Provides that medicaid reimbursement for services to medically fragile children rendered by pediatric rehabilitation diagnostic and treatment centers shall be at a fee-for-service rate until the workgroup on medicaid payment for services for medically fragile children completes its report.

---

S6742-2011 Actions

• Jun 20, 2012: referred to ways and means
• Jun 20, 2012: DELIVERED TO ASSEMBLY
• Jun 20, 2012: PASSED SENATE
• May 23, 2012: AMENDED ON THIRD READING (T) 6742A
• Mar 29, 2012: ADVANCED TO THIRD READING
• Mar 28, 2012: 2ND REPORT CAL.
• Mar 27, 2012: 1ST REPORT CAL.465
• Mar 16, 2012: REFERRED TO HEALTH

S6742-2011 Meetings

Health: Mar 27, 2012

S6742-2011 Calendars

Floor Calendar: Mar 28, 2012 , Floor Calendar: Mar 29, 2012 , Floor Calendar: Mar 30, 2012 , Floor Calendar: Apr 17, 2012 , Floor Calendar: Apr 18, 2012 , Floor Calendar: Apr 19, 2012 , Floor Calendar: Apr 25, 2012 , Floor Calendar: Apr 26, 2012 , Floor Calendar: Apr 30, 2012 , Floor Calendar: May 1, 2012 , Floor Calendar: May 2, 2012 , Floor Calendar: May 7, 2012 , Floor Calendar: May 8, 2012 , Floor Calendar: May 9, 2012 , Floor Calendar: May 14, 2012 , Floor Calendar: May 15, 2012 , Floor Calendar: May 16, 2012 , Floor Calendar: May 21, 2012 , Floor Calendar: May 22, 2012 , Floor Calendar: May 23, 2012

S6742-2011 Votes

S6742-2011 Memo

BILL NUMBER:S6742

TITLE OF BILL:
An act to amend the public health law, in relation to establishing the
New York state workgroup on Medicaid reimbursement for medically
fragile children

PURPOSE OR GENERAL IDEA OF BILL:
To establish a workgroup on Medicaid reimbursement for medically
fragile children in order to determine the most appropriate
reimbursement methodologies for this unique population.

SUMMARY OF PROVISIONS:
Section 1 adds a new Public Health Law �2804-b to establish the New
York state workgroup on Medicaid reimbursement for medically fragile
children. This section requires the commissioner, within 30 days of
the effective date, to convene and chair, directly or through a
designee, this workgroup to examine, evaluate and provide
recommendations on the adequacy and viability of Medicaid
reimbursement rates to certain pediatric providers who provide
critical services for medically fragile children.

The workgroup shall be comprised of stakeholders of medically fragile
children, including providers of pediatric nursing homes, home health
care agencies affiliated with pediatric nursing homes, and diagnostic
and treatment centers which primarily serve medically fragile
children, and other experts chosen by the commissioner. Members of the
workgroup shall have demonstrated knowledge and experience in
providing care to medically fragile children in pediatric nursing
homes, home health care agencies affiliated with pediatric nursing
homes, and diagnostic and treatment centers which primarily serve
medically fragile children, including those who provide care primarily
to the Medicaid population. A majority of workgroup members shall
constitute a quorum. Such members shall be allowed actual and
necessary expenses in the performance of their duties, but shall not
receive compensation. This section also specifies, at a minimum, the
reimbursement methodologies to be considered by the workgroup for
recommended changes. The workgroup is required to submit its findings
and recommendations in a report to the commissioner, the chair of the
Senate Finance Committee and the chair of the Assembly Ways & Means
Committee prior to January 1, 2013.

Lastly, this section provides that notwithstanding any other provision
of law to the contrary, services provided to medically fragile
children residing in pediatric nursing homes, receiving services at
pediatric rehabilitation diagnostic and treatment centers or home
health care agencies affiliated with pediatric nursing homes shall be
reimbursed at a fee-for-service Medicaid rate during the deliberations
of the workgroup and until such report is finalized and delivered. Any
change in reimbursement methodology necessary as a result of this
section shall be implemented by the department within 30 days of the
effective date of this section. The findings and recommendations in
the workgroup's report shall be approved, revised or rejected by the
legislature prior to the adoption of an alternative reimbursement
methodology.


Section 2 of the bill provides for an effective date.

