BILL NUMBER: S10315
SPONSOR: WEBER
 
TITLE OF BILL:
An act to amend the mental hygiene law and the public health law, in
relation to establishing a mandatory supplemental therapeutic services
reimbursement for individuals receiving services through the office for
people with developmental disabilities
 
SUMMARY OF PROVISIONS:
Section one adds a new section to the mental hygiene law requiring the
commissioner to authorize supplemental reimbursement when threshold
criteria are met. It establishes minimum reimbursement floors of $120.00
per hour for individual therapy, $90.00 per hour for group therapy, and
$150.00 per hour for ABA services, with maximum caps of $250.00,
$175.00, and $325.00 per hour respectively, all subject to mandatory
annual CPI-U adjustment. It requires the commissioner to act within
fifteen business days or the application is deemed approved. It provides
an administrative complaint pathway with a tenbusiness-day response
requirement and requires rulemaking within ninety days. Section two
authorizes program integrity review by the Medicaid inspector general.
Section three requires annual public reporting including the number of
approvals by operation of law. Section four clarifies that the bill
does not create a private right of action. Section five sets the effec-
tive date.
 
JUSTIFICATION:
Families and individuals who rely on therapeutic services routinely
encounter a gap between what is authorized on paper and what can be
secured in practice. State OMH reimbursement rates of approximately
$45-46 per hour are insufficient to attract qualified therapists in most
New York markets. Families who find and retain private therapists at
market rates receive little or no reimbursement support, despite the
fact that the service is medically necessary and plan-authorized.
This bill addresses that failure directly. By establishing mandatory
minimum dollar floors tied to the CPI-U medical care index, it ensures
that reimbursement rates remain meaningful over time. By setting a
fifteenbusiness-day decision deadline with deemed approval as the remedy
for inaction, it protects families from administrative delay. By short-
ening the provider-search period to twenty-one days recognizing that
many families already know from experience that no provider at the OMH
rate is available in their geographic area it reduces the burden of a
process that is in many cases purely formal. The deemed approval
provision and administrative complaint pathway together provide meaning-
ful accountability within the executive branch without resort to judi-
cial enforcement.
 
LEGISLATIVE HISTORY:
New Bill
 
FISCAL IMPLICATIONS:
This bill will increase expenditures for the OPWDD program. Cost is
constrained by: the twenty-one-day provider-unavailability documentation
requirement; the requirement that services be medically necessary and
included in an approved plan; the per-hour rate caps; the CPT-U adjust-
ment methodology; and utilization review and program integrity oversight
by the Medicaid inspector general. To the extent the bill reduces
service disruption, behavioral crises, and family caregiver breakdown,
it may also prevent higher-cost institutional or emergency inter-
ventions. The annual reporting requirement will allow the legislature to
monitor utilization and adjust program parameters as warranted.
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.

Statutes affected:
S10315: 32 public health law