senate Bill S5483

Amended

Relates to waiving recoupment of medical assistance payments for the capital costs of diagnostic and treatment centers primarily engaged in providing services to the developmentally disabled

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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 / May / 2013
    • REFERRED TO HEALTH
  • 10 / Jun / 2013
    • REPORTED AND COMMITTED TO FINANCE
  • 17 / Jun / 2013
    • AMEND AND RECOMMIT TO FINANCE
  • 17 / Jun / 2013
    • PRINT NUMBER 5483A
  • 20 / Jun / 2013
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 20 / Jun / 2013
    • ORDERED TO THIRD READING CAL.1535
  • 20 / Jun / 2013
    • SUBSTITUTED BY A7665C

Summary

Relates to waiving recoupment of medical assistance payments for the capital costs of diagnostic and treatment centers primarily engaged in providing services to the developmentally disabled.

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Bill Details

Versions:
S5483
S5483A
Legislative Cycle:
2013-2014
Law Section:
Public Health Law
Laws Affected:
Amd ยง2807, Pub Health L

Votes

16
0
16
Aye
0
Nay
1
aye with reservations
0
absent
0
excused
0
abstained
show Health committee vote details

Sponsor Memo

BILL NUMBER:S5483

TITLE OF BILL: An act to amend the public health law, in relation to
medical assistance payments for capital costs for certain diagnostic
and treatment centers

PURPOSE: The purpose of this bill is to ensure the financial stability
of diagnostic and treatment centers that provide critical services to
persons with developmental disabilities.

SUMMARY OF PROVISIONS:

Section 1 of this bill provides that a Diagnostic and Treatment Center
(D&TC) licensed under Article 28 of the Public Health Law that
provides, as its principal mission, services to individuals with
developmental disabilities, shall not be subject to any recoupment of
Medicaid payments for capital costs for the period September 2009 to
December 31, 2012.

In addition, Section 1 of the bill provides that reduced Medicaid
payments to such D&TCs by the New York State Department of Health will
be phased in over a period of 4 years, beginning January 1, 2013. The
payments will reflect a blended rate that includes: 1) the capitol
average Medicaid payment per claim that was in effect in 2007 and; 2)
a 2-year lagged rolling base year methodology.

Section 2 provides that the bill takes effect immediately and is
deemed to be in full force and effect on and after September 1, 2009.

JUSTIFICATION: Article 28 Diagnostic and Treatment Centers (DTCs),
with a primary mission to serve individuals with developmental
disabilities, were established to provide healthcare for individuals
with disabilities who other health care providers could not or would
not serve. These DTCs were established by not-for-profit providers and
family members who could not find healthcare services for individuals
with developmental disabilities. The reimbursement for these DTCs was
cost based until the rates were frozen in 1994. From 1994 until
September 2009, these clinics did not receive any increase, trend or
COLA to their reimbursement rate even though health care costs rose by
double digits annually. Overall, these DTC reimbursement rates were
inadequate to cover costs and led to deficits which averaged 20% of
operating costs. Then in September 2009, New York State began
implementation of the APG reimbursement system.

In the transition to APGs there was no recognition of the fifteen
years of unreimbursed costs. There was a recognition that in moving
forward, New York State wanted to invest in more primary and
preventive care in order to save money on acute and emergency care and
provide better health outcomes. DTCs, with a primary mission to serve
individuals with developmental disabilities, struggled to position
themselves in the evolving healthcare landscape to meet the needs of
their local communities and New York State.

In February 2013, as these DTCs continued to lose about 20% on
operations, the Department of Health (DOH) began to recoup 15% of
Medicaid payments. This 15% recoupment of clinics' Medicaid payment
was based on the retroactive recalculation of capital payments back to


September 1, 2009. The capital reimbursement that DTCs were receiving
up to this point had been calculated by DOH based on the DTCs 1992
cost report. When DOH implemented APGs they continued the capital
reimbursement and then three and a half years later decided to
retroactively recalculate these capital payments. As a result, these
DTC, which serve extremely vulnerable New Yorkers and have been
experiencing 20% losses, were suddenly and without warning losing an
additional 15% of their Medicaid payments.

