S T A T E O F N E W Y O R K
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7298--A
2015-2016 Regular Sessions
I N A S S E M B L Y
May 4, 2015
___________
Introduced by M. of A. NOJAY, PALMESANO -- read once and referred to the
Committee on Health -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the social services law, in relation to medicaid
reimbursement; and repealing certain provisions of such law relating
thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 368-a of the social services law is REPEALED and a
new section 368-a is added to read as follows:
S 368-A. STATE REIMBURSEMENT. 1. THE DEPARTMENT SHALL REVIEW THE
EXPENDITURES MADE BY LOCAL SOCIAL SERVICES DISTRICTS FOR MEDIAL ASSIST-
ANCE FOR NEEDY PERSONS, AND THE ADMINISTRATION THEREOF, BEFORE MAKING
REIMBURSEMENT. BEFORE APPROVING SUCH EXPENDITURES FOR REIMBURSEMENT, THE
DEPARTMENT SHALL GIVE DUE CONSIDERATION TO THE RESULTS OF THE REVIEWS
AND AUDITS CONDUCTED BY THE DEPARTMENT OF HEALTH PURSUANT TO SUBDIVISION
TWO OF SECTION THREE HUNDRED SIXTY-FOUR OF THIS TITLE. IF APPROVED BY
THE DEPARTMENT, SUCH EXPENDITURES SHALL NOT BE SUBJECT TO REIMBURSEMENT
BY THE STATE PURSUANT TO SECTION ONE HUNDRED FIFTY-THREE OR ANY
PROVISION OF THIS CHAPTER OTHER THAN THIS SECTION, BUT SHALL BE SUBJECT
TO REIMBURSEMENT BY THE STATE IN ACCORDANCE WITH THIS SECTION AND THE
REGULATIONS OF THE DEPARTMENT, AS FOLLOWS:
THERE SHALL BE PAID TO EACH SUCH DISTRICT:
(A) THE AMOUNT OF FEDERAL FUNDS, IF ANY, PROPERLY RECEIVED OR TO BE
RECEIVED ON ACCOUNT OF SUCH EXPENDITURES;
(B) THE FULL AMOUNT EXPENDED ON BEHALF OF THE DEPARTMENT FOR MEDICAL
ASSISTANCE FURNISHED UNDER THIS TITLE TO ELIGIBLE PATIENTS IN STATE
INSTITUTIONS FOR THE MENTALLY DISABLED, IN FACILITIES OR PARTS THEREOF
FOR THE CARE AND TREATMENT OF DRUG DEPENDENT PERSONS OPERATED PURSUANT
TO THE MENTAL HYGIENE LAW AND IN OTHER HOSPITALS WHILE SUCH PATIENTS ARE
ON RELEASE FROM AN INSTITUTION IN THE STATE DEPARTMENT OF MENTAL HYGIENE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10272-03-5
A. 7298--A 2
OR FROM A DRUG ABUSE TREATMENT FACILITY OR PART THEREOF OPERATED IN
COMPLIANCE WITH APPLICABLE PROVISIONS OF LAW AND SUPERVISED BY THE
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, TO ELIGIBLE VETERANS
AND THEIR DEPENDENTS IN THAT PART OF THE NEW YORK STATE HOME FOR VETER-
ANS AND THEIR DEPENDANTS AT OXFORD THAT HAS BEEN APPROVED PURSUANT TO
LAW AS A NURSING HOME AND IN A HOSPITAL WHILE ON RELEASE FROM THAT HOME
FOR THE PURPOSE OF RECEIVING CARE IN SUCH HOSPITAL, IN THAT PART OF A
PUBLIC INSTITUTION OPERATED FOR THE CARE OF THE MENTALLY DISABLED THAT
HAS BEEN APPROVED PURSUANT TO LAW AS AN INTERMEDIATE CARE FACILITY, TO
ELIGIBLE VETERANS AND THEIR DEPENDENTS IN THAT PART OF THE NEW YORK
STATE HOME FOR VETERANS AND THEIR DEPENDENTS AT OXFORD THAT HAS BEEN
APPROVED PURSUANT TO LAW AS AN INTERMEDIATE CARE FACILITY AND IN A
HOSPITAL WHILE ON RELEASE FROM SUCH INTERMEDIATE CARE FACILITIES FOR THE
