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A03298 Summary:

COSPNSRBores, Simon
Amd §§19.03 & 19.17, Ment Hyg L; amd §§365-a & 366-d, add §367-x, Soc Serv L; amd §13-d, Work Comp L
Requires the office of addiction services and supports to provide contingency management services, including financial incentives, for persons with addiction disorders who abstain from substance abuse and comply with treatment objectives; provides medical assistance coverage for such services.
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A03298 Text:

                STATE OF NEW YORK
                               2023-2024 Regular Sessions
                   IN ASSEMBLY
                                    February 2, 2023
        Introduced  by M. of A. CARROLL -- read once and referred to the Commit-
          tee on Alcoholism and Drug Abuse
        AN ACT to amend the mental hygiene law, the social services law and  the
          workers'  compensation  law,  in  relation to establishing contingency
          management services for certain persons with substance use disorders

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Section  19.03  of  the  mental hygiene law is amended by
     2  adding a new subdivision 3 to read as follows:
     3    3.  "Contingency  management  services"   means   addiction   disorder
     4  services,  including  digital  therapeutics  prescribed  by a healthcare
     5  professional, for persons with a substance use  disorder  that  provides
     6  individuals  with  a  financial  incentive  or positive reinforcement to
     7  abstain from substance use, by rewarding specified behaviors, including,
     8  but not limited to continued evidence of negative urinalysis, engagement
     9  in treatment, and other behavior which adheres to treatment goals.
    10    § 2. Section 19.17 of the mental hygiene law is amended  by  adding  a
    11  new subdivision (h) to read as follows:
    12    (h)  (1)  The  office  shall,  in  coordination with the department of
    13  health and the New York state conference of local mental hygiene  direc-
    14  tors, establish a program to provide contingency management services, as
    15  defined  in  subdivision  three  of  section  19.03  of this article for
    16  persons eligible for medical assistance under title  eleven  of  article
    17  five  of  the  social  services  law  for  individuals  in  recovery for
    18  substance use disorder.
    19    (2) Notwithstanding any  contrary  provision  of  law,  incentives  or
    20  rewards  for  contingency  management services received by an individual
    21  pursuant to this subdivision shall not be considered income or resources
    22  of an individual for the purposes of any determinations  of  eligibility
    23  for any other state program or benefit, including but not limited to the
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 3298                             2
     1  medical  assistance  program, any state or federal program, or any other
     2  means-tested program or benefit.
     3    (3) In developing the program under paragraph one of this subdivision,
     4  the  office  shall  ensure  that  incentives  or rewards for contingency
     5  management services are used for the intended purposes and not  diverted
     6  for  other  uses. The office shall develop a plan to monitor the program
     7  for fraud and misuse of contingency management incentives and rewards.
     8    (4) Notwithstanding any contrary provision of law,  the  commissioner,
     9  in  collaboration  with the commissioner of health, shall, to the extent
    10  necessary, develop and submit any appropriate waivers for implementation
    11  of this program, including, but not limited to, those authorized  pursu-
    12  ant  to  sections eleven hundred fifteen and nineteen hundred fifteen of
    13  the federal social security act, or successor provisions, and any  other
    14  waivers  necessary  to achieve the purposes of high quality, integrated,
    15  and cost effective care and integrated  financial  eligibility  policies
    16  under  the  medical assistance program or pursuant to title XVIII of the
    17  federal social security act. Copies of such original waiver applications
    18  shall be provided to the chair of the senate finance committee  and  the
    19  chair of the assembly ways and means committee simultaneously with their
    20  submission to the federal government.
    21    §  3.  Subdivision  2  of  section 365-a of the social services law is
    22  amended by adding a new paragraph (kk) to read as follows:
    23    (kk) contingency management services and supports provided pursuant to
    24  article nineteen of the mental hygiene law.
    25    § 4. The social services law is amended by adding a new section  367-x
    26  to read as follows:
    27    §  367-x.  Payment for contingency management services. 1. (a) For the
    28  purpose of this section, "contingency management  services"  shall  have
    29  the  same  meaning as set forth in subdivision three of section 19.03 of
    30  the mental hygiene law.
    31    (b) The receipt of any incentive or  reward  pursuant  to  contingency
    32  management  services  shall  not  be  considered  income for purposes of
    33  eligibility for public benefits or other public assistance to the extent
    34  allowed by law.
    35    2. The commissioner may authorize the payment  of  medical  assistance
    36  funds  for  contingency management services.  The commissioner shall, in
    37  consultation with  the  AIDS  Institute  and  the  office  of  addiction
    38  services and supports:
    39    (a)  Issue  guidance on the use of contingency management services for
    40  beneficiaries who access  substance  use  disorder  services  under  the
    41  medical assistance program;
    42    (b)  Establish  limits on the number and value of incentives available
    43  to beneficiaries who receive services pursuant to contingency management
    44  services; and
    45    (c) Determine  maximum  allowable  rates  for  contingency  management
    46  services  based  upon  the  medical  assistance  program fee-for-service
    47  outpatient rates for the same or similar services,  or  any  other  data
    48  deemed reliable and relevant by the commissioner.
    49    3.  Subdivision two of this section shall be effective if, and as long
    50  as, federal financial participation is available for medical  assistance
    51  expenditures made pursuant to it.
    52    4.  For  the  purposes  of implementing this section, the commissioner
    53  shall seek any necessary federal approvals, including approvals  of  any
    54  state  plan  amendment  or  federal  waivers, by the federal centers for
    55  medicare and Medicaid services no later than December thirty-first,  two
    56  thousand twenty-three.

