What's happening
This bill requires managed care providers and entities to apply increased behavioral health payment rates retroactively to the effective date of any changes.
Why it matters
Ensures Timely and Fair Provider Compensation. By mandating that increased behavioral health payment rates are effective retroactively, the bill prevents managed care organizations and similar entities from delaying payments at new, higher rates, ensuring service providers are fairly compensated for care delivered as soon as the change is in effect.
Reduces Financial Uncertainty for Behavioral Health Providers. Retroactive payment requirements protect providers from revenue gaps that could arise if there are administrative delays in updating payment systems, supporting financial stability for organizations that often operate with tight margins.
Promotes Parity and Compliance with Policy Changes. By requiring retroactive application of payment increases stemming from legal, regulatory, or official guidance changes, the bill closes loopholes that could otherwise allow managed care entities to delay or avoid implementing required improvements in behavioral health funding.
Potentially Improves Access and Continuity of Care. Reliable and prompt reimbursement makes it more feasible for providers to continue or expand behavioral health services, which can translate to better access and continuity of care for patients relying on these critical services.
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Who cares
Behavioral health service providers
They would be entitled to retroactive payments when covered payment increases are not paid as of their effective date.
Managed care providers
They would have to apply increased behavioral health payment rates, terms or scope on the same effective date that would apply outside managed care.
Entities paying under Public Health Law section 4403-f
They would face the same effective-date and retroactive-payment requirements for behavioral health payment increases resulting from laws, regulations, rules or official guidance.
Headline styles
Retroactive Behavioral Health Payments
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 62
1 Co-sponsor
History
- Referred to health
- Print number 6219b
- Amend and recommit to health
- Print number 6219a
- Amend (t) and recommit to health
- 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 Pay for Mental Health
In Senate Committee · Health · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6219--B
2017-2018 Regular Sessions
IN SENATE
May 11, 2017
Introduced by Sen. ORTT -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- 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.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11698-03-7
S. 6219--B 2
§ 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law and the public health law, in relation to payments for behavioral health services
Purpose or general idea of bill
To require Medicaid managed care plans, managed long term care plans, and plans under Child Health Plus to implement required changes in rates, coverage or payments for behavioral health providers on the same date as the change takes effect for Medicaid non-managed care, or to make updated payments retroactively to that date.
Summary of provisions
Section 1 amends section 364-j of the social services law by adding a new paragraph (e) to subdivision 18, providing that Medicaid managed care plans shall adjust payments to behavioral health providers required by law, regulations or guidelines, on the same date as changes in rates, coverage or other areas take effect for non-managed care. If such plans require additional time to make technical or other system updates, they shall make retroactive payments to the providers.
Sections 2 and 3 amend sections 2511 and 4403-f of the public health law respectively, to make the same change for Child Health Plus and managed long-term care plans.
Section 4 makes the bill effective immediately.
Justification
Medicaid managed care plans, managed long term care plans, and Child Health Plus organizations pay behavioral health providers using ambulatory patient group (APG) rates, which are occasionally adjusted by the state due to statutory or budgetary changes, re-basing, workforce increases, and market forces. When rates are adjusted upward, the state increases payments to managed care plans and Child Health Plus organizations accordingly, and the plans are supposed to pass the payment increase through to providers.
Under current law, however, plans can delay making the necessary system updates to reflect new provider payment rates and are not required to make retroactive payment adjustments, despite receiving increased payments from the state for that purpose.
This bill will ensure that state payments intended to reimburse behav- ioral health providers will be distributed appropriately, and will improve the viability of community health care providers that New Yorkers rely on.
Prior legislative history
New bill
Fiscal implications for state and local governments
None
Effective date
Immediate
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.