PURPOSE OF RECEIVING CARE IN SUCH HOSPITAL, AND FOR THE ADMINISTRATION
THEREOF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY
RECEIVED OR TO BE RECEIVED ON ACCOUNT THEREOF;
(C) THE FULL AMOUNT EXPENDED FOR MEDICAL ASSISTANCE FURNISHED UNDER
THIS TITLE TO ELIGIBLE INDIANS AND MEMBERS OF THEIR FAMILIES RESIDING ON
ANY INDIAN RESERVATION IN THIS STATE, AND FOR THE ADMINISTRATION THERE-
OF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY RECEIVED
OR TO BE RECEIVED ON ACCOUNT THEREOF;
(D) THE FULL AMOUNT EXPENDED FOR MEDICAL ASSISTANCE FURNISHED UNDER
THIS TITLE TO OTHER ELIGIBLE PERSONS, AND FOR THE ADMINISTRATION THERE-
OF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY RECEIVED
OR TO BE RECEIVED ON ACCOUNT THEREOF INCLUDING:
(I) THE DEVELOPMENT OF MEDICAL ASSISTANCE DATA SYSTEMS;
(II) MEDICAL ASSISTANCE FURNISHED TO PERSONS DESCRIBED IN SUBDIVISION
FIVE OF SECTION THREE HUNDRED SIXTY-FIVE OF THIS TITLE;
(III) THE FOLLOWING SERVICES: CARE, TREATMENT, MAINTENANCE AND NURSING
SERVICES IN NURSING HOMES AND HEALTH RELATED CARE AND SERVICES IN INTER-
MEDIATE CARE FACILITIES PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF
SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE;
HOME HEALTH SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (D) OF SUBDI-
VISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; PERSONAL
CARE SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (E) OF SUBDIVISION
TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; LONG TERM HOME
HEALTH CARE PROGRAMS SERVICES PROVIDED IN ACCORDANCE WITH SECTION THREE
HUNDRED SIXTY-SEVEN-C OF THIS TITLE; AND NURSING HOME TRANSITION AND
DIVERSION SERVICES PROVIDED IN ACCORDANCE WITH SUBDIVISION SIX-A OF
SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(IV) MEDICAL ASSISTANCE FOR THOSE INDIVIDUALS WHO ARE ELIGIBLE PURSU-
ANT TO SECTION THREE HUNDRED SIXTY-SIX OF THIS ARTICLE AS A RESULT OF A
MENTAL DISABILITY AS DETERMINED BY THE COMMISSIONER IN CONSULTATION WITH
THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMISSIONER OF
THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES AND WITH THE
APPROVAL OF THE DIRECTOR OF THE BUDGET;
(V) MEDICAL ASSISTANCE FURNISHED TO PERSONS DESCRIBED IN SUBDIVISION
EIGHT OF SECTION THREE HUNDRED SIXTY-FIVE OF THIS ARTICLE, INCLUDING THE
ADMINISTRATION THEREOF;
(VI) REIMBURSEMENTS FOR THE CARE AND SERVICES PROVIDED TO THOSE
PERSONS ELIGIBLE PURSUANT TO SUBPARAGRAPHS SEVEN OF PARAGRAPH (A) OF
SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(VII) PAYMENTS MADE, WHETHER BY THE DEPARTMENT ON BEHALF OF A LOCAL
SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-B
OF THIS ARTICLE OR BY A LOCAL SOCIAL SERVICES DISTRICT DIRECTLY, FOR A
SUPPLEMENTARY BAD DEBT AND CHARITY CARE ADJUSTMENT COMPONENT OF RATES OF
A. 7298--A 3
PAYMENT DETERMINED IN ACCORDANCE WITH SUBDIVISION FOURTEEN-A OF SECTION
TWENTY-EIGHT HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW FOR GENERAL HOSPI-
TAL INPATIENT HOSPITAL SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH
