NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4330
SPONSOR: Gunther
 
TITLE OF BILL:
An act to amend the mental hygiene law, in relation to establishing a
workgroup to conduct analysis on the ambulatory patient group rates and
commercial insurance rates for behavioral health services
 
PURPOSE:
The purpose of this bill is to ensure that mental health and substance
use service providers have fiscally viable programs.
 
SUMMARY OF PROVISIONS:
This bill would require the commissioner of the Office of.Mental
Health(CMH) in collaboration with the commissioner of the Department of
Health(DOH), and commissioner of the Office of Alcoholism and Substance
Abuse Services (OASAS) to establish a workgroup that would consist of
behavioral health providers and other relevant stakeholders. The work-
group would be tasked with conducting an analysis of the APG and commer-
cial insurance rates for behavioral health services and develop a report
which would make recommendations pertaining to the following:
* Rate adequacy related to the existing APC, reimbursement provided
under Medicaid managed care, as well as for commercial insurance rates:
*The actual costs of care associated with the delivery of behavioral
health services;
* One or more alternative reimbursement models that would adequately
compensate clinics for their costs of care under Medicaid managed care
and child health plus; and
* Any policy or fiscal resources necessary to carry out the recommenda-
tions of the report developed pursuant to this section. The report will
be submitted to the governor, the speaker of the assembly, and the
temporary president of the senate no Later than October 1, 2025.
 
STATEMENT OF SUPPORT:
The enacted budget for state fiscal year 201'2020 extended the legal
authority for the state mandate to provide behavioral health service
providers the APG rate for services rendered until March 31, 2023.
Generally, the APG payment methodology allows for greater payment homo-
geneity for comparable services across all ambulatory care settings.
Most importantly, the APG rate has given behavioral health service
providers assurance that they will receive a rate for service that will
enable such providers to maintain a fiscally viable program. However,
concerns have been raised by the behavioral health advocacy and service
provider community that the APG rates are not keeping pace with the
costs of care. Providers have a ranges of fixed and variable costs which
all continue to rise, such as maintenance of facilities, providing staff
benefits, etc. In addition, commercial insurance rates are far less and
must be brought on par with APG rates to ensure equal access to care for
commercial insurance beneficiaries. This bill would help to ensure that
behavioral health programs can provide quality care and maintain fiscal
viability by requiring the commissioner of OMH in collaboration with the
commissioner of DOH, and the commissioner of OASA S to establish a work-
group that would be tasked with conducting an analysis of the APG and
commercial insurance rates for behavioral health services and make
recommendations that would assist the State in providing an adequate
service rate which reflects the cost of care.
 
PRIOR LEGISLATIVE HISTORY:
2021-2022: A5878 referred to Ways and Means/S3476 passed Senate
2019-2020: referred to Ways and Means
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth after it shall have become
law.
STATE OF NEW YORK
________________________________________________________________________
4330
2023-2024 Regular Sessions
IN ASSEMBLY
February 14, 2023
___________
Introduced by M. of A. GUNTHER -- read once and referred to the Commit-
tee on Mental Health
AN ACT to amend the mental hygiene law, in relation to establishing a
workgroup to conduct analysis on the ambulatory patient group rates
and commercial insurance rates for behavioral health services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 7.07 of the mental hygiene law is amended by adding
2 a new subdivision (i) to read as follows:
3 (i) 1. The commissioner of the office of mental health, in collab-
4 oration with the commissioner of the department of health and the
5 commissioner of the office of addiction services and supports are
6 directed to convene and jointly chair, either directly or through a
7 designee or designees, a workgroup, which shall include membership that
8 ensures adequate statewide geographic representation selected with equal
9 contributions on such selection from the governor, the speaker of the
10 assembly and temporary president of the senate and be comprised of the
11 following members: (i) professional associations representing substance
12 use, mental health, and/or behavioral health providers; (ii) represen-
13 tatives from professional associations representing providers of peer
14 and recovery-based programs and services; (iii) representatives from
15 professional associations representing medicated assisted treatment
16 providers; (iv) representatives from professional associations repres-
17 enting children's behavioral health providers; (v) representatives from
18 hospital associations; (vi) representatives from associations represent-
19 ing behavioral health consumers and family members; and (vii) any addi-
20 tional stakeholder or expert that the commissioners deem necessary.
21 Members of the workgroup shall serve without compensation, but may be
22 reimbursed for actual costs incurred for participation on such work-
23 group.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06022-01-3
A. 4330 2
1 2. The workgroup shall conduct an analysis on the ambulatory patient
2 group rates and commercial insurance rates for behavioral health
3 services for the purpose of developing a report that shall provide
4 recommendations on the following: (i) rate adequacy related to the
5 existing ambulatory patient group-based reimbursement provided under
6 medicaid managed care, as well as for commercial insurance rates with
7 regards to services rendered under child health plus, or for services
8 provided by clinics licensed or certified pursuant to article thirty-one
9 or thirty-two of this chapter or dually licensed or certified under
10 article thirty-one or thirty-two of this chapter and article twenty-
11 eight of the public health law; (ii) the actual costs of care associated
12 with the delivery of behavioral health services; (iii) one or more
13 alternative reimbursement models that would adequately compensate clin-
14 ics licensed or holding an operating certificate under article thirty-
15 one or thirty-two of this chapter or dually licensed under article thir-
16 ty-one or thirty-two of this chapter and article twenty-eight of the
17 public health law for their costs of care under medicaid managed care
18 and child health plus; and (iv) any policy or fiscal resources necessary
19 to carry out the recommendations of the report developed pursuant to
20 this section. The report shall be submitted to the governor, the speaker
21 of the assembly and the temporary president of the senate no later than
22 October first, two thousand twenty-five.
23 § 2. This act shall take effect on the ninetieth day after it shall
24 have become a law.