This total capital recoupment amount results in a significant portion
of many DTCs overall clinic operations. One clinic, in Upstate New
York, would have a $700,000 recoupment on a $2 million annual budget.
Recoupments of this magnitude will close these DTCs that serve
patients who will otherwise have no or extremely limited access to
healthcare.

Therefore, this legislation will mitigate the impact of the capital
recalculation and allow DTC to continue to provide healthcare to the
most vulnerable New Yorkers.

PRIOR LEGISLATIVE HISTORY: None.

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: Immediately and deemed to be in full force and effect
on and after September 1, 2009.

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

                                  5483

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

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 public health law, in relation to medical assistance
  payments for  capital  costs  for  certain  diagnostic  and  treatment
  centers

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

  Section 1. Subdivision 2 of section 2807 of the public health  law  is
amended by adding a new paragraph (c) to read as follows:
  (C)  (I) NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, A
DIAGNOSTIC AND TREATMENT CENTER LICENSED PURSUANT TO THIS  ARTICLE  THAT
PROVIDES,  AS ITS PRINCIPAL MISSION, SERVICES TO INDIVIDUALS WITH DEVEL-
OPMENTAL DISABILITIES, SHALL NOT BE SUBJECT TO ANY RECOUPMENT OF MEDICAL
ASSISTANCE PAYMENTS FOR CAPITAL COSTS FOR THE  PERIOD  SEPTEMBER  FIRST,
TWO THOUSAND NINE TO DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE.
  (II)  NOTWITHSTANDING  ANY OTHER PROVISION OF LAW TO THE CONTRARY, THE
CAPITAL COST PER VISIT FOR A DIAGNOSTIC AND  TREATMENT  CENTER  LICENSED
PURSUANT  TO  THIS  ARTICLE  THAT  PROVIDES,  AS  ITS PRINCIPAL MISSION,
SERVICES TO INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, SHALL BE:
  (A) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND THIRTEEN THROUGH DECEM-
BER THIRTY-FIRST, TWO THOUSAND THIRTEEN,  SEVENTY-FIVE  PERCENT  OF  THE
AVERAGE  CAPITAL  COST  PER  VISIT PROVIDED TO THAT FACILITY IN CALENDAR
YEAR TWO THOUSAND SEVEN AND TWENTY-FIVE PERCENT OF THE CAPITAL COST  PER
VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND ELEVEN;
  (B) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH DECEM-
BER  THIRTY-FIRST,  TWO  THOUSAND FOURTEEN, FIFTY PERCENT OF THE AVERAGE
CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN  CALENDAR  YEAR  TWO
THOUSAND  SEVEN AND FIFTY PERCENT OF THE CAPITAL COST PER VISIT PROVIDED
TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND TWELVE;
  (C) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND FIFTEEN THROUGH  DECEM-
BER THIRTY-FIRST, TWO THOUSAND FIFTEEN, TWENTY-FIVE PERCENT OF THE AVER-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11118-01-3

S. 5483                             2

AGE  CAPITAL  COST  PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR
TWO THOUSAND SEVEN AND SEVENTY-FIVE PERCENT  OF  THE  CAPITAL  COST  PER
VISIT  PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND THIRTEEN;
AND
  (D)  FOR THE PERIOD JANUARY FIRST, TWO THOUSAND SIXTEEN THROUGH DECEM-
BER THIRTY-FIRST, TWO THOUSAND SIXTEEN,  ZERO  PERCENT  OF  THE  AVERAGE
CAPITAL  COST  PER  VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO
THOUSAND SEVEN AND ONE HUNDRED PERCENT OF THE  CAPITAL  COST  PER  VISIT
PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND FOURTEEN.
  S  2.  This  act  shall take effect immediately and shall be deemed to
have been in full force and effect on and  after  September  first,  two
thousand nine.

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