(B) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS
ARTICLE, LIMITED TO THE AMOUNT OF FEDERAL FUNDS PROPERLY RECEIVED OR TO
BE RECEIVED ON ACCOUNT OF SUCH EXPENDITURES; PROVIDED, HOWEVER, THAT
REIMBURSEMENT SHALL BE MADE BY THE STATE FOR THE FULL AMOUNT EXPENDED
FOR A SUPPLEMENTARY BAD DEBT AND CHARITY CARE ADJUSTMENT FOR A GENERAL
HOSPITAL OPERATED BY THE STATE OF NEW YORK OR BY THE STATE UNIVERSITY OF
NEW YORK;
(VIII) PAYMENTS MADE FOR A SUPPLEMENTARY LOW INCOME PATIENT ADJUSTMENT
COMPONENT OF RATES OF PAYMENT FOR A PUBLIC GENERAL HOSPITAL DETERMINED
IN ACCORDANCE WITH SUBDIVISION FOURTEEN-D OF SECTION TWENTY-EIGHT
HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW FOR GENERAL HOSPITAL INPATIENT
HOSPITAL SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF SUBDIVI-
SION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE, LIMITED
TO THE AMOUNT OF FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON
ACCOUNT OF SUCH EXPENDITURES; PROVIDED, HOWEVER, THAT REIMBURSEMENT
SHALL BE MADE BY THE STATE FOR THE FULL AMOUNT EXPENDED FOR A SUPPLEMEN-
TARY LOW INCOME PATIENT ADJUSTMENT FOR A GENERAL HOSPITAL OPERATED BY
THE STATE OF NEW YORK OR BY THE STATE UNIVERSITY OF NEW YORK;
(IX) MEDICAL ASSISTANCE FURNISHED UNDER THIS TITLE TO ELIGIBLE PERSONS
PURSUANT TO A STATEWIDE MANAGED CARE PLAN OR MANAGED CARE DEMONSTRATION
PROGRAM, OR TO ELIGIBLE PERSONS ENROLLED IN ANY HEALTH MAINTENANCE
ORGANIZATION OR OTHER ENTITY AUTHORIZED BY LAW TO FURNISH COMPREHENSIVE
HEALTH SERVICES PURSUANT TO A PLAN;
(X) PAYMENTS MADE FOR THE COMPONENT OF RATES OF PAYMENT FOR A GENERAL
HOSPITAL DETERMINED IN ACCORDANCE WITH PARAGRAPH (S) OF SUBDIVISION
ELEVEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW
FOR GENERAL HOSPITAL INPATIENT HOSPITAL SERVICES PROVIDED IN ACCORDANCE
WITH PARAGRAPH (B) OF SUBDIVISION TWO OF SECTION THREE HUNDRED
SIXTY-FIVE-A OF THIS ARTICLE;
(XI) PAYMENTS MADE FOR A PUBLIC GENERAL HOSPITAL INDIGENT CARE ADJUST-
MENT PAYMENT FOR A PUBLIC GENERAL HOSPITAL DETERMINED IN ACCORDANCE WITH
SUBDIVISION FOURTEEN-F OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THE
PUBLIC HEALTH LAW FOR GENERAL HOSPITAL INPATIENT HOSPITAL SERVICES
PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF SUBDIVISION TWO OF SECTION
THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE, LIMITED TO THE AMOUNT OF
FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH
EXPENDITURES; PROVIDED, HOWEVER, THAT REIMBURSEMENT SHALL BE MADE BY THE
STATE FOR THE FULL AMOUNT EXPENDED FOR A PUBLIC GENERAL HOSPITAL INDI-
GENT CARE ADJUSTMENT FOR A GENERAL HOSPITAL OPERATED BY THE STATE OF NEW
YORK OR BY THE STATE UNIVERSITY OF NEW YORK;
(XII) HEALTH CARE SERVICES AS DETERMINED IN ACCORDANCE WITH PARAGRAPH
(C) OF SUBDIVISION TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF THE
PUBLIC HEALTH LAW; AND
(XIII) HEALTH CARE SERVICES DESCRIBED IN SECTIONS THREE HUNDRED
SIXTY-EIGHT-D AND THREE HUNDRED SIXTY-EIGHT-E OF THIS TITLE.