        A. 3298                             3
     1    §  5.  Subdivision  2  of section 366-d of the social services law, as
     2  amended by chapter 2 of the laws of 1998, is amended to read as follows:
     3    2.  (a) No medical assistance provider shall:
     4    [(a)]  (i)  solicit, receive, accept or agree to receive or accept any
     5  payment or other consideration in any form from another  person  to  the
     6  extent  such  payment  or  other  consideration  is given[: (i)] for the
     7  referral of services for which payment is made under this title  [eleven
     8  of article five of this chapter;], or [(ii)] to purchase, lease or order
     9  any good, facility, service or item for which payment is made under this
    10  title [eleven of article five of this chapter]; or
    11    [(b)] (ii) offer, agree to give or give any payment or other consider-
    12  ation  in any form to another person to the extent such payment or other
    13  consideration is given[: (i)] for the referral  of  services  for  which
    14  payment  is  made under this title [eleven of article five of this chap-
    15  ter;], or [(ii)] to purchase, lease or order any good, facility, service
    16  or item for which payment is made under this title  [eleven  of  article
    17  five of this chapter;
    18    (c) as].
    19    (b)  As  used  in  this section "person"   shall have the meaning  set
    20  forth in subdivision seven of section 10.00 of the penal law.
    21    [(d) this] (c) This  subdivision  shall  not  apply  to  any  activity
    22  specifically exempt by federal statute or federal regulations promulgat-
    23  ed thereunder.
    24    (d)  This  subdivision  shall  not  apply  to  contingency  management
    25  services operated pursuant to section  three  hundred  sixty-seven-x  of
    26  this title.
    27    §  6.  Paragraph  (g) of subdivision 2 of section 13-d of the workers'
    28  compensation law, as amended by section 2 of part CC of  chapter  55  of
    29  the laws of 2019, is amended to read as follows:
    30    (g)  has directly or indirectly requested, received or participated in
    31  the division, transference, assignment, rebating, splitting or refunding
    32  of a fee for, or has directly or indirectly requested, received or prof-
    33  ited by means of a credit or other valuable consideration as  a  commis-
    34  sion,  discount or gratuity in connection with the furnishing of medical
    35  or surgical care,  an  independent  medical  examination,  diagnosis  or
    36  treatment  or service, including X-ray examination and treatment, or for
    37  or in connection with the sale, rental, supplying or furnishing of clin-
    38  ical laboratory services  or  supplies,  X-ray  laboratory  services  or
    39  supplies,  inhalation  therapy  service or equipment, ambulance service,
    40  hospital or medical supplies, physiotherapy or other therapeutic service
    41  or equipment, artificial limbs, teeth or eyes,  orthopedic  or  surgical
    42  appliances  or  supplies,  optical  appliances,  supplies  or equipment,
    43  devices for aid of hearing, drugs, medication or  medical  supplies,  or
    44  any  other goods, services or supplies prescribed for medical diagnosis,
    45  care or treatment, under this chapter; except that  reasonable  payment,
    46  not  exceeding  the technical component fee permitted in the medical fee
    47  schedule, established under this chapter for X-ray examinations, diagno-
    48  sis or treatment, may be made by a provider duly authorized as a  roent-
    49  genologist  to any hospital furnishing facilities and equipment for such
    50  examination, diagnosis or treatment, provided  such  hospital  does  not
    51  also  submit  a  charge for the same services. Nothing contained in this
    52  paragraph shall prohibit such providers who  practice  as  partners,  in
    53  groups or as a professional corporation or as a university faculty prac-
    54  tice  corporation  from  pooling fees and moneys received, either by the
    55  partnership,  professional  corporation,  university  faculty   practice
    56  corporation or group by the individual members thereof, for professional

        A. 3298                             4
     1  services furnished by any individual professional member, or employee of
     2  such  partnership,  corporation  or  group,  nor shall the professionals
     3  constituting the partnerships, corporations,  or  groups  be  prohibited
     4  from  sharing,  dividing or apportioning the fees and moneys received by
     5  them or by the partnership, corporation or group in  accordance  with  a
     6  partnership  or  other  agreement.  This  paragraph  shall  not apply to
     7  contingency management  services  operated  pursuant  to  section  three
     8  hundred sixty-seven-x of the social services law.
     9    § 7. This act shall take effect on the one hundred eightieth day after
    10  it  shall have become a law. Effective immediately, the addition, amend-
    11  ment and/or repeal of any rule or regulation necessary for the implemen-
    12  tation of this act on its effective date are authorized to be  made  and
    13  completed on or before such effective date.
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