What's happening
This bill ensures nephrologists are included among providers eligible for certain medical assistance payments for Medicare beneficiaries.
Why it matters
Expands access to specialist care for patients with kidney disease. by ensuring nephrologists are explicitly included among providers eligible for key medical assistance payments, potentially improving health outcomes for a vulnerable population.
Addresses gaps in payment equity. by guaranteeing nephrologists receive at least the Medicare co-insurance amount when treating dual-eligible or qualified Medicare beneficiaries, which may encourage more nephrologists to accept these patients.
May reduce administrative barriers and billing confusion. for nephrologists and their practices, ensuring clearer and more consistent reimbursement for services provided to some of the state’s most medically complex patients.
Could help alleviate disparities in care access. for low-income individuals with chronic kidney conditions, as consistent and adequate provider reimbursement is linked to broader provider participation in Medicaid and related programs.
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Who cares
Headline styles
Increase Medicaid Co-Pay Rates
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
3 Multi-sponsors
History
- Referred to health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
544
2017-2018 Regular Sessions
IN ASSEMBLY
January 9, 2017
Introduced by M. of A. GUNTHER, COOK -- Multi-Sponsored by -- M. of A. 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 for medical assistance for items and services provided to eligible persons
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (iii) of paragraph (d) of subdivision 1 of section 367-a of the social services law, as amended by section 31 of part B of chapter 57 of the laws of 2015, is amended to read as follows:
(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, a nephrologist licensed under article one hundred thirty-one of the education law, or a facility under the authority of an operating certificate issued
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03188-01-7
A. 544 2
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.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.