2. (A) FOR THE PURPOSE OF STATE REIMBURSEMENT UNDER THIS TITLE,
EXPENDITURES FOR ADMINISTRATION OF MEDICAL ASSISTANCE FOR NEEDY PERSONS
SHALL INCLUDE EXPENDITURES FOR SALARIES OF EMPLOYEES OF LOCAL WELFARE
DEPARTMENTS, EXCEPT FOR THOSE EXCLUDED UNDER PARAGRAPH (B) OF THIS
SUBDIVISION; OPERATION, MAINTENANCE AND SERVICE COSTS; AND SUCH OTHER
EXPENDITURES, SUCH AS EQUIPMENT COSTS, DEPRECIATION CHARGES, AND RENTAL
VALUES, AS MAY BE APPROVED BY THE DEPARTMENT. IT SHALL NOT INCLUDE
EXPENDITURES FOR CAPITAL ADDITIONS OR IMPROVEMENTS.
A. 7298--A 4
(B) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE SALARY
OF A SOCIAL SERVICES OFFICIAL, OR A CHIEF EXECUTIVE OFFICER OF A SOCIAL
SERVICES DEPARTMENT, WHOSE QUALIFICATIONS DO NOT CONFORM TO THOSE FIXED
BY THE DEPARTMENT, OR A CITY OR TOWN SERVICE OFFICER; NOR SHALL SUCH
REIMBURSEMENT BE MADE ON THE SALARY OF A DEPUTY COMMISSIONER, OR DEPUTY
DIRECTOR OR AN EMPLOYEE, UNLESS HIS EMPLOYMENT IS NECESSARY FOR THE
ADMINISTRATION OF MEDICAL ASSISTANCE AND HIS QUALIFICATIONS CONFORM TO
THOSE FIXED BY THE DEPARTMENT.
(C) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE SALARY
OF A LOCAL MEDICAL DIRECTOR APPOINTED AFTER THE EFFECTIVE DATE OF THIS
SECTION WHOSE QUALIFICATIONS DO NOT CONFORM TO THOSE ESTABLISHED PURSU-
ANT TO SECTION THREE HUNDRED SIXTY-FOUR OF THIS TITLE.
(D) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE COST OF
THOSE ITEMS OF CARE, SERVICES, SUPPLIES AND EQUIPMENT, AND DRUGS WHICH
REPRESENT CO-PAYMENT AMOUNTS FOR WHICH A PROVIDER OF MEDICAL ASSISTANCE
IS AUTHORIZED TO CHARGE A RECIPIENT IN ACCORDANCE WITH SUBDIVISION SIX
OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS ARTICLE.
3. (A) CLAIMS FOR STATE REIMBURSEMENT SHALL BE MADE IN SUCH FORM AND
MANNER AND AT SUCH TIMES AND FOR SUCH PERIODS AS THE DEPARTMENT SHALL
DETERMINE.
(B) WHEN CERTIFIED BY THE DEPARTMENT, STATE REIMBURSEMENT SHALL BE
PAID FROM THE STATE TREASURY UPON THE AUDIT AND WARRANT OF THE COMP-
TROLLER OUT OF FUNDS MADE AVAILABLE THEREFOR.
(C) WHEN THE MONEYS ALLOTTED TO THE STATE BY THE FEDERAL DEPARTMENT OF
HEALTH, EDUCATION AND WELFARE OR OTHER AUTHORIZED FEDERAL AGENCY FOR ANY
QUARTER SHALL HAVE BEEN RECEIVED BY THE DEPARTMENT OF TAXATION AND
FINANCE, THE DEPARTMENT SHALL, AS SOON AS POSSIBLE, CERTIFY TO THE COMP-
TROLLER THE AMOUNT TO WHICH EACH PUBLIC WELFARE DISTRICT IS ENTITLED FOR
SUCH QUARTER AND SUCH AMOUNT SHALL BE PAID OUT OF THE STATE TREASURY
AFTER AUDIT BY THE COMPTROLLER TO THE RESPECTIVE PUBLIC WELFARE
DISTRICTS.
