senate Bill S6742

Amended

Provides that medicaid reimbursement for services to medically fragile children by pediatric rehabilitation diagnostic and treatment centers be fee-for-service

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 16 / Mar / 2012
    • REFERRED TO HEALTH
  • 27 / Mar / 2012
    • 1ST REPORT CAL.465
  • 28 / Mar / 2012
    • 2ND REPORT CAL.
  • 29 / Mar / 2012
    • ADVANCED TO THIRD READING
  • 23 / May / 2012
    • AMENDED ON THIRD READING (T) 6742A
  • 20 / Jun / 2012
    • PASSED SENATE
  • 20 / Jun / 2012
    • DELIVERED TO ASSEMBLY
  • 20 / Jun / 2012
    • REFERRED TO WAYS AND MEANS

Summary

Provides that medicaid reimbursement for services to medically fragile children rendered by pediatric rehabilitation diagnostic and treatment centers shall be at a fee-for-service rate until the workgroup on medicaid payment for services for medically fragile children completes its report.

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Bill Details

Versions:
S6742
S6742A
Legislative Cycle:
2011-2012
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Add §2804-b, Pub Health L

Votes

15
0
15
Aye
0
Nay
2
aye with reservations
0
absent
0
excused
0
abstained
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Sponsor Memo

BILL NUMBER:S6742

TITLE OF BILL:
An act to amend the public health law, in relation to establishing the
New York state workgroup on Medicaid reimbursement for medically
fragile children

PURPOSE OR GENERAL IDEA OF BILL:
To establish a workgroup on Medicaid reimbursement for medically
fragile children in order to determine the most appropriate
reimbursement methodologies for this unique population.

SUMMARY OF PROVISIONS:
Section 1 adds a new Public Health Law §2804-b to establish the New
York state workgroup on Medicaid reimbursement for medically fragile
children. This section requires the commissioner, within 30 days of
the effective date, to convene and chair, directly or through a
designee, this workgroup to examine, evaluate and provide
recommendations on the adequacy and viability of Medicaid
reimbursement rates to certain pediatric providers who provide
critical services for medically fragile children.

The workgroup shall be comprised of stakeholders of medically fragile
children, including providers of pediatric nursing homes, home health
care agencies affiliated with pediatric nursing homes, and diagnostic
and treatment centers which primarily serve medically fragile
children, and other experts chosen by the commissioner. Members of the
workgroup shall have demonstrated knowledge and experience in
providing care to medically fragile children in pediatric nursing
homes, home health care agencies affiliated with pediatric nursing
homes, and diagnostic and treatment centers which primarily serve
medically fragile children, including those who provide care primarily
to the Medicaid population. A majority of workgroup members shall
constitute a quorum. Such members shall be allowed actual and
necessary expenses in the performance of their duties, but shall not
receive compensation. This section also specifies, at a minimum, the
reimbursement methodologies to be considered by the workgroup for
recommended changes. The workgroup is required to submit its findings
and recommendations in a report to the commissioner, the chair of the
Senate Finance Committee and the chair of the Assembly Ways & Means
Committee prior to January 1, 2013.

Lastly, this section provides that notwithstanding any other provision
of law to the contrary, services provided to medically fragile
children residing in pediatric nursing homes, receiving services at
pediatric rehabilitation diagnostic and treatment centers or home
health care agencies affiliated with pediatric nursing homes shall be
reimbursed at a fee-for-service Medicaid rate during the deliberations
of the workgroup and until such report is finalized and delivered. Any
change in reimbursement methodology necessary as a result of this
section shall be implemented by the department within 30 days of the
effective date of this section. The findings and recommendations in
the workgroup's report shall be approved, revised or rejected by the
legislature prior to the adoption of an alternative reimbursement
methodology.


Section 2 of the bill provides for an effective date.

JUSTIFICATION:
New York's health care reimbursement system has historically treated
providers of medically fragile children distinct from other health
care providers in light of the unique needs of the children they
serve. However, recent changes to Medicaid payment methodologies have
failed to recognize the unique nature of these facilities, and are
failing to adequately reimburse the cost of care for this extremely
small, yet highly complex population. For example, the implementation
of ambulatory patient groups which do not have a mechanism to
distinguish reimbursement for highly complex children have had a
negative effect on pediatric specialty clinics. Further, the
transition to Medicaid managed Care, which is scheduled to take place
this October, could be detrimental to highly specialized pediatric
nursing homes. Accordingly, this bill establishes a workgroup to
determine the most appropriate reimbursement methodologies to be used
to ensure the continued viability of these facilities, and authorizes
fee-for-service payments until the results of this workgroup are
released.

