BILL NUMBER:A458

TITLE  OF BILL:  An act to amend chapter 631 of the laws of 1997, amend-
ing the social services law relating to authorizing  medical  assistance
payments  to  certain  clinics  or  diagnostic and treatment centers, in
relation to extending the effectiveness thereof

PURPOSE:
The purpose of this bill is to continue  to  allow  certain  Article  28
clinics  to  bill  Medicaid  for  Individual  Education  Programs (IEPs)
related services for eligible preschool special education students until
the Department of Education implements a new preschool special education
rate-setting methodology.

SUMMARY OF SPECIFIC PROVISIONS:
Extends the sunset date of Chap. 47 of 2005 to July 1, 2011.

JUSTIFICATION:
When Social Services Law section 368-d and section 368-e were enacted in
1989, the intent was to increase the potential for  Medicaid  reimburse-
ment,  not  to  limit  who could bill Medicaid for IEP-related services.
Prior to this law, school districts and municipalities were not  billing
Medicaid  and,  therefore,  the  State  and municipalities lost Medicaid
revenue for children whose IEP-related services were not billed  through
a special education program which had an Article 28 clinic.

              

Currently, certain clinics across the state provide the related services
of  physical  therapy, speech therapy, and occupational therapy to Medi-
caid eligible preschoolers who attend their State  Education  Department
(SED) approved programs and bill Medicaid for the services through their
Article 28 clinics. SED then offsets the tuition rate for their programs
with  Medicaid reimbursement. The amount of reimbursement depends on the
number of Medicaid children, the number  of  related  services  provided
based on IEP requirements, and the clinic's Medicaid rate.

In  October  1993,  the  Office  of  Temporary and Disability Assistance
(OTDA), formerly the New York State Department of Social Services (DSS),
sent out a Medicaid Update which stated  that  only  municipalities  and
school  districts could bill Medicaid for IEP related services, which it
renamed Supportive Health Services. When OTDA and SED studied the fiscal
ramifications of not allowing clinics to bill for these  services,  they
revised their policy.

If  this  interpretation  by  OTDA were to ever be implemented, New York
State would incur additional costs. Clinic rates would increase  due  to
elimination  of  these services from current clinic reimbursement calcu-
lations, and the tuition rates of the preschool programs  will  increase
by the amount that had previously been offset by the Medicaid reimburse-
ment.  This  tuition  increase  would  be for all children, not just the
children who are eligible for Medicaid.

Since 1996, enacted legislation has continued the authority for  Article
28  clinics  to  bill Medicaid directly during which time a state evalu-
ation would be done. After all these  years,  no  evaluation  has  taken
place.  The legislation has also required that both the actual full cost
of  any  IEP related services incurred by any Article 28 clinic directly
billing Medicaid and the associated Medicaid revenue be reported on  the
New  York  State  Consolidated  Fiscal  Report.    Since  this reporting
requirement was implemented there have been no reports of double billing
or other fraud.

This year, Gov. Spitzer's Article VII Education  budget  bill  seeks  to
create  a  Temporary  Task  Force  on  Preschool  Education to study the
relationship between early childhood programs, their system of  delivery
and  their  funding  methodology.  While this task force would be a long
overdue and welcomed step, this legislation is necessary to continue the
authority for certain Article 28 clinics to bill Medicaid  for  services
rendered by them for preschool special education students.

LEGISLATIVE HISTORY:
A.5710 was signed into law Chap. 47 of 2007.
A.4248 was signed into law Chap. 142 of 2005.
A.9869 was signed into law Chap. 99 of 2002

FISCAL IMPLICATIONS:
To be determined.

EFFECTIVE DATE:
Immediately.