senate Bill S5483A

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

See Assembly Version of this Bill:
A7665C
Versions:
S5483
S5483A
Legislative Cycle:
2013-2014
Law Section:
Public Health Law
Laws Affected:
Amd §2807, Pub Health L

Sponsor Memo

BILL NUMBER:S5483A

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 the Commissioner of Health may
waive recoupment of Medicaid payments for capital costs for the period
September 2009 to December 31, 2012 for 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,

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 fox 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.

For some clinics, the total capital recoupment amount represents a
significant portion of their total operating funds. 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.

This legislation will mitigate the impact of the capital recalculation
by allowing the Commissioner of Health to fully or partially waive or
modify retroactive recoupments from the 2009-2012 period when
necessary in order to keep DTCs open and able to provide healthcare
services 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--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sens.  HANNON,  FELDER, LARKIN -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Health
  -- reported favorably from said committee and committed to the Commit-
  tee   on  Finance  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

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)  NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, FOR A
DIAGNOSTIC AND TREATMENT CENTER LICENSED PURSUANT TO THIS  ARTICLE  THAT
PROVIDES,  AS ITS PRINCIPAL MISSION, SERVICES TO INDIVIDUALS WITH DEVEL-
OPMENTAL DISABILITIES, THE COMMISSIONER MAY FULLY OR PARTIALLY WAIVE  OR
MODIFY  RECOUPMENT  OF  MEDICAL ASSISTANCE PAYMENTS BASED ON RETROACTIVE
CHANGES TO THE APPLICABLE FORMULA FOR CAPITAL COSTS FOR  THE  PERIOD  OF
SEPTEMBER  FIRST,  TWO THOUSAND NINE TO DECEMBER THIRTY-FIRST, TWO THOU-
SAND TWELVE.
  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.



 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11118-08-3

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