Memorandum in Support

For Immediate Release:  January 30, 2023

Re: S.2339 (Rivera) — AN ACT to amend the social services law, in relation to coverage for services provided by school-based health centers for  medical  assistance  recipients;  and  to  amend part JJ of chapter 57 of the laws of 2021 amending  the  social  services  law  relating  to  managed  care programs, in relation to the effectiveness thereof

HPA supports S.2339, which would allow school based health center (SBHC) services to remain outside the Medicaid Managed Care (MMC) benefit package.  Discussions between the Department of Health (DOH), SBHC providers, SBHC sponsors and health plans have been occurring over the past several years and substantial operational issues remain, including the transition period from fee-for-service (FFS), and credentialing, billing and claims processing concerns.  Furthermore, the unique relationship between SBHC providers and their sponsors create significant administrative burdens in the contracting process with MMC plans.

To achieve this carve-in according to the previous DOH guidance document, health plans, SBHC providers and SBHC sponsors are required to do a significant amount of work to comply with the implementation plan with no change in the benefit to the recipient, at a time when SBHCs are already struggling operationally.  All parties are likely to incur considerable administrative costs at a time when the state and plans need to focus on the massive Medicaid eligibility recertification effort that will begin at the end of March 2023.

For these reasons, HPA supports continuing to allow SBHC services to remain outside of the MMC benefit package.