Expands health care services provided by telehealth

• Democratic69
• Republican14

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

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.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.