What's happening
This bill requires managed care providers to promptly apply and retroactively pay for increased behavioral health service rates or coverage changes.
Why it matters
Ensures timely access to increased funding for behavioral health providers. The bill mandates that any increases in rates or expanded coverage for behavioral health services must take effect for managed care providers at the same time as for other providers, preventing delays in applying these changes.
Provides financial stability for service providers. By requiring retroactive payments when there are delays, the legislation helps behavioral health providers avoid cash flow disruptions and administrative burdens associated with waiting for managed care entities to implement new rates or coverage.
Closes a loophole in managed care payment practices. The amendment addresses a common issue where managed care organizations might lag in updating their payment systems after state-mandated changes, ensuring compliance and fair compensation as soon as changes are authorized.
Promotes parity and fairness in mental health funding. The bill supports equal treatment of behavioral health services compared to other medical services regarding the timing and amount of payment, reinforcing broader efforts to improve behavioral health care access and equity.
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Who cares
Behavioral health service providers
They would be entitled to retroactive payments when managed care payers delay implementing increases in payment rates, terms or scope beyond the applicable effective date.
Medicaid managed care providers
They would have to apply behavioral health payment increases on the same date those changes would take effect outside managed care.
Managed long-term care plans
Entities covered by section 4403-f would face the same effective-date and retroactive-payment requirements for behavioral health services.
Headline styles
Retroactive Pay for Mental Health
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Referred to health
- Delivered to senate
- Passed assembly
- Ordered to third reading cal.574
- Returned to assembly
- Died in senate
- Referred to rules
- Delivered to senate
- Passed assembly
- Ordered to third reading rules cal.517
- Rules report cal.517
- Reported
Show 5 earlier actions
- Reported referred to rules
- Print number 8011a
- Amend and recommit to ways and means
- Reported referred to ways and means
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Retroactive Behavioral Health Payments
In Senate Committee · Health · Sponsor Robert Ortt
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
8011--A
2017-2018 Regular Sessions
IN ASSEMBLY
May 25, 2017
Introduced by M. of A. GOTTFRIED, SEPULVEDA -- read once and referred to the Committee on Health -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the social services law and the public health law, in relation to payments for behavioral health services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 18 of section 364-j of the social services law is amended by adding a new paragraph (e) to read as follows:
(e) Increased rates, terms or scope of payment for behavioral health services under this title, where payment is made by a managed care provider under this section, as a result of a rate, coverage or other change made pursuant to a law, regulation, rule or official guidance, shall be deemed in effect on the same date that such change would have taken effect if payment were made other than by the managed care provider. Where payment is not made as of the effective date, the managed care provider shall make retroactive payments to the appropriate service providers.
§ 2. Subdivision 7 of section 4403-f of the public health law is amended by adding a new paragraph (i) to read as follows:
(i) Increased rates, terms or scope of payment for behavioral health services under this section, where payment is made by an entity under this section, as a result of a rate, coverage or other change made pursuant to a law, regulation, rule or official guidance, shall be deemed in effect on the same date that such change would have taken effect if payment were made other than by the entity. Where payment is not made as of the effective date, the entity shall make retroactive payments to the appropriate service providers.
§ 3. This act shall take effect immediately; provided, however, that the amendments to section 364-j of the social services law and section 4403-f of the public health law made by sections one and two of this act, respectively, shall not affect the repeal of such sections and shall be deemed repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11787-04-7
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.