What's happening
This bill requires a study and report on preventing financial hardship for Medicaid-funded providers serving people with developmental disabilities in New York.
Why it matters
Aims to protect efficient Medicaid providers. The bill focuses on preventing further financial cuts to efficient providers who already operate below the regional average, taking into account the complexity of the disabilities they serve. This could help maintain service quality and provider stability in underfunded areas.
Seeks fairer reimbursement methods. It calls for an evaluation of how provider payments are calculated to ensure they reflect actual costs and services delivered, including unforeseen closures or reduced attendance, which could help providers avoid revenue shortfalls from circumstances outside their control.
Proposes a new appeals process for rate increases. The legislation recommends creating a way for providers to appeal for rate increases during years when standard funding rates aren’t recalculated, ensuring faster financial relief if justified.
Focuses on long-term program stability and federal compliance. Recommendations include measures to enhance service stability and care quality, such as changing how often funding formulas are updated, and a plan for securing necessary federal approvals, which could help providers plan for the future and ensure continued federal funding.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Study Medicaid Disability Provider Rates
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 62
2 Co-sponsors
History
- Print number 257a
- Amend and recommit to health
- Referred to health
- Returned to senate
- Died in assembly
- Referred to mental health
- Delivered to assembly
- Passed senateVote 61–0
- Advanced to third reading
- 2nd report cal.
- 1st report cal.1036
- Reported and committed to finance
Show 1 earlier action
- 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.
Study Medicaid Disability Provider Rates
In Assembly Committee · Mental Health · Sponsor Aileen Gunther
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
257--A
2017-2018 Regular Sessions
IN SENATE (Prefiled)
January 4, 2017
Introduced by Sens. ORTT, ROBACH, YOUNG -- read twice and ordered printed, and when printed to be committed to the Committee on Health -recommitted to the Committee on Health in accordance with Senate Rule
6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT directing the office for people with developmental disabilities to study and develop suitable measures to prevent financial hardship and/or failure of providers serving individuals with developmental disabilities funded by Medicaid to support the uninterrupted continuation of necessary services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The commissioner of the office for people with developmental disabilities in conjunction with the commissioner of health, shall jointly prepare a report which shall include the following:
a. Recommendations for holding harmless from further rate reductions those efficient providers within a region that operate beneath the regional average rate. Severity of disability shall be taken into consideration for purposes of comparing efficient providers.
b. A methodology for adjusting rates so that total prospective reimbursement received by a provider for a program must equal the total costs of that program which shall include all necessary cost components for operating the program. The report shall examine the extent to which units used in rate calculations are reflective of the actual units delivered to ensure that providers are not penalized for lost revenue due to unforeseeable program closures, absenteeism and policies designed to curtail program enrollment.
c. Recommendations for a prospective rate appeal process designed to increase rates as necessary during a non-rebasing year to cover costs. Any recommended appeal process shall ensure that providers who prevail
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03798-02-8
S. 257--A 2
on such appeal receive additional reimbursement as of the date the appeal was submitted.
d. Recommendations to enhance program stability and the quality of care including but not limited to lengthening the period between base year updates and alternating base years by program.
e. Identification of those elements of the plan that must be approved by the Centers for Medicare and Medicaid Services and a plan for achieving such approval.
§ 2. The commissioner of the office for people with developmental disabilities shall submit a report detailing the issues set forth in this act and recommendations to the temporary president of the senate, the speaker of the assembly, the chairs of the senate committee on mental health and developmental disabilities and the assembly committee on mental health no later than February 1, 2019.
§ 3. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act directing the office for people with develop- mental disabilities to study and develop suitable measures to prevent financial hardship and/or failure of providers serving individuals with developmental disabilities funded by Medicaid to support the uninter- rupted continuation of necessary services
Purpose or idea of bill
This legislation requires the Office of People with Developmental Disa- bilities to prepare a report including recommendations as they relate to rate rationalization.
Summary of specific provisions
Section 1 requires the Commissioner of OPWDD to prepare a report that includes recommendations for holding harmless from future rate reductions providers that operate beneath a regional average ration, a methodology for adjusting rates so that total reimbursement is equal to the total costs of that program, establishment of a rate appeal process designed to increase rates during a non-rebasing year, consider length- ening the period between base year updates, and identify parts of the plan to be approved by CMS.
Read the full memo (613 words)
Section 2 requires DOH to submit a report detailing the recommendations set forth by this act by February 1, 2019.
Section 3 is the effective date.
Justification
Services for individuals with developmental disabilities funded by Medi- caid are subject to extraordinary financial stress under rate setting policies and methodologies known as "rate rationalization." Rate ratio- nalization poses a systemic threat to the entire system of OPWDD funded services. Specifically, it penalizes agencies efficient enough to real- ize savings by taking those savings away when program rates are rebased every other year. This ignores the fact that the system of OPWDD funded services is based in large measure on an agency's ability to operate efficiently enough to realize savings in various cost categories or programs in order to subsidize cost categories or programs which are chronically underfunded. Without this flexibility providers have been placed in a position of closing or curtailing services or allowing services to weaken because of insufficient funds to improve wages for underpaid employees, provide intensified services to meet challenging needs of people served, meet increases in health insurance costs and other costs necessary to successfully provide services for people with developmental disabilities.
Rate rationalization makes it unlikely the financially struggling providers can recover since reducing costs in order to operate more efficiently results in reimbursement rate cuts by the Department of Health which simply exacerbate the provider's weak financial condition. In one of many instances a financially struggling agency cut costs to produce savings. However it soon found those savings lost to rate cuts thus punishing it for being efficient further weakening it almost to the point of bankruptcy. Additionally, programs which must increase their costs in order to manage a more difficult population with severe needs must wait for two and a half to nearly three and a half years before rates are increased by DOH. If the agency is financially marginal the potential exists to fatally weaken the agency. In one of many examples a provider in a struggling agency accepted four behaviorally challenging individuals for placement from State facilities. The extraordinary costs associated with these placements created a financial hole in excess of almost $1 million and nearly bankrupted the entire agency placing the services for hundreds of individuals and families at risk.
Rate rationalization also means that the cost to the State for funding the entire services system must be budget neutral. However that doesn't recognize essential costs increases due, for example, to an aging popu- lation or meeting new mandates. Budget neutrality therefore contributes to fiscal instability and jeopardizes sustainability.
Prior legislative history
S. 7668A Passed Senate in 2016.
Fiscal implications
To be determined.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.