Adds certain school based health services (i.e., services provided by certain clinics which provide primary health care services within an elementary or secondary public school setting) to the list of services which need not be provided by a managed care program but which shall be continued to be provided outside of managed care programs in accordance with applicable reimbursement methodologies.
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.
STATE OF NEW YORK ________________________________________________________________________ 4253--A 2013-2014 Regular Sessions IN SENATE March 15, 2013 ___________Introduced by Sens. MONTGOMERY, GIPSON, HASSELL-THOMPSON, KENNEDY -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee AN ACT to amend the social services law, in relation to school-based health services under managed care programs THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subparagraphs (viii) and (ix) of paragraph (d) of subdivi- sion 3 of section 364-j of the social services law, as amended by section 38 of part A of chapter 56 of the laws of 2013, are amended to read as follows: (viii) HIV COBRA case management;
[and](ix) THE SERVICES PROVIDED ARE BY A CLINIC LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, OR SPONSORED BY A FACILITY LICENSED UNDER SUCH ARTICLE, WHICH PROVIDES PRIMARY CARE SERVICES WITHIN AN ELEMENTARY OR SECONDARY PUBLIC SCHOOL SETTING; AND (X) other services as determined by the commissioner of health. S 2. This act shall take effect immediately provided, however, that the amendments to paragraph (d) of subdivision 3 of section 364-j of the social services law made by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04069-03-4