Provides for medicaid reimbursement for ambulance services when treatment in place is administered and/or when transportation is provided to alternative health care settings instead of a general hospital.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9102C
SPONSOR: Kelles TITLE OF BILL:
An act to amend the social services law, in relation to Medicaid
reimbursement for treatment in place and transportation to alternative
health care settings by ambulance services
PURPOSE:
This bill would authorize Medicaid reimbursement to emergency medical
service agencies for
*providing emergency medical care to Medicaid enrollees without requir-
ing the transportation of these patients from the location where the
medical care was administered
*providing emergency medical care to Medicaid enrollees and transporting
them to alternative destinations (i.e.locations other than a hospital),
such as an urgent ,care clinic or mental health or rehabilitation facil-
ity
SUMMARY OF PROVISIONS:
Section 1; Establishes and defines reimbursement for treatment in place
and transportation to alternative health care settings.
Section 2: Effective Date
JUSTIFICATION:
Under current law, when responding to a 911 call, EMS agencies must
transport Medicaid enrollees to a general hospital in order to receive
Medicaid reimbursement. Each medical scenario is unique. Not every call
requires a visit to a hospital or emergency room. In some cases, a
patient may be better served at the scene of the emergency, and in these
instances the EMS agency is faced with not being reimbursed for the cost
of care (let alone the cost of the time it takes to respond in more
rural or remote areas). This contributes to the already dire financial.
situations that many EMS providers already experience. Furthermore, when
EMS agencies do transport enrollees to a hospital unnecessarily, that is
valuable time lost that could have been spent responding to more serious
emergencies while further burdening emergency rooms in the process. The
first piece here would allow EMS practitioners to treat Medicaid enrol-
lees in place (when deemed appropriate by the agency's medical director)
and be reimbursed for such services, saving time and money for emergency
responders, patients, and hospital staff.
Additionally, since each emergency call is unique, there must be a
degree of discretion allowed regarding the best treatment options for
the patient. Whereas EMS agencies are hamstrung into a "one-size-fit-
sall" approach of transporting a patient to a general hospital for
reimbursement, this bill would also authorize Medicaid reimbursement for
transportation to alternative destinations-"hospitals" as defined in NYS
Public Health Law--which can include mental health or rehabilitation
facilities.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
To be determined.
EFFECTIVE DATE:
This act shall take effect on the first of October next succeeding the
date on which it shall have become a law.
STATE OF NEW YORK
________________________________________________________________________
9102--C
IN ASSEMBLY
February 7, 2024
___________
Introduced by M. of A. KELLES, McDONALD, LUCAS, GUNTHER, HEVESI, THIELE,
BUTTENSCHON, LAVINE, CLARK, DICKENS, BURDICK, MEEKS, FAHY, EPSTEIN,
STIRPE, BARRETT, LEVENBERG, WOERNER, BURKE, JONES, MANKTELOW, LUNS-
FORD, RA, SILLITTI, J. M. GIGLIO, OTIS, LUPARDO, SHIMSKY, BENDETT,
DAVILA, SAYEGH, GRAY, SEAWRIGHT, PALMESANO -- read once and referred
to the Committee on Health -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
reported and referred to the Committee on Ways and Means -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the social services law, in relation to Medicaid
reimbursement for treatment in place and transportation to alternative
health care settings by ambulance services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The social services law is amended by adding a new section
2 367-y to read as follows:
3 § 367-y. Reimbursement for treatment in place and transportation to
4 alternative health care settings. 1. Notwithstanding any provision of
5 law to the contrary, any provision of this title providing for
6 reimbursement of transportation costs for an ambulance service shall
7 also apply where, instead of providing transportation to a general
8 hospital, such ambulance service when responding to an emergency call:
9 (a) Administers treatment in place, including but not limited to tele-
10 health visits approved by Medicaid for reimbursement when deemed neces-
11 sary; and/or
12 (b) Transports an individual to an alternative health care setting.
13 2. For the purposes of this section, the following terms shall have
14 the following meanings:
15 (a) "Alternative health care setting" means the following facilities
16 or institutions approved by Medicaid for reimbursement and accepting
17 Medicaid recipients:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14413-09-4
A. 9102--C 2
1 (i) a crisis stabilization center or certified community behavioral
2 health clinic operating pursuant to article thirty-six of the mental
3 hygiene law;
4 (ii) a facility under section 7.17 of the mental hygiene law;
5 (iii) a facility providing addiction disorder services or behavioral
6 health services, as such terms are defined by section 1.03 of the mental
7 hygiene law;
8 (iv) a diagnostic and treatment center established pursuant to article
9 twenty-eight of the public health law, or an upgraded diagnostic and
10 treatment center designated as such pursuant to section twenty-nine
11 hundred fifty-six of the public health law;
12 (v) a federally qualified health center; or
13 (vi) an urgent care center, which for the purposes of this section
14 shall mean a facility that provides episodic care related to an acute
15 illness or minor traumas that are not life-threatening or permanently
16 disabling.
17 (b) "Ambulance service" shall have the same meaning as defined by
18 section three thousand one of the public health law.
19 (c) "General hospital" shall have the same meaning as defined by
20 section twenty-eight hundred one of the public health law.
21 (d) "Treatment in place" means the administration of emergency medical
22 services, as defined by section three thousand one of the public health
23 law, by an employee or volunteer of an ambulance service. Such services
24 shall be consistent with protocols promulgated pursuant to article thir-
25 ty of the public health law.
26 3. This section shall be effective if, and as long as, federal finan-
27 cial participation is available therefor.
28 4. Nothing in this section shall be deemed to allow a person to
29 provide any service for which a license, registration, certification or
30 other authorization under title eight of the education law is required
31 and which the person does not possess.
32 § 2. This act shall take effect on the first of October next succeed-
33 ing the date on which it shall have become a law.