JUSTIFICATION:
New York's health care reimbursement system has historically treated
providers of medically fragile children distinct from other health
care providers in light of the unique needs of the children they
serve. However, recent changes to Medicaid payment methodologies have
failed to recognize the unique nature of these facilities, and are
failing to adequately reimburse the cost of care for this extremely
small, yet highly complex population. For example, the implementation
of ambulatory patient groups which do not have a mechanism to
distinguish reimbursement for highly complex children have had a
negative effect on pediatric specialty clinics. Further, the
transition to Medicaid managed Care, which is scheduled to take place
this October, could be detrimental to highly specialized pediatric
nursing homes. Accordingly, this bill establishes a workgroup to
determine the most appropriate reimbursement methodologies to be used
to ensure the continued viability of these facilities, and authorizes
fee-for-service payments until the results of this workgroup are
released.

PRIOR LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect immediately.

S6742-2011 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    6742

                              I N  SENATE

                               March 16, 2012
                                 ___________

  Introduced  by  Sens.  HANNON,  CARLUCCI,  DeFRANCISCO, GOLDEN, JOHNSON,
    KLEIN, LARKIN, LAVALLE, MARTINS, McDONALD, SALAND, SAVINO, VALESKY  --
    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  establishing  the
    New York state workgroup on Medicaid reimbursement for medically frag-
    ile children

    THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
  BLY, DO ENACT AS FOLLOWS:


    Section 1.  The public health law is amended by adding a  new  section
  2804-b to read as follows:

    S  2804-B.  NEW  YORK  STATE  WORKGROUP  ON MEDICAID REIMBURSEMENT FOR
  MEDICALLY FRAGILE CHILDREN. 1. THE  COMMISSIONER  SHALL,  WITHIN  THIRTY
  DAYS  OF THE EFFECTIVE DATE OF THIS SECTION, CONVENE AND CHAIR, DIRECTLY
  OR THROUGH A DESIGNEE OR DESIGNEES, A NEW YORK STATE WORKGROUP ON  MEDI-
  CAID  REIMBURSEMENT  FOR MEDICALLY FRAGILE CHILDREN TO EXAMINE, EVALUATE
  AND PROVIDE RECOMMENDATIONS ON THE ADEQUACY AND  VIABILITY  OF  MEDICAID
  REIMBURSEMENT  RATES TO CERTAIN PEDIATRIC PROVIDERS WHO PROVIDE CRITICAL
  SERVICES FOR MEDICALLY FRAGILE CHILDREN.
    2. SUCH WORKGROUP SHALL BE  COMPRISED  OF  STAKEHOLDERS  OF  MEDICALLY
  FRAGILE  CHILDREN,  INCLUDING PROVIDERS OF PEDIATRIC NURSING HOMES, HOME
  CARE AGENCIES AFFILIATED WITH PEDIATRIC NURSING HOMES AND DIAGNOSTIC AND
  TREATMENT CENTERS WHICH PRIMARILY SERVE MEDICALLY FRAGILE CHILDREN,  AND
  OTHER EXPERTS CHOSEN BY THE COMMISSIONER. MEMBERS OF THE WORKGROUP SHALL
  HAVE   DEMONSTRATED  KNOWLEDGE  AND  EXPERIENCE  IN  PROVIDING  CARE  TO
  MEDICALLY FRAGILE CHILDREN IN PEDIATRIC NURSING HOMES, HOME  CARE  AGEN-
  CIES  AFFILIATED  WITH PEDIATRIC NURSING HOMES AND DIAGNOSTIC AND TREAT-
  MENT CENTERS WHICH PRIMARILY SERVE MEDICALLY FRAGILE CHILDREN, INCLUDING
  PROVIDERS WHO PROVIDE CARE PRIMARILY TO  THE  MEDICAID  POPULATION.  THE
  PRESENCE OF A MAJORITY OF THE MEMBERS SHALL CONSTITUTE A QUORUM. MEMBERS
  SHALL  RECEIVE  NO COMPENSATION FOR THEIR SERVICES, BUT SHALL BE ALLOWED
  ACTUAL AND NECESSARY EXPENSES IN THE PERFORMANCE OF THEIR DUTIES  PURSU-
  ANT TO THIS SECTION.

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD14924-02-2

 S. 6742                             2

    3.  THE  WORKGROUP  SHALL  DEVELOP  AND  RECOMMEND CHANGES TO MEDICAID
  REIMBURSEMENT RATES FOR PEDIATRIC  NURSING  HOMES,  HOME  CARE  AGENCIES
  AFFILIATED  WITH  PEDIATRIC  NURSING  HOMES AND DIAGNOSTIC AND TREATMENT
  CENTERS PRIMARILY PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN,  INCLUD-
  ING BUT NOT LIMITED TO:

    (A)  THE  ADEQUACY  OF  CURRENT  AMBULATORY  PATIENT  GROUP  RATES  OF
  REIMBURSEMENT FOR PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS THAT PRIMA-
  RILY PROVIDE REHABILITATION AND  CARE  TO  MEDICALLY  FRAGILE  CHILDREN,
  RECOMMENDING  MODIFICATIONS, WHERE APPROPRIATE, TO PROTECT THE VIABILITY
  OF SUCH FACILITIES. SUCH  RECOMMENDATIONS  SHALL  INCLUDE,  BUT  NOT  BE
  LIMITED  TO,  AN ANALYSIS OF WHETHER SUCH FACILITIES SHALL RECEIVE SEPA-
  RATE AND DISTINCT AMBULATORY PATIENT GROUP BASE  RATES,  AND  ANY  OTHER
  MODIFICATIONS TO THE AMBULATORY PATIENT GROUP METHODOLOGY TO ENSURE THAT
  SUCH RATES ADEQUATELY REIMBURSE THE COST OF PROVIDING REHABILITATION AND
  CARE TO MEDICALLY FRAGILE CHILDREN;
    (B)  THE  ADEQUACY  AND  APPROPRIATENESS  OF THE CURRENT REIMBURSEMENT
  METHODOLOGY FOR PEDIATRIC NURSING HOMES, AND HOME CARE  AGENCIES  AFFIL-
  IATED  WITH  PEDIATRIC  NURSING  HOMES RECOMMENDING MODIFICATIONS, WHERE
  APPROPRIATE, TO PROTECT THE VIABILITY OF SUCH FACILITIES. SUCH RECOMMEN-
  DATIONS, SHALL INCLUDE, BUT NOT BE LIMITED TO, THE DEVELOPMENT OF A  NEW
  PEDIATRIC  NURSING HOME RATE, THE DEVELOPMENT OF NEW RATES FOR HOME CARE
  AGENCIES AFFILIATED WITH PEDIATRIC NURSING  HOMES THE APPROPRIATE USE OF
  CASE MIX ADJUSTMENTS FOR THIS POPULATION,  ANY  ADDITIONAL  SUPPLEMENTAL
  ADJUSTMENTS  THAT  ARE  DEEMED  NECESSARY AND APPROPRIATE, AND ANY OTHER
  REVISIONS NECESSARY TO ENSURE THAT SUCH RATES ADEQUATELY  REIMBURSE  THE
  COST OF PROVIDING REHABILITATION AND CARE TO MEDICALLY FRAGILE CHILDREN;
    (C)  THE  MEDICAID MANAGED CARE PREMIUM METHODOLOGY TO PEDIATRIC DIAG-
  NOSTIC AND TREATMENT CENTERS PRIMARILY PROVIDING REHABILITATION AND CARE
  TO MEDICALLY FRAGILE CHILDREN, AND  WHETHER  SUCH  PLAN  PREMIUMS  SHALL
  INCLUDE  AN  ADD-ON  TO  REFLECT  THE  AMBULATORY  PATIENT GROUP RATE OF
  REIMBURSEMENT;
    (D) THE TRANSITION OF THE PEDIATRIC NURSING HOME POPULATION AND  BENE-
  FIT  INTO MEDICAID MANAGED CARE, INCLUDING HOME CARE AGENCIES AFFILIATED
  WITH PEDIATRIC NURSING HOMES AND WHETHER SUCH A TRANSITION WOULD PROVIDE
  ADEQUATE REIMBURSEMENT TO SUCH FACILITIES TAKING INTO ACCOUNT  THE  COST
  OF  PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN NECESSARY AND APPROPRI-
  ATE TO MEET THEIR NURSING AND RELATED CARE NEEDS AS WELL AS THEIR DEVEL-
  OPMENTAL NEEDS. SUCH ANALYSIS SHALL ALSO INCLUDE AN EXAMINATION  OF  THE
  DEPARTMENT'S  CASE  MIX  INDEX AND CONSIDERATION OF THE DEVELOPMENT OF A
  NEW OR MODIFIED CASE MIX INDEX THAT  ADEQUATELY  CAPTURES  THE  COST  OF
  PROVIDING CARE TO MEDICALLY FRAGILE CHILDREN;
    (E) THE EVALUATION OF ALTERNATIVES TO MAINSTREAM MEDICAID MANAGED CARE
  FOR  MEDICALLY  FRAGILE CHILDREN RESIDING IN PEDIATRIC NURSING HOMES AND
  PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS PRIMARILY  SERVING  MEDICALLY
  FRAGILE CHILDREN, OR SERVED BY HOME CARE AGENCIES AFFILIATED WITH PEDIA-
  TRIC  NURSING HOMES INCLUDING THE DEVELOPMENT OF DEMONSTRATION PROJECTS,
  TO TEST ALTERNATIVE PAYMENT AND CARE MANAGEMENT MODELS FOR THIS  COMPLEX
  PATIENT  POPULATION.  SUCH  EVALUATION  SHALL  INCLUDE  CONSIDERATION OF
  WHETHER PEDIATRIC NURSING HOMES AND/OR  PEDIATRIC  SPECIALTY  DIAGNOSTIC
  AND TREATMENT CENTERS SHALL REMAIN IN FEE-FOR-SERVICE MEDICAID;
    (F)  THE  EXAMINATION OF PROVIDING RETROACTIVE, TEMPORARY, OR PROSPEC-
  TIVE RATE RELIEF TO PROVIDERS WITH DEMONSTRATED FINANCIAL  HARDSHIP  WHO
  EXCLUSIVELY PROVIDE CARE TO MEDICALLY FRAGILE CHILDREN;
    (G)  A  COST-BENEFIT ANALYSIS, INCLUDING BUT NOT LIMITED TO, EXAMINING
  HOW SUCH SERVICES PROVIDED TO  MEDICALLY  FRAGILE  CHILDREN  IN  NURSING
  HOMES,  HOME  CARE  AGENCIES AFFILIATED WITH PEDIATRIC NURSING HOMES AND

