S T A T E O F N E W Y O R K
________________________________________________________________________
7298--A
2015-2016 Regular Sessions
I N A S S E M B L Y
May 4, 2015
___________
Introduced by M. of A. NOJAY, PALMESANO -- 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; and repealing certain provisions of such law relating
thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Section 368-a of the social services law is REPEALED and a
2 new section 368-a is added to read as follows:
3 S 368-A. STATE REIMBURSEMENT. 1. THE DEPARTMENT SHALL REVIEW THE
4 EXPENDITURES MADE BY LOCAL SOCIAL SERVICES DISTRICTS FOR MEDIAL ASSIST-
5 ANCE FOR NEEDY PERSONS, AND THE ADMINISTRATION THEREOF, BEFORE MAKING
6 REIMBURSEMENT. BEFORE APPROVING SUCH EXPENDITURES FOR REIMBURSEMENT, THE
7 DEPARTMENT SHALL GIVE DUE CONSIDERATION TO THE RESULTS OF THE REVIEWS
8 AND AUDITS CONDUCTED BY THE DEPARTMENT OF HEALTH PURSUANT TO SUBDIVISION
9 TWO OF SECTION THREE HUNDRED SIXTY-FOUR OF THIS TITLE. IF APPROVED BY
10 THE DEPARTMENT, SUCH EXPENDITURES SHALL NOT BE SUBJECT TO REIMBURSEMENT
11 BY THE STATE PURSUANT TO SECTION ONE HUNDRED FIFTY-THREE OR ANY
12 PROVISION OF THIS CHAPTER OTHER THAN THIS SECTION, BUT SHALL BE SUBJECT
13 TO REIMBURSEMENT BY THE STATE IN ACCORDANCE WITH THIS SECTION AND THE
14 REGULATIONS OF THE DEPARTMENT, AS FOLLOWS:
15 THERE SHALL BE PAID TO EACH SUCH DISTRICT:
16 (A) THE AMOUNT OF FEDERAL FUNDS, IF ANY, PROPERLY RECEIVED OR TO BE
17 RECEIVED ON ACCOUNT OF SUCH EXPENDITURES;
18 (B) THE FULL AMOUNT EXPENDED ON BEHALF OF THE DEPARTMENT FOR MEDICAL
19 ASSISTANCE FURNISHED UNDER THIS TITLE TO ELIGIBLE PATIENTS IN STATE
20 INSTITUTIONS FOR THE MENTALLY DISABLED, IN FACILITIES OR PARTS THEREOF
21 FOR THE CARE AND TREATMENT OF DRUG DEPENDENT PERSONS OPERATED PURSUANT
22 TO THE MENTAL HYGIENE LAW AND IN OTHER HOSPITALS WHILE SUCH PATIENTS ARE
23 ON RELEASE FROM AN INSTITUTION IN THE STATE DEPARTMENT OF MENTAL HYGIENE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10272-03-5
A. 7298--A 2
1 OR FROM A DRUG ABUSE TREATMENT FACILITY OR PART THEREOF OPERATED IN
2 COMPLIANCE WITH APPLICABLE PROVISIONS OF LAW AND SUPERVISED BY THE
3 OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, TO ELIGIBLE VETERANS
4 AND THEIR DEPENDENTS IN THAT PART OF THE NEW YORK STATE HOME FOR VETER-
5 ANS AND THEIR DEPENDANTS AT OXFORD THAT HAS BEEN APPROVED PURSUANT TO
6 LAW AS A NURSING HOME AND IN A HOSPITAL WHILE ON RELEASE FROM THAT HOME
7 FOR THE PURPOSE OF RECEIVING CARE IN SUCH HOSPITAL, IN THAT PART OF A
8 PUBLIC INSTITUTION OPERATED FOR THE CARE OF THE MENTALLY DISABLED THAT
9 HAS BEEN APPROVED PURSUANT TO LAW AS AN INTERMEDIATE CARE FACILITY, TO
10 ELIGIBLE VETERANS AND THEIR DEPENDENTS IN THAT PART OF THE NEW YORK
11 STATE HOME FOR VETERANS AND THEIR DEPENDENTS AT OXFORD THAT HAS BEEN
12 APPROVED PURSUANT TO LAW AS AN INTERMEDIATE CARE FACILITY AND IN A
13 HOSPITAL WHILE ON RELEASE FROM SUCH INTERMEDIATE CARE FACILITIES FOR THE
14 PURPOSE OF RECEIVING CARE IN SUCH HOSPITAL, AND FOR THE ADMINISTRATION