PRIOR LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6742

                            I N  S E N A T E

                             March 16, 2012
                               ___________

Introduced  by  Sens.  HANNON,  CARLUCCI,  DeFRANCISCO, GOLDEN, JOHNSON,
  KLEIN, LARKIN, LAVALLE, MARTINS, McDONALD, SALAND, SAVINO, VALESKY  --
  read  twice  and  ordered printed, and when printed to be committed to
  the Committee on Health

AN ACT to amend the public health law, in relation to  establishing  the
  New York state workgroup on Medicaid reimbursement for medically frag-
  ile children

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  The public health law is amended by adding a  new  section
2804-b to read as follows:
  S  2804-B.  NEW  YORK  STATE  WORKGROUP  ON MEDICAID REIMBURSEMENT FOR
MEDICALLY FRAGILE CHILDREN. 1. THE  COMMISSIONER  SHALL,  WITHIN  THIRTY
DAYS  OF THE EFFECTIVE DATE OF THIS SECTION, CONVENE AND CHAIR, DIRECTLY
OR THROUGH A DESIGNEE OR DESIGNEES, A NEW YORK STATE WORKGROUP ON  MEDI-
CAID  REIMBURSEMENT  FOR MEDICALLY FRAGILE CHILDREN TO EXAMINE, EVALUATE
AND PROVIDE RECOMMENDATIONS ON THE ADEQUACY AND  VIABILITY  OF  MEDICAID
REIMBURSEMENT  RATES TO CERTAIN PEDIATRIC PROVIDERS WHO PROVIDE CRITICAL
SERVICES FOR MEDICALLY FRAGILE CHILDREN.
  2. SUCH WORKGROUP SHALL BE  COMPRISED  OF  STAKEHOLDERS  OF  MEDICALLY
FRAGILE  CHILDREN,  INCLUDING PROVIDERS OF PEDIATRIC NURSING HOMES, HOME
CARE AGENCIES AFFILIATED WITH PEDIATRIC NURSING HOMES AND DIAGNOSTIC AND
TREATMENT CENTERS WHICH PRIMARILY SERVE MEDICALLY FRAGILE CHILDREN,  AND
OTHER EXPERTS CHOSEN BY THE COMMISSIONER. MEMBERS OF THE WORKGROUP SHALL
HAVE   DEMONSTRATED  KNOWLEDGE  AND  EXPERIENCE  IN  PROVIDING  CARE  TO
MEDICALLY FRAGILE CHILDREN IN PEDIATRIC NURSING HOMES, HOME  CARE  AGEN-
CIES  AFFILIATED  WITH PEDIATRIC NURSING HOMES AND DIAGNOSTIC AND TREAT-
MENT CENTERS WHICH PRIMARILY SERVE MEDICALLY FRAGILE CHILDREN, INCLUDING
PROVIDERS WHO PROVIDE CARE PRIMARILY TO  THE  MEDICAID  POPULATION.  THE
PRESENCE OF A MAJORITY OF THE MEMBERS SHALL CONSTITUTE A QUORUM. MEMBERS
SHALL  RECEIVE  NO COMPENSATION FOR THEIR SERVICES, BUT SHALL BE ALLOWED
ACTUAL AND NECESSARY EXPENSES IN THE PERFORMANCE OF THEIR DUTIES  PURSU-
ANT TO THIS SECTION.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14924-02-2

