What's happening
This bill requires managed care and related entities to provide retroactive payments for behavioral health services when rates or coverage increase.
Why it matters
Ensures timely compensation for behavioral health providers. By mandating retroactive payments when rates or coverage increase, the bill helps providers avoid financial gaps that can occur when payers are slow to update payments after policy changes.
Reduces administrative uncertainty and disputes. Providers no longer have to negotiate or appeal for back payments when rates change, streamlining operations and reducing the risk of unpaid services.
Supports continuity and quality of behavioral health care. Reliable and consistent payment practices can help stabilize provider networks, making it less likely that providers will drop out of managed care networks due to financial shortfalls—ultimately supporting patient access to care.
Aligns managed care payment practices with fee-for-service models. The bill ensures that managed care entities must implement payment changes as promptly as traditional payment systems, promoting fairness and consistency across the healthcare system.
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Who cares
Headline styles
Retroactive Behavioral Health Payments
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Substituted by A2787
- Ordered to third reading cal.1494
- 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.
Pay More for Mental Health
Signed by Governor · Sponsor Richard Gottfried
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3960
2019-2020 Regular Sessions
IN SENATE
February 21, 2019
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health
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 (k) to read as follows:
(k) 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.
LBD02696-01-9
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 ambula- tory 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 organiza- tions 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 York- ers rely on.
Prior legislative history
2017-2018: S6219B (Ortt)
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.