This bill has been amended

Bill S5483-2013

Provides that there shall be no recoupment of medical assistance payments for the capital costs of diagnostic and treatment centers primarily engaged in providing services to the developmentally disabled

Relates to waiving recoupment of medical assistance payments for the capital costs of diagnostic and treatment centers primarily engaged in providing services to the developmentally disabled.

Details

Actions

  • Jun 10, 2013: REPORTED AND COMMITTED TO FINANCE
  • May 16, 2013: REFERRED TO HEALTH

Meetings

Votes

VOTE: COMMITTEE VOTE: - Health - Jun 10, 2013
Ayes (16): Hannon, Ball, Farley, Felder, Fuschillo, Golden, Larkin, Savino, Seward, Young, Rivera, Montgomery, Hassell-Thompson, Adams, Peralta, O'Brien
Ayes W/R (1): Hoylman

Memo

BILL NUMBER:S5483

TITLE OF BILL: An act to amend the public health law, in relation to medical assistance payments for capital costs for certain diagnostic and treatment centers

PURPOSE: The purpose of this bill is to ensure the financial stability of diagnostic and treatment centers that provide critical services to persons with developmental disabilities.

SUMMARY OF PROVISIONS:

Section 1 of this bill provides that a Diagnostic and Treatment Center (D&TC) licensed under Article 28 of the Public Health Law that provides, as its principal mission, services to individuals with developmental disabilities, shall not be subject to any recoupment of Medicaid payments for capital costs for the period September 2009 to December 31, 2012.

In addition, Section 1 of the bill provides that reduced Medicaid payments to such D&TCs by the New York State Department of Health will be phased in over a period of 4 years, beginning January 1, 2013. The payments will reflect a blended rate that includes: 1) the capitol average Medicaid payment per claim that was in effect in 2007 and; 2) a 2-year lagged rolling base year methodology.

Section 2 provides that the bill takes effect immediately and is deemed to be in full force and effect on and after September 1, 2009.

JUSTIFICATION: Article 28 Diagnostic and Treatment Centers (DTCs), with a primary mission to serve individuals with developmental disabilities, were established to provide healthcare for individuals with disabilities who other health care providers could not or would not serve. These DTCs were established by not-for-profit providers and family members who could not find healthcare services for individuals with developmental disabilities. The reimbursement for these DTCs was cost based until the rates were frozen in 1994. From 1994 until September 2009, these clinics did not receive any increase, trend or COLA to their reimbursement rate even though health care costs rose by double digits annually. Overall, these DTC reimbursement rates were inadequate to cover costs and led to deficits which averaged 20% of operating costs. Then in September 2009, New York State began implementation of the APG reimbursement system.

In the transition to APGs there was no recognition of the fifteen years of unreimbursed costs. There was a recognition that in moving forward, New York State wanted to invest in more primary and preventive care in order to save money on acute and emergency care and provide better health outcomes. DTCs, with a primary mission to serve individuals with developmental disabilities, struggled to position themselves in the evolving healthcare landscape to meet the needs of their local communities and New York State.

In February 2013, as these DTCs continued to lose about 20% on operations, the Department of Health (DOH) began to recoup 15% of Medicaid payments. This 15% recoupment of clinics' Medicaid payment was based on the retroactive recalculation of capital payments back to

September 1, 2009. The capital reimbursement that DTCs were receiving up to this point had been calculated by DOH based on the DTCs 1992 cost report. When DOH implemented APGs they continued the capital reimbursement and then three and a half years later decided to retroactively recalculate these capital payments. As a result, these DTC, which serve extremely vulnerable New Yorkers and have been experiencing 20% losses, were suddenly and without warning losing an additional 15% of their Medicaid payments.

This total capital recoupment amount results in a significant portion of many DTCs overall clinic operations. One clinic, in Upstate New York, would have a $700,000 recoupment on a $2 million annual budget. Recoupments of this magnitude will close these DTCs that serve patients who will otherwise have no or extremely limited access to healthcare.

Therefore, this legislation will mitigate the impact of the capital recalculation and allow DTC to continue to provide healthcare to the most vulnerable New Yorkers.

PRIOR LEGISLATIVE HISTORY: None.

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: Immediately and deemed to be in full force and effect on and after September 1, 2009.


Text

STATE OF NEW YORK ________________________________________________________________________ 5483 2013-2014 Regular Sessions IN SENATE May 16, 2013 ___________
Introduced by Sen. HANNON -- 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 medical assistance payments for capital costs for certain diagnostic and treatment centers THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 2 of section 2807 of the public health law is amended by adding a new paragraph (c) to read as follows: (C) (I) NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, A DIAGNOSTIC AND TREATMENT CENTER LICENSED PURSUANT TO THIS ARTICLE THAT PROVIDES, AS ITS PRINCIPAL MISSION, SERVICES TO INDIVIDUALS WITH DEVEL- OPMENTAL DISABILITIES, SHALL NOT BE SUBJECT TO ANY RECOUPMENT OF MEDICAL ASSISTANCE PAYMENTS FOR CAPITAL COSTS FOR THE PERIOD SEPTEMBER FIRST, TWO THOUSAND NINE TO DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE. (II) NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, THE CAPITAL COST PER VISIT FOR A DIAGNOSTIC AND TREATMENT CENTER LICENSED PURSUANT TO THIS ARTICLE THAT PROVIDES, AS ITS PRINCIPAL MISSION, SERVICES TO INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, SHALL BE: (A) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND THIRTEEN THROUGH DECEM- BER THIRTY-FIRST, TWO THOUSAND THIRTEEN, SEVENTY-FIVE PERCENT OF THE AVERAGE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND SEVEN AND TWENTY-FIVE PERCENT OF THE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND ELEVEN; (B) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH DECEM- BER THIRTY-FIRST, TWO THOUSAND FOURTEEN, FIFTY PERCENT OF THE AVERAGE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND SEVEN AND FIFTY PERCENT OF THE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND TWELVE; (C) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND FIFTEEN THROUGH DECEM- BER THIRTY-FIRST, TWO THOUSAND FIFTEEN, TWENTY-FIVE PERCENT OF THE AVER-
AGE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND SEVEN AND SEVENTY-FIVE PERCENT OF THE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND THIRTEEN; AND (D) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND SIXTEEN THROUGH DECEM- BER THIRTY-FIRST, TWO THOUSAND SIXTEEN, ZERO PERCENT OF THE AVERAGE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND SEVEN AND ONE HUNDRED PERCENT OF THE CAPITAL COST PER VISIT PROVIDED TO THAT FACILITY IN CALENDAR YEAR TWO THOUSAND FOURTEEN. S 2. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after September first, two thousand nine.

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