S. 6742                             2

  3.  THE  WORKGROUP  SHALL  DEVELOP  AND  RECOMMEND CHANGES TO MEDICAID
REIMBURSEMENT RATES FOR PEDIATRIC  NURSING  HOMES,  HOME  CARE  AGENCIES
AFFILIATED  WITH  PEDIATRIC  NURSING  HOMES AND DIAGNOSTIC AND TREATMENT
CENTERS PRIMARILY PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN,  INCLUD-
ING BUT NOT LIMITED TO:
  (A)  THE  ADEQUACY  OF  CURRENT  AMBULATORY  PATIENT  GROUP  RATES  OF
REIMBURSEMENT FOR PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS THAT PRIMA-
RILY PROVIDE REHABILITATION AND  CARE  TO  MEDICALLY  FRAGILE  CHILDREN,
RECOMMENDING  MODIFICATIONS, WHERE APPROPRIATE, TO PROTECT THE VIABILITY
OF SUCH FACILITIES. SUCH  RECOMMENDATIONS  SHALL  INCLUDE,  BUT  NOT  BE
LIMITED  TO,  AN ANALYSIS OF WHETHER SUCH FACILITIES SHALL RECEIVE SEPA-
RATE AND DISTINCT AMBULATORY PATIENT GROUP BASE  RATES,  AND  ANY  OTHER
MODIFICATIONS TO THE AMBULATORY PATIENT GROUP METHODOLOGY TO ENSURE THAT
SUCH RATES ADEQUATELY REIMBURSE THE COST OF PROVIDING REHABILITATION AND
CARE TO MEDICALLY FRAGILE CHILDREN;
  (B)  THE  ADEQUACY  AND  APPROPRIATENESS  OF THE CURRENT REIMBURSEMENT
METHODOLOGY FOR PEDIATRIC NURSING HOMES, AND HOME CARE  AGENCIES  AFFIL-
IATED  WITH  PEDIATRIC  NURSING  HOMES RECOMMENDING MODIFICATIONS, WHERE
APPROPRIATE, TO PROTECT THE VIABILITY OF SUCH FACILITIES. SUCH RECOMMEN-
DATIONS, SHALL INCLUDE, BUT NOT BE LIMITED TO, THE DEVELOPMENT OF A  NEW
PEDIATRIC  NURSING HOME RATE, THE DEVELOPMENT OF NEW RATES FOR HOME CARE
AGENCIES AFFILIATED WITH PEDIATRIC NURSING  HOMES THE APPROPRIATE USE OF
CASE MIX ADJUSTMENTS FOR THIS POPULATION,  ANY  ADDITIONAL  SUPPLEMENTAL
ADJUSTMENTS  THAT  ARE  DEEMED  NECESSARY AND APPROPRIATE, AND ANY OTHER
REVISIONS NECESSARY TO ENSURE THAT SUCH RATES ADEQUATELY  REIMBURSE  THE
COST OF PROVIDING REHABILITATION AND CARE TO MEDICALLY FRAGILE CHILDREN;
  (C)  THE  MEDICAID MANAGED CARE PREMIUM METHODOLOGY TO PEDIATRIC DIAG-
NOSTIC AND TREATMENT CENTERS PRIMARILY PROVIDING REHABILITATION AND CARE
TO MEDICALLY FRAGILE CHILDREN, AND  WHETHER  SUCH  PLAN  PREMIUMS  SHALL
INCLUDE  AN  ADD-ON  TO  REFLECT  THE  AMBULATORY  PATIENT GROUP RATE OF
REIMBURSEMENT;
  (D) THE TRANSITION OF THE PEDIATRIC NURSING HOME POPULATION AND  BENE-
FIT  INTO MEDICAID MANAGED CARE, INCLUDING HOME CARE AGENCIES AFFILIATED
WITH PEDIATRIC NURSING HOMES AND WHETHER SUCH A TRANSITION WOULD PROVIDE
ADEQUATE REIMBURSEMENT TO SUCH FACILITIES TAKING INTO ACCOUNT  THE  COST
OF  PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN NECESSARY AND APPROPRI-
ATE TO MEET THEIR NURSING AND RELATED CARE NEEDS AS WELL AS THEIR DEVEL-
OPMENTAL NEEDS. SUCH ANALYSIS SHALL ALSO INCLUDE AN EXAMINATION  OF  THE
DEPARTMENT'S  CASE  MIX  INDEX AND CONSIDERATION OF THE DEVELOPMENT OF A
NEW OR MODIFIED CASE MIX INDEX THAT  ADEQUATELY  CAPTURES  THE  COST  OF
PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN;
  (E) THE EVALUATION OF ALTERNATIVES TO MAINSTREAM MEDICAID MANAGED CARE
FOR  MEDICALLY  FRAGILE CHILDREN RESIDING IN PEDIATRIC NURSING HOMES AND
PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS PRIMARILY  SERVING  MEDICALLY
FRAGILE CHILDREN, OR SERVED BY HOME CARE AGENCIES AFFILIATED WITH PEDIA-
TRIC  NURSING HOMES INCLUDING THE DEVELOPMENT OF DEMONSTRATION PROJECTS,
TO TEST ALTERNATIVE PAYMENT AND CARE MANAGEMENT MODELS FOR THIS  COMPLEX
PATIENT  POPULATION.  SUCH  EVALUATION  SHALL  INCLUDE  CONSIDERATION OF
WHETHER PEDIATRIC NURSING HOMES AND/OR  PEDIATRIC  SPECIALTY  DIAGNOSTIC
AND TREATMENT CENTERS SHALL REMAIN IN FEE-FOR-SERVICE MEDICAID;
  (F)  THE  EXAMINATION OF PROVIDING RETROACTIVE, TEMPORARY, OR PROSPEC-
TIVE RATE RELIEF TO PROVIDERS WITH DEMONSTRATED FINANCIAL  HARDSHIP  WHO
EXCLUSIVELY PROVIDE CARE TO MEDICALLY FRAGILE CHILDREN;
  (G)  A  COST-BENEFIT ANALYSIS, INCLUDING BUT NOT LIMITED TO, EXAMINING
HOW SUCH SERVICES PROVIDED TO  MEDICALLY  FRAGILE  CHILDREN  IN  NURSING
HOMES,  HOME  CARE  AGENCIES AFFILIATED WITH PEDIATRIC NURSING HOMES AND

