NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7866
SPONSOR: Gottfried TITLE OF BILL: An act to amend the social services law, in relation
to school-based health centers
PURPOSE OR GENERAL IDEA OF BILL:
To permanently carve-out School-Based Health Centers (SBHC) from the
State's Medicaid Managed Care (MMC) program.
SUMMARY OF SPECIFIC PROVISIONS:
The bill amends Social Services law § 364-j to define "School-Based
Health Center" and a "Sponsoring organization" and to provide a perma-
nent carve-out from mandatory managed care. In addition the bill would
require the Department to:
*Reimburse SBHCs sponsored by Federally Qualified Health Centers (FQHCs)
pursuant to federally mandated rate methodologies.
*Reimburse SBHCs that are not sponsored by FQHCs or those who do not opt
for the FQHC rate at APG rates.
*Develop a standard memorandum of understanding to be entered into by
sponsoring organizations and managed care providers to provide for the
delivery of coordinated health care and participation in quality
improvement initiatives.
JUSTIFICATION:
SBHCs provide comprehensive physical, chronic, mental and dental health
services to over 230,000 underserved youth in rural, urban and suburban
areas of the State, regardless of insurance status or ability to pay.
They are a proven model for increasing access to health and mental
health services, reducing ethnic and racial disparities in the communi-
ties they serve, and improving school attendance and performance.
According to the Department of Health (DOH), 31% of students served are
black or African American and 44% are identified as Hispanic or Latino.
Currently 13% are uninsured.
Since 1985, SBHCs have been "carved-out" of the MMC program, being paid
under fee-for-service. However, DOH is now planning to end the carve-out
as of July 1, 2018. SBHCs will be required to negotiate the terms and
conditions of payment by managed care plans. A report by the Children's
Defense Fund found that this transition will cost SBHCs over sixteen
million in lost revenue. Already, SBHCs have suffered over seven million
or nearly 30% in funding cuts since 2008, while their patient population
has grown.
SBHCs have a proven track record of reducing health care costs including
unnecessary hospitalizations and emergency room visits. This bill will
preserve access to vital health services for underserved children and
adolescents in New York State.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
None to the state.
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
7866
2017-2018 Regular Sessions
IN ASSEMBLY
May 18, 2017
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the social services law, in relation to school-based
health centers
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 1 of section 364-j of the social services law
2 is amended by adding two new paragraphs (w) and (w-1) to read as
3 follows:
4 (w) "School-based health center". A clinic licensed under article
5 twenty-eight of the public health law or sponsored by a facility
6 licensed under article twenty-eight of the public health law which
7 provides primary and preventative care which may include but is not
8 limited to health maintenance, well-child care, diagnosis and treatment
9 of injury and acute illness, diagnosis and management of chronic
10 disease, behavioral health services, vision care, dental care, and
11 nutritional or other enhanced services to children and adolescents, any
12 of which may be provided by referral, within an elementary, secondary or
13 prekindergarten public school setting.
14 (w-1) "Sponsoring organization". A facility licensed under article
15 twenty-eight of the public health law which acts as the sponsor for a
16 school-based health center.
17 § 2. Subparagraph (iii) of paragraph (a) of subdivision 4 of section
18 364-j of the social services law is amended by adding a new clause (E-2)
19 to read as follows:
20 (E-2) the service is provided by school-based health centers: any such
21 services provided other than by a managed care provider shall be paid in
22 accordance with applicable reimbursement methodologies, which shall
23 mean:
24 (1) for school-based health centers that are sponsored by a federally
25 qualified health center, rates of reimbursement and requirements in
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11493-02-7
A. 7866 2
1 accordance with those mandated by 42 U.S.C. Secs. 1396a(bb),
2 1396b(m)(2)(A)(ix) and 1936a(a)(13)(C); and
3 (2) for school-based health centers that are sponsored by an entity
4 licensed pursuant to article twenty-eight of the public health law that
5 is not a federally qualified health center or is a federally qualified
6 health center that chooses not to receive reimbursement pursuant to
7 subclause one of this clause, rates of reimbursement at the fee for
8 service rate for such services in effect on the effective date of this
9 clause for the ambulatory patient group rate for the applicable service
10 and in accordance with any future adjustments made to such rates by the
11 department of health; provided that the commissioner of health shall
12 develop a standard memorandum of understanding to be entered into by
13 school-based health centers or their sponsoring organizations and
14 managed care providers to provide for the delivery of coordinated health
15 care and participation in quality improvement initiatives; and provided
16 further that this clause shall not preclude a school-based health center
17 or sponsoring organization from choosing to receive payments for
18 services through managed care providers.
19 § 3. This act shall take effect immediately, provided that the amend-
20 ments to section 364-j of the social services law, made by sections one
21 and two of this act, shall not affect the expiration and repeal of such
22 section, and shall expire and be deemed repealed therewith.
