This bill has been amended

Bill S6742-2011

Establishes the New York state workgroup on Medicaid reimbursement for medically fragile children within the department of health

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.

Details

Actions

  • 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

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Health - Mar 27, 2012
Ayes (15): Hannon, Ball, Farley, Fuschillo, Golden, Larkin, McDonald, Seward, Young, Adams, Montgomery, Rivera, Smith, Stewart-Cousins, Peralta
Ayes W/R (2): Duane, Gianaris

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.


Text

STATE OF NEW YORK ________________________________________________________________________ 6742 IN 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.
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
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.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus