BILL NUMBER:S5345

TITLE  OF  BILL:   An act to amend the public health law, in relation to
case payment rates for pediatric ventilator services

PURPOSE:  To enable the Department of  Health  ("DOH")  to  establish  a
discrete  Medicaid  reimbursement rate for hospital pediatric ventilator
services.

SUMMARY OF PROVISIONS:

Section 1 of the bill would amend subparagraph (i) of paragraph (e-2) of
subdivision four of section 2807-c of the Public Health Law  related  to
Medicaid reimbursement for physical medical rehabilitation services. The
amendment would authorize the Commissioner of Health to make adjustments
to such rates for the purpose of reimbursing hospital pediatric ventila-
tor services.

Section 2 of the bill would make the bill effective immediately.

EXISTING  LAW:  Paragraph (e-2) of subdivision four of section 2807-c of
the Public Health Law governs Medicaid reimbursement for specialty inpa-
tient services provided by hospitals.

JUSTIFICATION:   Currently, DOH does not  have  statutory  authority  to
establish  a  discrete  Medicaid  rate for pediatric ventilator services
              

provided by hospitals (DOH does have authority to establish  such  rates
for  nursing  homes).  While  DOH  has authority to establish a rate for
physical medical rehabilitation services, the costs to provide pediatric
ventilator services are different from, and generally higher  than,  the
costs  to  provide physical medical rehabilitation services. Thus, given
the current reimbursement situation, hospitals have little incentive  to
provide  pediatric  ventilator services, even though there is a need for
such services. In particular, the addition of such services is  in  line
with  the  recommendation of the Governor's Medicaid Redesign Team (MRT)
to repatriate children needing ventilator care who have been  left  with
no  choice  but to be placed in out-of-state facilities due to a lack of
services in New York State.

Currently, at least one hospital has not opened up its planned pediatric
ventilator unit due to  concerns  about  adequate  reimbursement.  After
working  with  DOH  to  receive  a reimbursement rate that reflects this
cost-intensive service, DOH has stated that they do not  have  statutory
authority to establish a discrete rate for this service, but rather only
to set a rate for physical medical rehabilitation services. Section 1 of
this  bill  was drafted with input from DOH in order to provide DOH with
the authority to establish a discrete rate for this essential service.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS:  Expected savings. While the bill would provide the
Commissioner of Health with the authority to establish a rate for pedia-

tric ventilator services in hospitals the  bill  does  not  specify  the
amount  of  the  rate.  However,  Medicaid  cost savings are expected as
currently there are children who require this service who are housed  in
expensive  out-of-state facilities. Some of these children would be able
to receive the service in New York State.

LOCAL FISCAL IMPLICATIONS: None.

EFFECTIVE DATE:  This bill would take effect immediately.