15 THEREOF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY
16 RECEIVED OR TO BE RECEIVED ON ACCOUNT THEREOF;
17 (C) THE FULL AMOUNT EXPENDED FOR MEDICAL ASSISTANCE FURNISHED UNDER
18 THIS TITLE TO ELIGIBLE INDIANS AND MEMBERS OF THEIR FAMILIES RESIDING ON
19 ANY INDIAN RESERVATION IN THIS STATE, AND FOR THE ADMINISTRATION THERE-
20 OF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY RECEIVED
21 OR TO BE RECEIVED ON ACCOUNT THEREOF;
22 (D) THE FULL AMOUNT EXPENDED FOR MEDICAL ASSISTANCE FURNISHED UNDER
23 THIS TITLE TO OTHER ELIGIBLE PERSONS, AND FOR THE ADMINISTRATION THERE-
24 OF, AFTER FIRST DEDUCTING THEREFROM ANY FEDERAL FUNDS PROPERLY RECEIVED
25 OR TO BE RECEIVED ON ACCOUNT THEREOF INCLUDING:
26 (I) THE DEVELOPMENT OF MEDICAL ASSISTANCE DATA SYSTEMS;
27 (II) MEDICAL ASSISTANCE FURNISHED TO PERSONS DESCRIBED IN SUBDIVISION
28 FIVE OF SECTION THREE HUNDRED SIXTY-FIVE OF THIS TITLE;
29 (III) THE FOLLOWING SERVICES: CARE, TREATMENT, MAINTENANCE AND NURSING
30 SERVICES IN NURSING HOMES AND HEALTH RELATED CARE AND SERVICES IN INTER-
31 MEDIATE CARE FACILITIES PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF
32 SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE;
33 HOME HEALTH SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (D) OF SUBDI-
34 VISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; PERSONAL
35 CARE SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (E) OF SUBDIVISION
36 TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; LONG TERM HOME
37 HEALTH CARE PROGRAMS SERVICES PROVIDED IN ACCORDANCE WITH SECTION THREE
38 HUNDRED SIXTY-SEVEN-C OF THIS TITLE; AND NURSING HOME TRANSITION AND
39 DIVERSION SERVICES PROVIDED IN ACCORDANCE WITH SUBDIVISION SIX-A OF
40 SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
41 (IV) MEDICAL ASSISTANCE FOR THOSE INDIVIDUALS WHO ARE ELIGIBLE PURSU-
42 ANT TO SECTION THREE HUNDRED SIXTY-SIX OF THIS ARTICLE AS A RESULT OF A
43 MENTAL DISABILITY AS DETERMINED BY THE COMMISSIONER IN CONSULTATION WITH
44 THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMISSIONER OF
45 THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES AND WITH THE
46 APPROVAL OF THE DIRECTOR OF THE BUDGET;
47 (V) MEDICAL ASSISTANCE FURNISHED TO PERSONS DESCRIBED IN SUBDIVISION
48 EIGHT OF SECTION THREE HUNDRED SIXTY-FIVE OF THIS ARTICLE, INCLUDING THE
49 ADMINISTRATION THEREOF;
50 (VI) REIMBURSEMENTS FOR THE CARE AND SERVICES PROVIDED TO THOSE
51 PERSONS ELIGIBLE PURSUANT TO SUBPARAGRAPHS SEVEN OF PARAGRAPH (A) OF
52 SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
53 (VII) PAYMENTS MADE, WHETHER BY THE DEPARTMENT ON BEHALF OF A LOCAL
54 SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-B
55 OF THIS ARTICLE OR BY A LOCAL SOCIAL SERVICES DISTRICT DIRECTLY, FOR A
56 SUPPLEMENTARY BAD DEBT AND CHARITY CARE ADJUSTMENT COMPONENT OF RATES OF
A. 7298--A 3
1 PAYMENT DETERMINED IN ACCORDANCE WITH SUBDIVISION FOURTEEN-A OF SECTION
2 TWENTY-EIGHT HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW FOR GENERAL HOSPI-
