Relates to federal qualified health center rate adequacy

• Democratic62
• Republican15

◆ 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 the ability to pay. CHCs are a critical safety net for quality healthcare services, particularly for low-income communities and communities of color. Among CHC patients, 89% are low-income, 68% are Black, Hispanic/Latinx, or otherwise people of color, 13% are uninsured, and nearly 60% of CHCs' patients are enrolled in Medicaid, CHIP, or are dually enrolled in Medicare and Medicaid. CHCs deliver a full spectrum of services, including many social care supports, such as housing, transportation vouchers, and food, many of which were never envisioned when the CHCs' base rate was developed over 20 years ago. Current reimbursement rates are still based on costs from 1999 and 2000. These reimbursement rates are the oldest cost-based rates, among all New York State Medicaid provider types. CHC rates are further suppressed by arbitrary rate ceilings regulatorily imposed by the DOH. Costs today for personnel, benefits, equipment, medical supplies, and office space are all significantly higher than they were decades ago and have risen exponentially since the pandemic. Adding to the inadequacy of these outdated rates is the onset of more widely used healthcare delivery modes such as telehealth, further driving down the ability of rates to meet contemporary cost pressures. The outdated reimbursement methodology for CHCs does not account for the current model of comprehensive primary care including behavioral health services, oral health services, reproductive health services, and services addressing social needs. CHCs are also experiencing unprecedented workforce attrition and workforce shortages that are affecting operations. CHCs' insufficient reimbursement rates undermine their ability to engage in long-term sustainability and expansion plan- ning, limiting access to care. This legislation would ensure that the DOH evaluates and implements updated payment rates to sufficiently account for increases in operation costs and the new, expanded model of health and social care that is the hallmark of CHCs.

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.