BILL NUMBER: S3359
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, in relation to expanding health
care services provided by telehealth; and to amend part V of chapter 57
of the laws of 2022, amending the public health law and the insurance
law relating to reimbursement for commercial and Medicaid services
provided via telehealth, in relation to the effectiveness thereof
 
PURPOSE OR GENERAL IDEA OF BILL:
Corrects the methodology by which Medicaid reimburses community health
centers for telehealth services, to be aligned with other providers that
are paid through a bundled payment.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends section 2999-dd of the Public Health Law (PHL), as it
relates to telehealth delivery of services, to ensure that all Federally
Qualified Health Centers (FQHCs) that are licensed pursuant to Article
28 of PHL, including those that also hold licenses under the Mental
Hygiene Law, are sufficiently reimbursed for telehealth services.
Section 2 amends section 7 of Part V of Chapter 57 of the laws of 2022,
updating provisions regarding telehealth reimbursement for an additional
two years from April 1, 2026, until April 1, 2028.
Section 3 provides an effective date.
 
JUSTIFICATION:
FQHCs also known as community health centers (CHCs), are located in
medically underserved neighborhoods, providing quality and affordable
healthcare services to all, regardless of immigration status, insurance
coverage, or ability to pay. CHCs act as an access point to quality
healthcare services, particularly for low-income communities and commu-
nities of color. Among CHC patients, 89% are low-income, 68% are Black,
Hispanic/Latinx, or otherwise people of color, 13% are uninsured, and
59% are enrolled in Medicaid or Child Health Plus. This patient popu-
lation has disproportionately experienced poor health outcomes due to
pervasive structural inequities that have led to health disparities that
were further exacerbated by the COVID-19 pandemic.
CHCs have been able to combat these inequities by offering telehealth
services. Telehealth decreases access barriers that can inhibit
patients' ability to visit a provider, such as lack of transportation,
childcare issues, or time off from work. CHCs have found fewer
"no-shows" for telehealth visits, especially for behavioral health
visits. However, due to an inequity in current law that prevents CHCs
with an Article 28 license from being fully reimbursed when conducting
services via telehealth if both the patient and provider are outside of
the facility, CHCs relying on telehealth options are facing financial
distress. CHCs bill a bundled payment rate and there are no separate
professional fee schedules or facility fees that CHCs may bill. Existing
law recognizes mental hygiene law Article 31 and 32 clinics bill using
Ambulatory Patient Groups - a bundled payment rate similar to that used
by CHCs - and statutorily exempts those clinics from the facility fee
restriction. Instead, those mental hygiene providers are receiving a
standard bundled rate regardless of whether the service is provided via
telehealth or in person, and regardless of where the patient or provider
is located.
The Department of Health has interpreted the current law to mean that
effective May 11, 2023 (the end of the federal Public Health Emergency),
CHCs will only be reimbursed at one-third of the in-person rate if the
CHC delivers services via telehealth offsite. This will result not only
in a major financial loss for CHCs and undermine New York's goal of
advancing health equity, but severely restrict access to health
services. Implementing this lower reimbursement rate will prevent CHCs
from retaining and recruiting providers, especially behavioral health
providers, who are scarce and already in high demand. CHCs will be
forced to reduce the number of behavioral health visits in the primary
care setting available to patients and thereby limit access to care.
This legislation will ensure that CHCs with an Article 28 license are
fully reimbursed when conducting services via telehealth, regardless of
the location of both the patient and provider. This bill aligns the CHCs
that also receive bundled payments with those mental hygiene law Article
31 and 32 licensed facilities since none of these entities bill a facil-
ity fee.
 
PRIOR LEGISLATIVE HISTORY:
2023-2024: S6733/A7316 Paulin
 
EFFECTIVE DATE:
This bill shall take effect immediately, with the provisions of section
one of the act to take effect on April 1, 2026

Statutes affected:
S3359: 2999-dd public health law, 2999-dd(1) public health law