3 TAL INPATIENT HOSPITAL SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH
4 (B) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS
5 ARTICLE, LIMITED TO THE AMOUNT OF FEDERAL FUNDS PROPERLY RECEIVED OR TO
6 BE RECEIVED ON ACCOUNT OF SUCH EXPENDITURES; PROVIDED, HOWEVER, THAT
7 REIMBURSEMENT SHALL BE MADE BY THE STATE FOR THE FULL AMOUNT EXPENDED
8 FOR A SUPPLEMENTARY BAD DEBT AND CHARITY CARE ADJUSTMENT FOR A GENERAL
9 HOSPITAL OPERATED BY THE STATE OF NEW YORK OR BY THE STATE UNIVERSITY OF
10 NEW YORK;
11 (VIII) PAYMENTS MADE FOR A SUPPLEMENTARY LOW INCOME PATIENT ADJUSTMENT
12 COMPONENT OF RATES OF PAYMENT FOR A PUBLIC GENERAL HOSPITAL DETERMINED
13 IN ACCORDANCE WITH SUBDIVISION FOURTEEN-D OF SECTION TWENTY-EIGHT
14 HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW FOR GENERAL HOSPITAL INPATIENT
15 HOSPITAL SERVICES PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF SUBDIVI-
16 SION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE, LIMITED
17 TO THE AMOUNT OF FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON
18 ACCOUNT OF SUCH EXPENDITURES; PROVIDED, HOWEVER, THAT REIMBURSEMENT
19 SHALL BE MADE BY THE STATE FOR THE FULL AMOUNT EXPENDED FOR A SUPPLEMEN-
20 TARY LOW INCOME PATIENT ADJUSTMENT FOR A GENERAL HOSPITAL OPERATED BY
21 THE STATE OF NEW YORK OR BY THE STATE UNIVERSITY OF NEW YORK;
22 (IX) MEDICAL ASSISTANCE FURNISHED UNDER THIS TITLE TO ELIGIBLE PERSONS
23 PURSUANT TO A STATEWIDE MANAGED CARE PLAN OR MANAGED CARE DEMONSTRATION
24 PROGRAM, OR TO ELIGIBLE PERSONS ENROLLED IN ANY HEALTH MAINTENANCE
25 ORGANIZATION OR OTHER ENTITY AUTHORIZED BY LAW TO FURNISH COMPREHENSIVE
26 HEALTH SERVICES PURSUANT TO A PLAN;
27 (X) PAYMENTS MADE FOR THE COMPONENT OF RATES OF PAYMENT FOR A GENERAL
28 HOSPITAL DETERMINED IN ACCORDANCE WITH PARAGRAPH (S) OF SUBDIVISION
29 ELEVEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THE PUBLIC HEALTH LAW
30 FOR GENERAL HOSPITAL INPATIENT HOSPITAL SERVICES PROVIDED IN ACCORDANCE
31 WITH PARAGRAPH (B) OF SUBDIVISION TWO OF SECTION THREE HUNDRED
32 SIXTY-FIVE-A OF THIS ARTICLE;
33 (XI) PAYMENTS MADE FOR A PUBLIC GENERAL HOSPITAL INDIGENT CARE ADJUST-
34 MENT PAYMENT FOR A PUBLIC GENERAL HOSPITAL DETERMINED IN ACCORDANCE WITH
35 SUBDIVISION FOURTEEN-F OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THE
36 PUBLIC HEALTH LAW FOR GENERAL HOSPITAL INPATIENT HOSPITAL SERVICES
37 PROVIDED IN ACCORDANCE WITH PARAGRAPH (B) OF SUBDIVISION TWO OF SECTION
38 THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE, LIMITED TO THE AMOUNT OF
39 FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH
40 EXPENDITURES; PROVIDED, HOWEVER, THAT REIMBURSEMENT SHALL BE MADE BY THE
41 STATE FOR THE FULL AMOUNT EXPENDED FOR A PUBLIC GENERAL HOSPITAL INDI-
42 GENT CARE ADJUSTMENT FOR A GENERAL HOSPITAL OPERATED BY THE STATE OF NEW
43 YORK OR BY THE STATE UNIVERSITY OF NEW YORK;
44 (XII) HEALTH CARE SERVICES AS DETERMINED IN ACCORDANCE WITH PARAGRAPH
45 (C) OF SUBDIVISION TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF THE
