts payable under this title for items and services provided to eligible persons who are also beneficiaries under part B or to qualified medicare beneficiaries by an ambulance service under the authority of an operating certificate issued pursuant to article thirty of the public health law, or a psychologist licensed under article one hundred fifty-three of the education law, shall not be less than the amount of any co-insurance liability of such eligible persons or such qualified medicare beneficiaries, or for which such eligible persons or such qualified medicare beneficiaries would be liable under federal law were they not eligible for medical assistance or were they not qualified medicare beneficiaries with respect to such benefits under part B.]
§ 2. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after July 1, 2003.
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