Directs the commissioner of health to make recommendations to the governor and legislature on increasing ambulatory patient group rates, in the 2015-2016 state fiscal year, for services provided by rural critical access hospitals.
TITLE OF BILL: An act to amend the public health law, in relation to directing the commissioner of health to make recommendations relating to increasing certain ambulatory patient group reimbursement rates
PURPOSE: Directs the commissioner of health to make recommendations to the governor and the legislature on increasing ambulatory patient group rates for services provided by rural critical access hospitals.
SUMMARY OF PROVISIONS: Amends Subdivision 2-a of section 2807 of the Public Health Law by adding a new paragraph (j) directing the commissioner of health, in conjunction with hospital industry representatives, to make written recommendations to the Governor and the legislature, including proposed legislation, for increasing Ambulatory Patient group rates for rural critical access hospitals by October 1, 2013. The recommendations must account for increased operating expenses of inherent to these hospitals, as well as the need to maintain access, in rural areas. The proposed language, subject to legislative approval, would be for inclusion in the 2014-2015 state budget, with rate increases to be effective April 1, 2014.
Section two states the enactment date.
JUSTIFICATION: Critical access hospitals (CAH) serve medically underserved geographically isolated communities. They provide limited stay special care, acute care and swing bed services, as well as 24 hour emergency service capability. The maintenance of CAHs is critical for preserving access to basic health care services for rural New Yorkers.
Currently, Medicare reimburses CAHs on the basis of reasonable costs, while New York State Medicaid reimbursement rates are capped at lower than operational costs.
Because these hospitals must distribute substantial fixed costs over a small number of visits, an enhanced Medicaid reimbursement would help to ensure their long range financial viability and preserve access to needed health care services for isolated communities. Further, this maintains the States shift in policy of preserving patient care while improving population health through shifting to outpatient care. This legislation would support these goals.
Beginning in late 2008, the Department of Health began to implement a new outpatient payment system that focuses reimbursement based upon the intensity of the services provided known as Ambulatory patient groups (APGs).
This legislation would require the Commissioner of Health and the Hospital industry to collaboratively produce recommendations and legislative language to provide for an enhanced APG rate that recognizes the low volume, costly nature of a rural safety net provider. The legislative proposal will be for inclusion in the SFY 2014/2015 Budget and effective on April 1, 2014.
Because APGs are an already existing rate structure, this legislation provides consistency with reimbursement methodologies currently used to pay for outpatient services performed by hospitals, negates the needs for DOH to implement a new payment methodology specific to CAHs, and ensures CAHs will receive crucial funding to preserving their fiscal viability.
LEGISLATIVE HISTORY: This is a new bill
FISCAL IMPLICATIONS: Undetermined
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 4375 2013-2014 Regular Sessions IN SENATE March 25, 2013 ___________Introduced by Sen. YOUNG -- (at request of the Legislative Commission on Rural Resources) -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to directing the commissioner of health to make recommendations relating to increasing certain ambulatory patient group reimbursement rates THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 2-a of section 2807 of the public health law is amended by adding a new paragraph (j) to read as follows: (J) THE COMMISSIONER SHALL, IN CONJUNCTION WITH HOSPITAL INDUSTRY REPRESENTATIVES, PROVIDE WRITTEN RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE ON OR BEFORE OCTOBER FIRST, TWO THOUSAND THIRTEEN, ON INCREASING AMBULATORY PATIENT GROUPS REIMBURSEMENT RATES ESTABLISHED PURSUANT TO THIS SUBDIVISION FOR GENERAL HOSPITAL OUTPATIENT SERVICES, GENERAL HOSPITAL EMERGENCY SERVICES, DIAGNOSTIC AND TREATMENT CENTER SERVICES AND AMBULATORY SURGICAL SERVICES, PROVIDED BY RURAL HOSPITALS DESIGNATED AS CRITICAL ACCESS HOSPITALS IN ACCORDANCE WITH TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT. SUCH RECOMMENDATIONS SHALL TAKE INTO CONSIDERATION THE INCREASED COSTS OF PROVIDING SUCH SERVICES IN RURAL AREAS AS WELL AS THE NEED TO MAINTAIN ACCESS TO SUCH SERVICES IN RURAL AREAS. IN ADDITION, THE RECOMMENDATIONS SHALL CONTAIN PROPOSED LEGIS- LATION, FOR INCORPORATION INTO THE STATE BUDGET FOR THE TWO THOUSAND FOURTEEN--TWO THOUSAND FIFTEEN FISCAL YEAR, TO EFFECTUATE RATE INCREASES EFFECTIVE APRIL FIRST, TWO THOUSAND FOURTEEN. S 2. This act shall take effect immediately.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10025-01-3