BILL NUMBER: S4178
SPONSOR: PARKER
 
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:
Section 1: Section 7.07 of the mental hygiene law is amended by adding a
new subdivision (i).
Section 2: This act shall take effect on the ninetieth day after it
shall have become a law.
 
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:
2023-24: S5773-Referred to Mental Health
2021-22: S3476 - Referred to Mental Health
2019-20: S6694-Passed Senate
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth after it shall have become a
law.

Statutes affected:
S4178: 7.07 mental hygiene law