Commissions a study regarding the quality of health care services received by foster children in New York state; provides for a report to be submitted by the commissioner of the office of children and family services detailing the findings of such study.
Ayes (5): Montgomery, Schneiderman, Huntley, Duane, McDonald
Ayes W/R (1): Marcellino
Ayes (19): Kruger, Krueger, Stachowski, Oppenheimer, Montgomery, Duane, Parker, Stavisky, Dilan, Stewart-Cousins, Thompson, Breslin, Diaz, Espada, Klein, Perkins, Valesky, Volker, Padavan
Ayes W/R (6): DeFrancisco, LaValle, Saland, Hannon, Maziarz, Robach
Nays (7): Johnson O, Seward, Farley, Larkin, Nozzolio, Leibell, Marcellino
BILL NUMBER: S5924
TITLE OF BILL : An act to commission a study regarding the quality of health care services received by foster children in New York state
PURPOSE OR GENERAL IDEA OF BILL : Commission a study to gather information from State agencies, foster care agencies, local districts and advocates to better understand how the Per-Diem, Fee-for Service and Managed Care financing constructs affect the health outcomes of children in foster care.
SUMMARY OF SPECIFIC PROVISIONS : Section one would require the office of children and family services to contract with an external organization to conduct an evaluation of the implementation and effectiveness of New York state's health care delivery system for children in the custody or guardianship of the state.
Section two would authorize the organization selected to conduct the evaluation, access to nonidentifiable information from the office of children and family services, department of health and local social services district and voluntary agencies for the purpose of the study. Allow for the collection of supplemental information as needed for the purpose of the study.
Section three would require the office of children and family service by June 30, 2010 to submit a report to the Governor, temporary president of the senate, speaker of the assembly, chairperson of the senate committee on social services and children and families and chairperson of the assembly committee on children and families, and the chairperson of the senate and assembly committees on health.
JUSTIFICATION : Studies have shown that in the United States, children entering foster care have significantly higher rates of chronic and acute medical problems, developmental delays, and psychological and behavioral disorders than children within the general population, including children from low income families. In New York State all children in foster care who are citizens or permanent residents of the United States, are eligible for healthcare services including mental health treatment and behavioral therapies, under Medicaid. New York State has a three tiered system for providing health care services to foster children under Medicaid: a per-diem, fee-for-services and managed care system. Approximately 75 percent of voluntary agencies use the per-diem system for children place under their care. Within the per-diem system a set amount of money is provided to the voluntary foster care agency to cover the cost of a foster child's medical care, based upon the number of days that foster child is placed with the agency. The per-diem rate also allows agencies .to offer health and mental health services on site or use the rate to hire other medical professionals to work part-time on the agency's premises. The remaining 25 percent of foster care agencies opt to use the traditional fee-for services in lieu of the Medicaid per-diem. The fee for-services Medicaid system allows beneficiaries to go to any doctor who accepts their Medicaid card. The doctor then bills Medicaid directly for the service provided. Some agencies choose to use both the per-diem and fee-for-services to access health care services which are either not allowed or cannot be afforded under the agency's per-diem rate. An alternative to the per-diem/fee-for-service option for Medicaid services is Medicaid managed Care which is not available to all foster children. Managed care provides a consistent network of medical providers that treat both health and mental health care issues. Only foster children that are in the direct care of the local social services districts are able to enroll into Medicaid Managed Care, however, not those placed in volunteer agencies. With the state placing more children in the care of volunteer agencies, there are a large number of children in care that are ineligible for Medicaid Managed Care under current state law, and instead, receive healthcare services through the per-diem system.
Evidence suggests that when foster care agencies use both the Medicaid per-diem and fee-for-service billing mechanisms children in care receive inconsistent health and mental health care services. Whether this is due to an inadequately low per-diem rate or merely a gradual evolution of the foster care medical financing construct, this scattered usage of medical providers and billing arrangements means that it is unknown whether foster children are receiving all necessary medical services required by law and regulation. Exploring whether the Medicaid per-diem/Fee-for-Service system for foster children are effective in meeting the healthcare needs of New York State's foster children is an essential first step in identifying a solution. Although it has been proven that adequate health care for foster children is vital in ensuring that they become healthy and productive adults. Currently, many of the children's medical needs are going untreated and unaccounted for. Gathering more information from State agencies, foster care agencies, local districts and advocates to better understand how the Per-Diem, Fee-For-Service and Managed Care financing constructs affect the health outcomes of these children in need, will allow policy makers to make better decisions that will improve the health of children in foster care.
