Provides for increasing the applicability of brand name and generic prescription drug and other medical services, except diagnostic services, co-payments for medicaid recipients.
TITLE OF BILL: An act to amend the social services law, in relation to medicaid co-payments for prescription drugs and other services
PURPOSE OF THE BILL: This bill provides for increasing brand name and generic prescription drug and other medical services co-payments for Medicaid recipients and requires prepayment.
SUMMARY OF SPECIFIC PROVISIONS: Section 1 - Amends paragraph (b) of subdivision 6 of § 367-a of the Social Services Law to redefine those persons not subject to co-payments for services.
Section 2 - Amends the opening paragraph of paragraph (d) of subdivision 6 of § 367-a of the Social Services Law to require that co-payments shall apply to all services covered by the title, except diagnostic services, and to require that co-payments must be pre-paid at the time when services are rendered.
Section 3 - Authorizes the Commissioner of Health to promulgate or adopt any rules or regulations necessary to implement the provisions of this Act.
Section 4 - Effective date.
JUSTIFICATION: The rising cost of the Medicaid program is threatening the ability for the State and its counties to maintain the current program. Just as private health insurance requires co-payments for services in order to rein in costs of health care, New York State should implement the same model to rein in costs and ensure that the cost of the Medicaid program can be sustained. In an effort to modernize the Medicaid program so that it is similar to private health insurance, this legislation institutes co-payments for all services, except diagnostic services. To ensure that co-payments to the providers of the services are received, prepayment of the co-payments must be made when the services are rendered. Currently, the law does not allow for providers to withhold services if the recipient states that he or she can not pay the copayment. However, abuse of this provision has become increasingly apparent, and therefore steps must be taken to ensure that providers receive their payments for the services that they provide to the consumers.
PRIOR LEGISLATIVE HISTORY: 2005-2006 - S.3578-B/A.5466-C 2007-08 - S.3292/A.4676 -- HEALTH/Health
2009-10: - S.2990-A/A.6678 -- HEALTH/Health 2011-12 S.3221/A.2339 - HEALTH/Health
FISCAL IMPLICATIONS: Yet to be determined. Cost savings to both counties and the state are expected.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 1436 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________Introduced by Sens. RANZENHOFER, GALLIVAN, LARKIN -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law, in relation to medicaid co-pay- ments for prescription drugs and other services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (b) of subdivision 6 of section 367-a of the social services law, as added by chapter 41 of the laws of 1992, subpar- agraph (iii) as amended by chapter 843 of the laws of 1992 and subpara- graph (iv) as amended by section 40 of part C of chapter 58 of the laws of 2005, is amended to read as follows: (b) Co-payments shall apply to all eligible persons for the services defined in paragraph (d) of this subdivision with the exception of: (i)
[individuals under twenty-one years of age; (ii) pregnant women; (iii)]individuals who are inpatients in a medical facility who have been required to spend all of their income for medical care, except their personal needs allowance or residents of community based residen- tial facilities licensed by the office of mental health or the office of mental retardation and developmental disabilities who have been required to spend all of their income, except their personal needs allowance; [(iv) individuals enrolled in health maintenance organizations or other entities which provide comprehensive health services, or other managed care programs for services covered by such programs, except that such persons, other than persons otherwise exempted from co-payments pursuant to subparagraphs (i), (ii), (iii) and (v) of this paragraph, and other than those persons enrolled in a managed long term care program, shall be subject to co-payments as described in subparagraph (v) of paragraph (d) of this subdivision;]andEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04848-01-3 S. 1436 2
[(v)](II) any other individuals required to be excluded by federal law or regulations. S 2. The opening paragraph of paragraph (d) of subdivision 6 of section 367-a of the social services law, as added by chapter 41 of the laws of 1992, is amended to read as follows: Co-payments shall apply to [the following]ALL services COVERED BY THIS TITLE, EXCEPT DIAGNOSTIC SERVICES, AND SHALL BE PRE-PAID AT THE TIME WHEN SUCH SERVICES ARE RENDERED, subject to such exceptions for subcategories of these services as recognized by the commissioner OF HEALTH in regulations, provided in accordance with section three hundred sixty-five-a of this [article]TITLE and the regulations of the depart- ment, to the extent permitted by title XIX of the federal social securi- ty act: S 3. The commissioner of health is authorized to promulgate or adopt any rules or regulations necessary to implement the provisions of this act and any co-payments, procedures, forms, or instructions necessary for such implementation may be adopted and issued on or after the effec- tive date of this act. Notwithstanding any inconsistent provision of the state administrative procedure act or any other provision of law, rule or regulation, the commissioner of health and the superintendent of financial services and any appropriate council are authorized to adopt or amend or promulgate on an emergency basis any regulation he or she or such council determines necessary to implement any provision of this act on its effective date. S 4. This act shall take effect immediately.