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: A9102A
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 facili-
ty
SUMMARY OF PROVISIONS:
Sec. 1- Establishes and defines reimbursement for treatment in place and
transportation to alternative health care settings.
Sec. 2 - Effective date
***A-print changes:
-narrows the scope to 911 calls;
-clarifies and makes explicit the nature of the bill pertaining to Medi-
caid payments , that this doesn't relate to private insurance;
-assures that protocols that are used are in line with purview of DOH
and protocols that have already been promulgated;
-aligns with Medicaid fiscal year, giving time to implement;
-assures that alternate locations includes a specialist related to
specific condition a person might have.
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, sometimes costing
valuable time lost that could have been spent responding to more serious
emergencies, and needlessly burdening emergency rooms.
This "TIP & TAD" bill's treatment in place ("TIP") provisions would
allow EMS practitioners to treat Medicaid enrollees 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. 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-fits-all" approach of transporting a patient to a general hospital
for reimbursement, this bill would also authorize Medicaid reimbursement
for transportation to alternative destinations ("TAD"), other than
"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 January 1 after enactment.
STATE OF NEW YORK
________________________________________________________________________
9102--A
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 --
read once and referred to the Committee on Health -- 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 facilities or institutions
16 approved by Medicaid for reimbursement and accepting Medicaid recipients
17 including but not limited to:
18 (i) a crisis stabilization center or certified community behavioral
19 health clinic operating pursuant to article thirty-six of the mental
20 hygiene law;
21 (ii) a facility under section 7.17 of the mental hygiene law;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14413-02-4
A. 9102--A 2
1 (iii) a facility providing addiction disorder services and/or behav-
2 ioral health services, as such terms are defined by section 1.03 of the
3 mental hygiene law;
4 (iv) a diagnostic and treatment center established pursuant to article
5 twenty-eight of the public health law, or an upgraded diagnostic and
6 treatment center designated as such pursuant to section twenty-nine
7 hundred fifty-six of the public health law;
8 (v) a federally qualified health center; or
9 (vi) an office engaged principally in providing services by or under
10 the supervision of a physician licensed under article one hundred thir-
11 ty-one of the education law.
12 (b) "Ambulance service" shall have the same meaning as defined by
13 section three thousand one of the public health law.
14 (c) "General hospital" shall have the same meaning as defined by
15 section twenty-eight hundred one of the public health law.
16 (d) "Treatment in place" means the administration of emergency medical
17 services, as defined by section three thousand one of the public health
18 law, by an employee or volunteer of an ambulance service. Such services
19 shall be consistent with protocols promulgated pursuant to article thir-
20 ty of the public health law.
21 § 2. This act shall take effect on the first of October next succeed-
22 ing the date on which it shall have become a law.
