Senate Bill S2513

                                 BILL NUMBER:  S2513         REVISED 03/19/09

 TITLE OF BILL :
An act to amend chapter 631 of the laws of 1997, amending 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
reimbursement, 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 Medicaid 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 EIP
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
calculations, and the tuition rates of the preschool programs will
increase by the amount that had previously been offset by the Medicaid
reimbursement. 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
evaluation 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.

 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.