46 PUBLIC HEALTH LAW; AND
47 (XIII) HEALTH CARE SERVICES DESCRIBED IN SECTIONS THREE HUNDRED
48 SIXTY-EIGHT-D AND THREE HUNDRED SIXTY-EIGHT-E OF THIS TITLE.
49 2. (A) FOR THE PURPOSE OF STATE REIMBURSEMENT UNDER THIS TITLE,
50 EXPENDITURES FOR ADMINISTRATION OF MEDICAL ASSISTANCE FOR NEEDY PERSONS
51 SHALL INCLUDE EXPENDITURES FOR SALARIES OF EMPLOYEES OF LOCAL WELFARE
52 DEPARTMENTS, EXCEPT FOR THOSE EXCLUDED UNDER PARAGRAPH (B) OF THIS
53 SUBDIVISION; OPERATION, MAINTENANCE AND SERVICE COSTS; AND SUCH OTHER
54 EXPENDITURES, SUCH AS EQUIPMENT COSTS, DEPRECIATION CHARGES, AND RENTAL
55 VALUES, AS MAY BE APPROVED BY THE DEPARTMENT. IT SHALL NOT INCLUDE
56 EXPENDITURES FOR CAPITAL ADDITIONS OR IMPROVEMENTS.
A. 7298--A 4
1 (B) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE SALARY
2 OF A SOCIAL SERVICES OFFICIAL, OR A CHIEF EXECUTIVE OFFICER OF A SOCIAL
3 SERVICES DEPARTMENT, WHOSE QUALIFICATIONS DO NOT CONFORM TO THOSE FIXED
4 BY THE DEPARTMENT, OR A CITY OR TOWN SERVICE OFFICER; NOR SHALL SUCH
5 REIMBURSEMENT BE MADE ON THE SALARY OF A DEPUTY COMMISSIONER, OR DEPUTY
6 DIRECTOR OR AN EMPLOYEE, UNLESS HIS EMPLOYMENT IS NECESSARY FOR THE
7 ADMINISTRATION OF MEDICAL ASSISTANCE AND HIS QUALIFICATIONS CONFORM TO
8 THOSE FIXED BY THE DEPARTMENT.
9 (C) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE SALARY
10 OF A LOCAL MEDICAL DIRECTOR APPOINTED AFTER THE EFFECTIVE DATE OF THIS
11 SECTION WHOSE QUALIFICATIONS DO NOT CONFORM TO THOSE ESTABLISHED PURSU-
12 ANT TO SECTION THREE HUNDRED SIXTY-FOUR OF THIS TITLE.
13 (D) STATE REIMBURSEMENT SHALL NOT BE MADE FOR ANY PART OF THE COST OF
14 THOSE ITEMS OF CARE, SERVICES, SUPPLIES AND EQUIPMENT, AND DRUGS WHICH
15 REPRESENT CO-PAYMENT AMOUNTS FOR WHICH A PROVIDER OF MEDICAL ASSISTANCE
16 IS AUTHORIZED TO CHARGE A RECIPIENT IN ACCORDANCE WITH SUBDIVISION SIX
17 OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS ARTICLE.
18 3. (A) CLAIMS FOR STATE REIMBURSEMENT SHALL BE MADE IN SUCH FORM AND
19 MANNER AND AT SUCH TIMES AND FOR SUCH PERIODS AS THE DEPARTMENT SHALL
20 DETERMINE.
21 (B) WHEN CERTIFIED BY THE DEPARTMENT, STATE REIMBURSEMENT SHALL BE
22 PAID FROM THE STATE TREASURY UPON THE AUDIT AND WARRANT OF THE COMP-
23 TROLLER OUT OF FUNDS MADE AVAILABLE THEREFOR.
24 (C) WHEN THE MONEYS ALLOTTED TO THE STATE BY THE FEDERAL DEPARTMENT OF
25 HEALTH, EDUCATION AND WELFARE OR OTHER AUTHORIZED FEDERAL AGENCY FOR ANY
26 QUARTER SHALL HAVE BEEN RECEIVED BY THE DEPARTMENT OF TAXATION AND
27 FINANCE, THE DEPARTMENT SHALL, AS SOON AS POSSIBLE, CERTIFY TO THE COMP-
28 TROLLER THE AMOUNT TO WHICH EACH PUBLIC WELFARE DISTRICT IS ENTITLED FOR
29 SUCH QUARTER AND SUCH AMOUNT SHALL BE PAID OUT OF THE STATE TREASURY
30 AFTER AUDIT BY THE COMPTROLLER TO THE RESPECTIVE PUBLIC WELFARE
31 DISTRICTS.
32 (D) THE DEPARTMENT IS AUTHORIZED IN ITS DISCRETION TO MAKE ADVANCES TO
33 PUBLIC WELFARE DISTRICTS IN ANTICIPATION OF THE STATE REIMBURSEMENT
34 PROVIDED FOR IN THIS SECTION.
35 4. PAYMENT OF STATE REIMBURSEMENT AND ADVANCES SHALL BE MADE TO THE
36 FISCAL OFFICER OF THE PUBLIC WELFARE DISTRICT ENTITLED THERETO PURSUANT
37 TO THE PROVISIONS OF THIS CHAPTER.
38 S 2. Section 368-b of the social services law, as added by chapter 256
39 of the laws of 1966, is amended to read as follows:
40 S 368-b. State reimbursement to local health districts; chargebacks.
41 1. Each approved local health district which enters into a contract
42 with the department of health pursuant to section three hundred sixty-
43 four-a of this title shall submit to the department of health a quarter-
44 ly report of expenditures for administrative expenses incurred in the
45 performance of such contract. The department of health shall review
46 such expenditures and, upon approval, shall submit the report to the
47 department. Upon receipt of such approved report, there shall be paid
