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A04330 Summary:

BILL NOA04330
 
SAME ASSAME AS S05773
 
SPONSORGunther
 
COSPNSR
 
MLTSPNSR
 
Amd §7.07, Ment Hyg L
 
Establishes a workgroup to conduct analysis on the ambulatory patient group rates and commercial insurance rates for behavioral health services.
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A04330 Memo:

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.
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A04330 Text:



 
                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.
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