Provides that physician fee reimbursement under the Medicaid program for office visits be no less than the amount reimbursed for physician treatment in hospital out-patient settings.
TITLE OF BILL: An act to amend the social services law, in relation to physician fee reimbursements under the medical assistance for needy persons (medicaid) program
PURPOSE/SUMMARY OF PROVISIONS: This bill provides that physician fee reimbursement under the Medicaid program for office visits be no less than the amount reimbursed for hospital out-patient settings.
JUSTIFICATION: In 1999, less than two percent of the entire Medicaid fee-for-service budget was spent on physician services. This equates into physician payment of just over $7 per patient visit. Medicaid payments to physicians have remained virtually unchanged over the past three decades. There have been no adjustments for inflation, increased overhead costs or increased paperwork required by the Medicaid program. The result is a failed health care program that creates beneficiary access problems to private practicing physicians. In contrast to individual physician compensation, hospitals and clinics received approximately $100 for each Medicaid patient visit. Forcing patients to seek primary and preventive care in more costly and clinically inappropriate institutional settings drives up already spiraling health care costs and is not in the best interest of the beneficiary. New York's Medicaid system will continue to be the most costly, inefficient and ineffective health insurance program in the country unless the physician's office is restored as the health care setting of choice for beneficiaries.
FISCAL IMPLICATIONS: This legislation would produce significant savings to the state over time in both the Medicaid fee-for-service and Medicaid managed care systems, and, more importantly, will assure low income patients have the benefit of access to providers of their choice.
EFFECTIVE DATE: This act shall take effect on the one hundred twentieth day after it shall have become a law, provided, however, that effective immediately, the addition, amendment and/or repeal of any rules or regulations necessary for the implementation of the foregoing section of this act on its effective date is authorized and directed to be made and completed on or before such effective date.
STATE OF NEW YORK ________________________________________________________________________ 2035 2011-2012 Regular Sessions IN SENATE January 18, 2011 ___________Introduced by Sen. KRUGER -- 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 physician fee reimbursements under the medical assistance for needy persons (medi- caid) program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (a) of subdivision 1 of section 367-a of the social services law, as amended by chapter 165 of the laws of 1991, is amended to read as follows: (a) Any inconsistent provision of this chapter or other law notwith- standing, no assignment of the claim of any supplier of medical assist- ance shall be valid and enforceable as against any LOCAL social services district or the STATE department OF HEALTH, and any payment with respect to any medical assistance shall be made to the person, institu- tion, state department or agency or municipality supplying such medical assistance at rates established by the appropriate LOCAL social services district and contained in its approved local medical plan, except as otherwise permitted or required by applicable federal and state provisions, including the regulations of the STATE department OF HEALTH; provided, however, that for those districts for whom the STATE depart- ment OF HEALTH has assumed payment responsibilities pursuant to section three hundred sixty-seven-b of this
[chapter]TITLE, rates shall be established by the STATE department OF HEALTH, except as otherwise required by applicable provisions of federal or state law; AND PROVIDED FURTHER, HOWEVER, THAT AMOUNTS PAYABLE UNDER THIS TITLE FOR MEDICAL ASSISTANCE FOR SERVICES PROVIDED BY PHYSICIANS IN THEIR OFFICES SHALL BE NO LESS THAN THE AMOUNTS PAYABLE UNDER THIS TITLE FOR MEDICAL ASSISTANCE FOR SERVICES PROVIDED BY PHYSICIANS IN OUT-PATIENT DEPARTMENTS OF HOSPI- TALS LOCATED IN THE SAME LOCAL SOCIAL SERVICES DISTRICT AS SUCH PHYSI- CIAN'S OFFICE IS LOCATED. A LOCAL social services official may apply toEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06816-01-1 S. 2035 2
the STATE department OF HEALTH for local variations in rates to be applicable, upon approval by the STATE department OF HEALTH, to recipi- ents for whom such district is responsible. Claims for payment shall be made in such form and manner as the STATE department OF HEALTH shall determine. S 2. This act shall take effect on the one hundred twentieth day after it shall have become a law, provided, however, that effective immediate- ly, the addition, amendment and/or repeal of any rules or regulations necessary for the implementation of the foregoing section of this act on its effective date is authorized and directed to be made and completed on or before such effective date.