What's happening
This bill creates a workgroup to analyze and recommend improvements to behavioral health service reimbursement rates in New York.
Why it matters
Brings together a wide range of behavioral health stakeholders. including providers, recovery advocates, hospitals, and consumer representatives—to ensure diverse input on reimbursement challenges and solutions.
Mandates a detailed analysis not just of Medicaid managed care rates, but also commercial insurance and Child Health Plus rates. , potentially identifying gaps and inequities in funding for different populations and service settings.
Requires examination of the true costs of delivering behavioral health care. , which could highlight underfunding issues and inform future policy and budget decisions to improve provider sustainability and patient access.
Directs the workgroup to recommend alternative reimbursement models and necessary policies or resources. , potentially leading to significant changes in how clinics and providers are paid for behavioral health services in New York.
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Who cares
Headline styles
Review Behavioral Health Rates
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 38
2 Co-sponsors
History
- Referred to ways and means
- Delivered to assembly
- Passed senateVote 61–0
- Advanced to third reading
- 2nd report cal.
- 1st report cal.184
- Referred to mental health and developmental disabilities
- Referred to rules
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 Behavioral Health Payment Rates
In Assembly Committee · Ways And Means · Sponsor Aileen Gunther
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6694
2019-2020 Regular Sessions
IN SENATE
September 6, 2019
Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the mental hygiene law, in relation to establishing a workgroup to conduct analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 7.07 of the mental hygiene law is amended by adding a new subdivision (h) to read as follows:
(h) 1. The commissioner of the office of mental health, in collaboration with the commissioner of the department of health and the commissioner of the office of alcoholism and substance abuse services are directed to convene and jointly chair, either directly or through a designee or designees, a workgroup, which shall include membership that ensures adequate statewide geographic representation selected with equal contributions on such selection from the governor, the speaker of the assembly and temporary president of the senate and be comprised of the following members: (i) professional associations representing substance use, mental health, and/or behavioral health providers; (ii) representatives from professional associations representing providers of peer and recovery-based programs and services; (iii) representatives from professional associations representing medicated assisted treatment providers; (iv) representatives from professional associations representing children's behavioral health providers; (v) representatives from hospital associations; (vi) representatives from associations representing behavioral health consumers and family members; and (vii) any additional stakeholder or expert that the commissioners deem necessary. Members of the workgroup shall serve without compensation, but may be reimbursed for actual costs incurred for participation on such workgroup. 2. The workgroup shall conduct an analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11227-01-9
S. 6694 2
services for the purpose of developing a report that shall provide recommendations on the following: (i) rate adequacy related to the existing ambulatory patient group-based reimbursement provided under medicaid managed care, as well as for commercial insurance rates with regards to services rendered under child health plus, or for services provided by clinics licensed or certified pursuant to article thirty-one or thirty-two of this chapter or dually licensed or certified under article thirty-one or thirty-two of this chapter and article twentyeight of the public health law; (ii) the actual costs of care associated with the delivery of behavioral health services; (iii) one or more alternative reimbursement models that would adequately compensate clinics licensed or holding an operating certificate under article thirtyone or thirty-two of this chapter or dually licensed under article thirty-one or thirty-two of this chapter and article twenty-eight of the public health law for their costs of care under medicaid managed care and child health plus; and (iv) any policy or fiscal resources necessary to carry out the recommendations of the report developed pursuant to this section. The report shall be submitted to the governor, the speaker of the assembly and the temporary president of the senate no later than October first, two thousand twenty-one.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the mental hygiene law, in relation to establishing a workgroup to conduct analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health services
Purpose
The purpose of this bill is to ensure that mental health and substance use service providers have fisca11y viable programs.
Summary of provisions
This bill would require the commissioner of the Office of Mental Health (CMH) in collaboration with the commissioner of the Department of Health (DOH), and commissioner of the Office of Alcoholism and Subtance Abuse Services (OASAS) to establish a workgroup that would consist of behav- ioral health providers and other relevant stakeholders.
The workgroup would be tasked with conducting an analysis of the APG and commercial insurance rates for behavioral health services and develop a repart which would make recommendations pertaining to the following:
*Rate adequacy related to the existing APC, reimbursement provided under Medicaid managed care, as well as for commercial insurance rates: *The actual costs of care associated with the delivery of behavioral health services; *One or more alternative reimbursement models that would adequately compensate clinics for their costs of care under Medicaid managed care and child health plus; and *Any policy or fiscal resources necessary to carry out the recommenda- tions of the report developed pursuant to this section.
The report eouid be submitted to the governor, the speaker of the assem- bly, and the temporary president of the senate no later than October 1, 2021.
Statement of support
The enacted budget for state fiscal year 201'2020 extended the legal authority for the state mandate to provide behavioral health service providers the APG rate for services rendered until March 31, 2023.
Generally, the APG payment methodolcov allows for greater payment hono- geneity for comparable services across all ambulatory care settings.
Most importantly, the APG rate has given behavioral health service providers assurance that they will receive a rate for service which will enable such providers to maintain a fiscally viable program.
However, concerns have been raised by the behavioral health advocacy and service provider community that the APG rates are not keeping pace with the costs of care. Providers have a ranges of fixed and variable costs which a11 continne to rise, such as maintenace of facilities, providing staff benefits, etc. In addition, commercial insurance rates are far less and must be brought on par with APG rates to ensure equal access to care for commercial insurance beneficiaries. This bill would help to ensure that behavioral health programs can provide quality care and maintain fiscal viabilty by requiring the commissioner of OMH in collaboration with the commissioner of DOH, and the commissioner of OASAS to establish a workgroup that would be tasked with conducting an analysis of the APG and commercial insurance rates for behavioral health services and make recommendations that would assist the State in providing an adequate service rate which reflects the cost of care.
Prior legislative history
This is a new bill.
Fiscal implications
Undetermined.
Effective date
This act shall take effect on the ninetieth after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.