BILL NUMBER: S3092

SPONSOR: HELMING
 
TITLE OF BILL:

An act to amend the public health law, in relation to directing the
commissioner of health to make recommendations relating to increasing
certain ambulatory patient group reimbursement rates and certain
reimbursement rates for patient health care services provided by physi-
cians in rural and underserved areas

 
PURPOSE:

Directs the Commissioner of Health to make recommendations to the Gover-
nor and the Legislature on increasing ambulatory patient group rates for
services provided by rural critical access hospitals and on increasing
reimbursement rates for patient health services provided by physicians
in rural and underserved areas.

 
SUMMARY OF PROVISIONS:

Section 1: Amends Subdivision 2-a of section 2807 of the Public Health
              

Law by adding a new paragraph (j) directing the Commissioner of Health,
in conjunction with hospital industry representatives, to make written
recommendations to the Governor and the Legislature, including proposed
legislation, for increasing Ambulatory Patient group rates for rural
critical access hospitals by October 1, 2021.  The recommendations must
account for increased operating expenses of inherent to these hospitals,
as well as the need to maintain access, in rural areas. The proposed
language, subject to legislative approval, would be for inclusion in the
2024-2025 state budget, with rate increases to be effective April
1,2024.

Section one further directs the Commissioner of Health to provide writ-
ten recommendations, including proposed legislation, to the Governor and
Legislature on increasing reimbursement rates for patient health care
services provided by physicians in rural and underserved areas.

Section 2: provides the enactment date.

 
JUSTIFICATION:

Critical access hospitals (CAH) serve medically underserved geograph-
ically isolated communities. They provide limited stay special care,
acute care and swing bed services, as well as 24-hour emergency service
capability. The maintenance of CAHs is critical for preserving access to
basic health care services for rural New Yorkers. Currently, Medicare
reimburses CAHs on the basis of reasonable costs, while New York State
Medicaid reimbursement rates are capped at lower than operational costs.

Because these hospitals must distribute substantial fixed costs over a
small number of visits, an enhanced Medicaid reimbursement would help to
ensure their long-range financial viability and preserve access to need-
ed health care services for isolated communities. Further, this main-
tains the State's shift in policy of preserving patient care while
improving population health through shifting to outpatient care. This
legislation would support these goals.


Beginning in late 2008, the Department, of Health began to implement a
new outpatient payment system that focuses reimbursement based upon the
intensity of the services provided known as Ambulatory patient groups
(APGs).

This legislation would require the Commissioner of Health and the Hospi-
tal industry to collaboratively produce recommendations and legislative
language to provide for an enhanced APG rate that recognize the low
volume, costly nature of a rural safety net provider. This legislative
proposal will be for inclusion in the SFY 2022/2023 Budget and effective
on April 1, 2024.

Because APGs are an already existing rate structure, this legislation
provides consistency with reimbursement methodologies currently used to
pay for outpatient services performed by hospitals, negates the needs
for DOH to implement a new payment methodology specific to CAHs, and
ensures CAHs will receive crucial funding to preserve their fiscal
viability.

Additionally, this legislation would require the Commissioner of Health,
in conjunction with representatives of physician advocacy organizations,
including the Medical Society, to provide written recommendations and a
report and suggested legislation on increasing reimbursement rates for
patient health care services provided by physicians in rural and under-
served areas.

 
LEGISLATIVE HISTORY:

2021-2022: S.2607 referred to Health

2020: S.2086-A referred to Health

2019: S.2086 referred to Health

2018: S.4532-A referred to Health

2017: S.4532 referred to Health

2016: S.6619 referred to Health/A.7101-A amend and recommit to Health

2015: S.1288 referred to Health/A.7101 referred to health

2014: S.4375-A referred to Health

2013: S.4375 reported and Committed to Finance

 
FISCAL IMPLICATIONS:

Undetermined.

 
EFFECTIVE DATE:
This act shall take effect immediately.