BILL NUMBER:S4253

TITLE OF BILL:  An act to amend the social services law, in relation
to school-based health services under managed care programs

PURPOSE OR GENERAL IDEA OF BILL: To assure that Medicaid managed care
enrollees have continued access to school-based health services.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends section 364-j(3)(e)
of the Social Services Law by adding a new subparagraph (x) adding
school-based health services to the list of services which need not be
provided by a managed care program.

Section 2 provides for an immediate effective date.

JUSTIFICATION: School-based health centers are recognized as a highly
effective vehicle for delivering crucially needed, timely health care
services to the most vulnerable underserved and uninsured school-age
children. The Department of Health has on several occasions delayed a
requirement that managed care programs contract with school-based
health centers. Managed care programs require each enrollee to choose
a primary care practitioner. But they generally will only contract
with physicians as primary care practitioners. Since school-based
health centers use mostly nurse practitioners, physician's assistants
and certified social workers with back up of physicians and
psychologists or psychiatrists, managed care programs are unlikely to
              

contract with school-based health centers as primary care providers
for eligible students who are enrolled in managed care. School-based
health centers have become an integral part of the fabric of the
communities where they are located. Often, they are the only
accessible primary care and mental health providers for the most
high-risk children and youth. While this bill would eliminate the
requirement that managed care providers offer school based health
services, it would allow for the establishment of procedures and
linkages which assure that the care of children enrolled in Medicaid
managed care programs is coordinated. This bill maintains a reasonable
balance between the development of managed care programs and the need
to assure continued access to school based health services.

PRIOR LEGISLATIVE HISTORY: Senate: New Bill.  Assembly: 1999-00:
A.8634 passed the Assembly; 2001-02: A.2531 passed the Assembly;
2003-04:  A.3503 passed the Assembly; 2005-06: A.3270 passed the
Assembly; 2007:  A.3600 referred to Social Services; 2008: A.3600
passed Assembly; 2009-10: A.1022 passed the Assembly; 2011-12: A.1444
referred to Social Services Committee.

FISCAL IMPLICATIONS: None. The Department of Health has been unable to
develop a model for the incorporation of school-based health services
into managed care programs.

EFFECTIVE DATE: Immediate.