Relates to Medicaid reimbursement rates for residential facilities for the care and treatment of persons with developmental disabilities operating pursuant to article 16 of the mental hygiene law.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7327A
SPONSOR: Gunther TITLE OF BILL:
An act to amend part H of chapter 59 of the laws of 2011, amending the
public health law and other laws, relating to general hospital inpatient
reimbursement for annual rates, in relation to supplemental Medicaid
managed care payments
PURPOSE:
Restores the MRT 26 cut to article 16 clinics.
SUMMARY OF PROVISIONS:
Section one amends section 26 of part H of chapter 59 of the laws of
2011 to remove clinics certified pursuant to article 16 of the mental
hygiene law from targeted Medicaid reimbursement rate reductions.
Section two is the effective date.
JUSTIFICATION:
Article 16 clinics are under the Office for People with Developmental
Disabilities (OPWDD) and can only serve individuals designated by OPWDD.
Article 16 clinics provide health care for individuals with disabilities
because other health care providers cannot or will not serve them. Many
individuals used to receive their therapies from Department of Health
(DOH) Article 28 Clinics. But, beginning in 2009, DOH required that
Article 16 clinics be established and that all long term therapies be
moved from the Article 28 clinics to OPWDD Article 16 clinics. Although
OPWDD supports and services were not supposed to be included in the 2011
Medicaid Redesign Team (MRT) discussion or cuts, Article 16 clinics were
included in the MRT 26 cut.
Rather than a 2% across the board cut, the MRT 26 cut reduces overall
payment levels to those Article 16 clinics with higher visits per
patient in comparison to their peers, in essence penalizing individuals
and the clinics who serve those with more severe physical disabilities.
The more significant the physical disability of the patients served, the
deeper the cut to the Article 16 rate. Individuals with severe physical
disabilities require more frequent and intensive therapy services, and
by implementing a cut based on the average number of services provided
per month, DOH is discriminating against individuals with severe phys-
ical disabilities.
Additionally, this cut is based on utilization; however, Article 16
clinics already had utilization controls in place. Each Article 16 clin-
ic is provided with a service authorization based on the population they
serve. The service authorization is the total number of services the
clinic may bill for in a given year. If an agency wants to provide and
bill for services above the utilization assigned to their clinic, they
must submit a CON to OPWDD.
The State fiscal plan savings for all of the MRT cuts, including 26,
ended as of 4-1-15. The 2014-2015 Budget restored all of the MRT 2%
across the board cuts one year early but included language to continue
this discriminatory Article 16 cut except that the Commissioner of
Health, in consultation with the Director of the Division of the Budget,
has the authority to terminate this cut "upon a finding that they are no
longer necessary to maintain essential cost savings."
Therefore, because this cut is unnecessary and discriminates against
individuals with the most severe disabilities and the clinics that serve
them, MRT 26 must be restored for Article 16 clinics.
LEGISLATIVE HISTORY:
New Bill.
FISCAL IMPACT ON THE STATE:
To be determined.
EFFECTIVE DATE:
This act shall take immediately.