(D) THE DEPARTMENT IS AUTHORIZED IN ITS DISCRETION TO MAKE ADVANCES TO
PUBLIC WELFARE DISTRICTS IN ANTICIPATION OF THE STATE REIMBURSEMENT
PROVIDED FOR IN THIS SECTION.
4. PAYMENT OF STATE REIMBURSEMENT AND ADVANCES SHALL BE MADE TO THE
FISCAL OFFICER OF THE PUBLIC WELFARE DISTRICT ENTITLED THERETO PURSUANT
TO THE PROVISIONS OF THIS CHAPTER.
S 2. Section 368-b of the social services law, as added by chapter 256
of the laws of 1966, is amended to read as follows:
S 368-b. State reimbursement to local health districts; chargebacks.
1. Each approved local health district which enters into a contract
with the department of health pursuant to section three hundred sixty-
four-a of this title shall submit to the department of health a quarter-
ly report of expenditures for administrative expenses incurred in the
performance of such contract. The department of health shall review
such expenditures and, upon approval, shall submit the report to the
department. Upon receipt of such approved report, there shall be paid
to each such district
(a) the amount of federal funds, if any, properly received or to be
received on account of such expenditures; and
(b) [fifty] ONE HUNDRED per centum of the amount expended for such
administrative expenses, after first deducting therefrom any federal
funds properly received or to be received on account thereof.
2. The department of health shall submit a quarterly report to the
department of expenditures for administrative expenses incurred by each
of the state health districts in the performance of the cooperative
A. 7298--A 5
agreement entered into pursuant to section three hundred sixty-four-a of
this title. Upon receipt of such report, the department shall deduct the
amount of federal funds, if any, properly received or to be received on
account of such expenditures from the total amounts reported for each
such district [Fifty]. ONE HUNDRED per centum of the balance shall be
apportioned among the public welfare districts served by such district
[in the ratio that the total expenditures by each such public welfare
district for medical assistance for needy persons for the quarter bears
to the total expenditures by all such public welfare districts for such
quarter. The proportionate share shall be deducted from the next
payment due each of such public welfare districts pursuant to section
three hundred sixty-eight-a of this title].
S 3. The commissioners of the department of family assistance shall
study and propose all necessary legislative adjustments needed to
correct erroneous references throughout the social services law necessi-
tated through this act.
S 4. State assumption of non-federal share Medicaid costs. 1.
Notwithstanding any other provision of law, the state shall assume one
hundred percent of the non-federal share of Medicaid costs by January
first, two thousand twenty.
2. (a) Commencing state fiscal year two thousand sixteen the local
share/county share of Medicaid costs expended through the medical
assistance amount for social services districts shall be reduced by
twenty percent under the year 2015 expenditure.
(b) Commencing state fiscal year two thousand seventeen the local
share/county share of Medicaid costs expended through the medical
assistance amount for social services districts shall be reduced by
forty percent under the year 2015 expenditure.
(c) Commencing state fiscal year two thousand eighteen the local
share/county share of Medicaid costs expended through the medical
assistance amount for social services districts shall be reduced by
sixty percent under the year 2015 expenditure.
(d) Commencing state fiscal year two thousand nineteen the local
share/county share of Medicaid costs expended through the medical
assistance amount for social services districts shall be reduced by
eighty percent under the year 2015 expenditure.
(e) Commencing state fiscal year two thousand twenty the local
share/county share of Medicaid costs expended through the medical
assistance amount for social services districts shall be reduced by one
hundred percent under the year 2015 expenditure.
(f) The state by and through the governor may choose to override the
cap established in this section after the year two thousand twenty,
however, any increases to expenditures approved by the governor shall be
funded through the state budget.
(g) As used in this section the following term shall have the follow-
ing meaning: "Local share/county share" shall mean the portion of any
expenses covered by counties for the administration, benefits and
service provided under the state's Medicaid program.
S 5. This act shall take effect April 1, 2016.