48 to each such district
49 (a) the amount of federal funds, if any, properly received or to be
50 received on account of such expenditures; and
51 (b) [fifty] ONE HUNDRED per centum of the amount expended for such
52 administrative expenses, after first deducting therefrom any federal
53 funds properly received or to be received on account thereof.
54 2. The department of health shall submit a quarterly report to the
55 department of expenditures for administrative expenses incurred by each
56 of the state health districts in the performance of the cooperative
A. 7298--A 5
1 agreement entered into pursuant to section three hundred sixty-four-a of
2 this title. Upon receipt of such report, the department shall deduct the
3 amount of federal funds, if any, properly received or to be received on
4 account of such expenditures from the total amounts reported for each
5 such district [Fifty]. ONE HUNDRED per centum of the balance shall be
6 apportioned among the public welfare districts served by such district
7 [in the ratio that the total expenditures by each such public welfare
8 district for medical assistance for needy persons for the quarter bears
9 to the total expenditures by all such public welfare districts for such
10 quarter. The proportionate share shall be deducted from the next
11 payment due each of such public welfare districts pursuant to section
12 three hundred sixty-eight-a of this title].
13 S 3. The commissioners of the department of family assistance shall
14 study and propose all necessary legislative adjustments needed to
15 correct erroneous references throughout the social services law necessi-
16 tated through this act.
17 S 4. State assumption of non-federal share Medicaid costs. 1.
18 Notwithstanding any other provision of law, the state shall assume one
19 hundred percent of the non-federal share of Medicaid costs by January
20 first, two thousand twenty.
21 2. (a) Commencing state fiscal year two thousand sixteen the local
22 share/county share of Medicaid costs expended through the medical
23 assistance amount for social services districts shall be reduced by
24 twenty percent under the year 2015 expenditure.
25 (b) Commencing state fiscal year two thousand seventeen the local
26 share/county share of Medicaid costs expended through the medical
27 assistance amount for social services districts shall be reduced by
28 forty percent under the year 2015 expenditure.
29 (c) Commencing state fiscal year two thousand eighteen the local
30 share/county share of Medicaid costs expended through the medical
31 assistance amount for social services districts shall be reduced by
32 sixty percent under the year 2015 expenditure.
33 (d) Commencing state fiscal year two thousand nineteen the local
34 share/county share of Medicaid costs expended through the medical
35 assistance amount for social services districts shall be reduced by
36 eighty percent under the year 2015 expenditure.
37 (e) Commencing state fiscal year two thousand twenty the local
38 share/county share of Medicaid costs expended through the medical
39 assistance amount for social services districts shall be reduced by one
40 hundred percent under the year 2015 expenditure.
41 (f) The state by and through the governor may choose to override the
42 cap established in this section after the year two thousand twenty,
43 however, any increases to expenditures approved by the governor shall be
44 funded through the state budget.
45 (g) As used in this section the following term shall have the follow-
46 ing meaning: "Local share/county share" shall mean the portion of any
47 expenses covered by counties for the administration, benefits and
48 service provided under the state's Medicaid program.
49 S 5. This act shall take effect April 1, 2016.