 S. 6742                             3

  PEDIATRIC DIAGNOSTIC AND TREATMENT CENTERS ARE COST  EFFECTIVE  COMPARED
  TO OTHER ALTERNATIVES OF CARE SUCH AS ACUTE CARE SETTINGS;
    (H)  CONSIDERATION  OF  THE  MEASURES  NEEDED  TO MAINTAIN FINANCIALLY
  VIABLE PEDIATRIC PROVIDERS IN THE STATE SUFFICIENT TO MEET THE NEEDS  OF
  THE STATE'S MEDICALLY FRAGILE CHILDREN; AND
    (I)  ANY OTHER AREAS DEEMED APPROPRIATE BY THE COMMISSIONER OR MEMBERS
  OF THE WORKGROUP.
    4. PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN, THE WORKGROUP  SHALL
  PRESENT  ITS FINDINGS AND RECOMMENDATIONS IN A REPORT, AND SHALL PROVIDE
  SUCH REPORT TO THE COMMISSIONER, THE CHAIR OF THE SENATE FINANCE COMMIT-
  TEE, THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE,  THE  CHAIR  OF
  THE SENATE HEALTH COMMITTEE AND THE CHAIR OF THE ASSEMBLY HEALTH COMMIT-
  TEE.
    5.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW  TO  THE CONTRARY,
  SERVICES PROVIDED TO MEDICALLY FRAGILE CHILDREN  RESIDING  IN  PEDIATRIC
  NURSING  HOMES  RECEIVING SERVICES AT HOME CARE AGENCIES AFFILIATED WITH
  PEDIATRIC NURSING HOMES OR RECEIVING  SERVICES  AT  PEDIATRIC  REHABILI-
  TATION  DIAGNOSTIC  AND  TREATMENT  CENTERS ESTABLISHED PURSUANT TO THIS
  ARTICLE SHALL BE REIMBURSED AT A FEE-FOR-SERVICE  MEDICAID  RATE  DURING
  THE  DELIBERATIONS  OF  THE WORKGROUP AND UNTIL SUCH REPORT IS FINALIZED
  AND DISTRIBUTED TO THE COMMISSIONER, THE CHAIR  OF  THE  SENATE  FINANCE
  COMMITTEE, THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE, THE CHAIR
  OF  THE  SENATE  HEALTH  COMMITTEE  AND THE CHAIR OF THE ASSEMBLY HEALTH
  COMMITTEE. ANY CHANGE IN REIMBURSEMENT METHODOLOGY NECESSARY AS A RESULT
  OF THIS SECTION SHALL BE IMPLEMENTED BY  THE  DEPARTMENT  WITHIN  THIRTY
  DAYS  OF THE EFFECTIVE DATE OF THIS SECTION.  THE FINDINGS AND RECOMMEN-
  DATIONS IN THE WORKGROUP'S REPORT SHALL BE APPROVED, REVISED OR REJECTED
  BY THE LEGISLATURE PRIOR TO THE ADOPTION OF AN ALTERNATIVE REIMBURSEMENT
  METHODOLOGY.
    S 2. This act shall take effect immediately.