Allows for reimbursement of transportation costs for emergency care without prior authorization by the social services official including emergency medical transportation by an ambulance service certified under article 30 of the public health law; and further authorizes the commissioner of health to establish a reimbursement methodology to ensure providers are reimbursed.
TITLE OF BILL: An act to amend the social services law, in relation to reimbursement of transportation costs for emergency care
PURPOSE: To establish a Medicaid reimbursement methodology for ambulance transportation with rates that allow providers to recoup their costs.
SUMMARY OF PROVISIONS: Section 1. Amends Subdivision 1 of section 365-h of the Social Services Law to exempt transportation to obtain emergency care from the requirement for prior authorization under Medicaid, to conform with the exemption in § 365a(2)(i) of the Social Services Law.
Amends Section 365-h of the Social Services Law to direct the Commissioner of Health to establish a Medicaid reimbursement methodology for ambulance transportation and care that ensures that providers are reimbursed at the greater of the Medical Assistance Rate on the effective date of the bill or the Federal Medicare allowable charge. This reimbursement methodology shall be phased in over three years as follows: in the state fiscal year in which the bill becomes a law, 33 percent; in the following state fiscal year, 66 percent; and in the second state fiscal year following the fiscal year in which the bill becomes a law and all subsequent fiscal years, 100 percent.
Section 2. Amends Subdivision 1 of section 368-a of the Social Services Law to ensure that the state bears 100 percent of the increase in medical assistance under this title, after first deducting any federal funds properly received or to be received on account thereof.
Section 3. Provides that this act shall take effect immediately.
JUSTIFICATION: The Medicaid reimbursement rate for ambulance trips is currently determined on a county-by-county basis. Almost every county in the state fails to adequately reimburse ambulance companies for the costs incurred in transporting patients.
This bill would create a methodology for ambulance reimbursement under Medicaid that more closely approximates the cost of providing the service. Ambulances are required by law to pick everyone up, including Medicaid patients. It is unfair to require these ambulance companies to accept Medicaid
patients and then not fairly reimburse them for the costs of providing services to these patients.
LEGISLATIVE HISTORY: S.5068 of 2009-10.
FISCAL IMPLICATIONS: Dependent on the costs of transporting patients. The State would also assume the local share of any additional Medicaid spending.
EFFECTIVE DATE: This act shall take effect April 1, 2013, with provisions.
STATE OF NEW YORK ________________________________________________________________________ 2715--A 2011-2012 Regular Sessions IN SENATE January 31, 2011 ___________Introduced by Sen. SEWARD -- read twice and ordered printed, and when printed to be committed to the Committee on Social Services -- recom- mitted to the Committee on Social Services in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the social services law, in relation to reimbursement of transportation costs for emergency care THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 1 of section 365-h of the social services law, as amended by section 20 of part B of chapter 109 of the laws of 2010, is amended and a new subdivision 5 is added to read as follows: 1. The local social services official and, subject to the provisions of subdivision four of this section, the commissioner of health shall have responsibility for prior authorizing transportation of eligible persons and for limiting the provision of such transportation to those recipients and circumstances where such transportation is essential, medically necessary and appropriate to obtain medical care, services or supplies otherwise available under this title. HOWEVER, PRIOR AUTHORI- ZATION SHALL NOT BE REQUIRED FOR TRANSPORTATION TO OBTAIN EMERGENCY CARE, INCLUDING EMERGENCY MEDICAL TRANSPORTATION BY AN AMBULANCE SERVICE CERTIFIED UNDER ARTICLE THIRTY OF THE PUBLIC HEALTH LAW. 5. WITH RESPECT TO TRANSPORTATION AND CARE PROVIDED TO AN ELIGIBLE PERSON BY AN AMBULANCE SERVICE CERTIFIED UNDER ARTICLE THIRTY OF THE PUBLIC HEALTH LAW, THE COMMISSIONER OF THE DEPARTMENT OF HEALTH SHALL ESTABLISH A REIMBURSEMENT METHODOLOGY THAT ENSURES THAT PROVIDERS ARE REIMBURSED AT THE GREATER OF THE MEDICAL ASSISTANCE RATE IN EFFECT ON THE EFFECTIVE DATE OF THIS SUBDIVISION, OR THE MEDICARE ALLOWABLE CHARGE (PURSUANT TO TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT) FOR SUCH TRANSPORTATION AND CARE. THE AMOUNT OF INCREASE IN REIMBURSEMENT PRODUCED BY THIS METHODOLOGY OVER WHAT WOULD OTHERWISE HAVE BEEN PAIDEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02510-02-2 S. 2715--A 2
SHALL BE PHASED IN AS FOLLOWS: IN THE STATE FISCAL YEAR IN WHICH THE PROVISIONS OF THIS SUBDIVISION BECOME A LAW, THIRTY-THREE PERCENT; IN THE FOLLOWING STATE FISCAL YEAR, SIXTY-SIX PERCENT; AND IN THE SECOND STATE FISCAL YEAR FOLLOWING THE STATE FISCAL YEAR IN WHICH THE PROVISIONS OF THIS SUBDIVISION BECOME A LAW AND ALL SUBSEQUENT FISCAL YEARS, ONE HUNDRED PERCENT. S 2. Subdivision 1 of section 368-a of the social services law is amended by adding a new paragraph (aa) to read as follows: (AA) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS CHAPTER OR ANY OTHER PROVISION OF LAW TO THE CONTRARY, ONE HUNDRED PERCENT OF THE AMOUNT EXPENDED FOR MEDICAL ASSISTANCE UNDER THIS TITLE FOR TRANSPORTA- TION AND CARE FURNISHED UNDER SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-FIVE-H OF THIS TITLE ON OR AFTER APRIL FIRST, TWO THOUSAND THIR- TEEN, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT THEREOF. S 3. This act shall take effect April 1, 2013, provided that the amendments to subdivision 1 of section 365-h of the social services law made by section one of this act shall not affect the repeal and rever- sion of such section pursuant to subdivision (a) of section 40 of part B of chapter 109 of the laws of 2010, as amended.