PRIOR LEGISLATIVE HISTORY : New bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS : Undetermined.
EFFECTIVE DATE : This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 5924 2009-2010 Regular Sessions IN SENATE June 18, 2009 ___________Introduced by Sen. PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to commission a study regarding the quality of health care services received by foster children in New York state THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. 1. The commissioner of the office of children and family services shall contract with an external research organization to evalu- ate the implementation and effectiveness of New York state's health care delivery system for children in the care, custody or guardianship of the office of children and family services or local social services districts pursuant to articles 3, 7 and 10 of the family court act or section 358-a, 384-a or 384-b of the social services law. The evalu- ation shall include recommendations for improving the access to, and the quality of, health and behavioral health services for children in the care, custody or guardianship of the office of children and family services or the local social services district. Such commissioner shall select such research organization pursuant to a request for proposals process. Preference shall be given to an organization based on adequacy of the proposed research design, research staff qualifications, and availability of non-state dollars to support the project, and other criteria as determined by the commissioner of the office of children and family services. The evaluation shall include, but not be limited to, an examination of: (a) the quality of health and behavioral health services provided to children in the care, custody or guardianship of the office of children and family services or the local social services district, including, but not limited to, whether children are receiving effective or neces- sary treatment in a timely fashion and in accordance with the regu- lations of the office of children and family services; (b) the average length of time from referrals for children in the care, custody or guardianship of the office of children and family services or the local social services district, to receive treatment to the date of initial treatment;EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07737-01-9 S. 5924 2
(c) whether sufficient information is provided to educate foster parents on the health care delivery system for foster children, includ- ing identification of providers and appropriate billing arrangements; (d) the existence and adequacy of current oversight practice regarding health care services for children in the care, custody or guardianship of the office of children and family services or the local social services district, including monitoring or record keeping practices of voluntary agencies, social services districts, family courts, the office of children and family services and the department of health; (e) whether foster children who receive health care coverage under the medicaid per-diem system receive adequate health and behavioral health services; (f) whether foster children who receive health care coverage under the medicaid fee-for service system receive adequate health and behavioral health services; (g) to what extent the medicaid per-diem is used in conjunction with direct billing under fee-for service and whether this practice provides foster children with adequate health and behavioral health services; (h) whether foster children who receive health care services through enrollment in a medicaid managed care plan receive adequate health and behavioral health services; (i) whether any difficulties exist in accessing prescription drugs for foster children; (j) whether foster children or foster parents are being billed for health care services provided to foster children which should be covered under medicaid; (k) the number of voluntary agencies throughout the state that provide health care services to foster children in their care through health care professionals employed by their agency; (l) the quality of health care provided by health care professionals hired by voluntary agencies and the benefits and drawbacks of having health care services provided by voluntary agencies; (m) whether children leaving foster care or placement in juvenile justice facilities, who would be otherwise eligible for medicaid cover- age upon leaving placement, experience difficulty in accessing transi- tional medicaid coverage or medicaid coverage in the community; and (n) what barriers exist for children in the care, custody or guardian- ship of the office of children and family services or the local social services district, to access health care services in the community. 2. Notwithstanding any other law to the contrary, the selected organ- ization shall have access to necessary non-identifiable data collected by the office of children and family services, the department of health, local social services districts and voluntary agencies, and shall collect supplemental data as needed to conduct a thorough and comprehen- sive evaluation. Data collected shall not reveal the name, social secu- rity number or any other information which may be used to identify the child or the family of the child. 3. The commissioner of the office of children and family services shall submit a report detailing the findings of such study to the gover- nor, the temporary president of the senate, the speaker of the assembly, and the chairperson of the senate committee on social services, children and families, the chairperson of the assembly committee on children and families and the chairpersons of the senate and assembly committees on health on or before June 30, 2011. S 2. This act shall take effect immediately.