S. 6742                             3

PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS ARE COST  EFFECTIVE  COMPARED
TO OTHER ALTERNATIVES OF CARE SUCH AS ACUTE CARE SETTINGS;
  (H)  CONSIDERATION  OF  THE  MEASURES  NEEDED  TO MAINTAIN FINANCIALLY
VIABLE PEDIATRIC PROVIDERS IN THE STATE SUFFICIENT TO MEET THE NEEDS  OF
THE STATE'S MEDICALLY FRAGILE CHILDREN; AND
  (I)  ANY OTHER AREAS DEEMED APPROPRIATE BY THE COMMISSIONER OR MEMBERS
OF THE WORKGROUP.
  4. PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN, THE WORKGROUP  SHALL
PRESENT  ITS FINDINGS AND RECOMMENDATIONS IN A REPORT, AND SHALL PROVIDE
SUCH REPORT TO THE COMMISSIONER, THE CHAIR OF THE SENATE FINANCE COMMIT-
TEE, THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE,  THE  CHAIR  OF
THE SENATE HEALTH COMMITTEE AND THE CHAIR OF THE ASSEMBLY HEALTH COMMIT-
TEE.
  5.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW  TO  THE CONTRARY,
SERVICES PROVIDED TO MEDICALLY FRAGILE CHILDREN  RESIDING  IN  PEDIATRIC
NURSING  HOMES  RECEIVING SERVICES AT HOME CARE AGENCIES AFFILIATED WITH
PEDIATRIC NURSING HOMES OR RECEIVING  SERVICES  AT  PEDIATRIC  REHABILI-
TATION  DIAGNOSTIC  AND  TREATMENT  CENTERS ESTABLISHED PURSUANT TO THIS
ARTICLE SHALL BE REIMBURSED AT A FEE-FOR-SERVICE  MEDICAID  RATE  DURING
THE  DELIBERATIONS  OF  THE WORKGROUP AND UNTIL SUCH REPORT IS FINALIZED
AND DISTRIBUTED TO THE COMMISSIONER, THE CHAIR  OF  THE  SENATE  FINANCE
COMMITTEE, THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE, THE CHAIR
OF  THE  SENATE  HEALTH  COMMITTEE  AND THE CHAIR OF THE ASSEMBLY HEALTH
COMMITTEE. ANY CHANGE IN REIMBURSEMENT METHODOLOGY NECESSARY AS A RESULT
OF THIS SECTION SHALL BE IMPLEMENTED BY  THE  DEPARTMENT  WITHIN  THIRTY
DAYS  OF THE EFFECTIVE DATE OF THIS SECTION.  THE FINDINGS AND RECOMMEN-
DATIONS IN THE WORKGROUP'S REPORT SHALL BE APPROVED, REVISED OR REJECTED
BY THE LEGISLATURE PRIOR TO THE ADOPTION OF AN ALTERNATIVE REIMBURSEMENT
METHODOLOGY.
  S 2. This act shall take effect immediately.

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