What's happening
This bill ensures Medicaid payment rates for clinic services provided to people with traumatic brain injuries are at least equal to those for developmental disabilities.
Why it matters
Expands Medicaid payment protections. to include people with traumatic brain injuries (TBI), meaning clinics that serve TBI patients will receive at least the same Medicaid rates as those serving people with developmental disabilities.
Addresses a gap in service funding. , which could help ensure clinics are financially able to serve TBI patients, potentially reducing disparities in access to care for this population.
Aligns financial incentives for clinics. , encouraging more providers to accept and treat TBI patients by guaranteeing more consistent and adequate reimbursement from Medicaid.
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Who cares
Headline styles
Fund Brain Injury Care
Plain English, a few words. Used as the page title.
Sponsors
History
- Vetoed memo.202
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.567
- Substituted for A8241
- Referred to health
- Delivered to assembly
- Passed senateVote 60–0
- Ordered to third reading cal.1744
- Committee discharged and committed to rules
- 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.
Fund Brain Injury Clinics
Assembly Floor Calendar · Sponsor Joseph Morelle
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6511
2017-2018 Regular Sessions
IN SENATE
May 30, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to medical assistance payments for clinical services provided to persons with a traumatic brain injury
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (e) of subdivision 1 of section 367-a of the social services law, as amended by section 41 of part D of chapter 56 of the laws of 2012, is amended to read as follows:
(e) Amounts payable under this title for medical assistance in the form of clinic services pursuant to article twenty-eight of the public health law and article sixteen of the mental hygiene law provided to eligible persons diagnosed with a developmental disability or a traumatic brain injury who are also beneficiaries under part B of title XVIII of the federal social security act, or provided to persons diagnosed with a developmental disability or a traumatic brain injury who are qualified medicare beneficiaries under part B of title XVIII of such act shall not be less than the approved medical assistance payment level less the amount payable under part B.
§ 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11949-02-7
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, in relation to medical assistance payments for clinical services provided to persons with a traumatic brain injury
Purpose
The purpose of this bill is to restore the full payment amounts for patients with traumatic brain injury to the same amount that are received for developmentally disabled patients in Article 28 clinics after the Medicare payment is deducted.
Summary of provisions
Section 1 of the bill includes patients with traumatic brain injury as well as those with developmental disabilities to Section 367-a of the social services law to clarify that article 28 facilities serving both groups of patients who also have Medicare coverage should be reimbursed at the same rate by Medicaid.
Section 2 provides an effective date.
Justification
Individuals with a traumatic brain injury (TBI) and those with developmental disabilities (DD) have been treated similarly with regard to Article 28 clinic services and reimbursement for many years. Both have a Recipient Exception (RE) Code (code 95 for DD and 81 for TBI) and both (1) receive an enhanced payment under Article 28 Medicaid APGs; (2) are included in the exemption for Medicaid therapy caps; and (3) get paid up to the Medicaid rate for nonparticipating Commercial Insurance.
However, due to a 2012 statutory change and a 2013 federal Medicare settlement (the Jimmo Settlement), clinic services for TBI patients are no longer paid the balance up to the Medicaid rate after the Medicare payment.
Because Medicare does not have a clinic rate and only pays a much lower physician practice rate, Article 28 clinics that serve TBI patients are losing 20 -30% of what even Medicaid would reimburse on every TBI patient visit. This additional 20-30% reimbursement cut threatens the fiscal viability of Article 28 clinics that are often the only health care providers for individuals with disabilities and other Medicaid patients. Therefore, in order to preserve both the fiscal viability of these clinics and access to healthcare services for these vulnerable New Yorkers, this bill would authorize clinics to receive payments up to the Medicaid rate for all TBI and DD patients.
Legislative history
New bill
Fiscal implications
A very small fiscal amount statewide to be determined as rates are restored to this small population in certain article 28 settings.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.