1. Recent Changes to Health Care Reimbursement Impact New York Residents, by Elly Kleinman
The President and Chief Executive Officer of the Americare Companies, Elly Kleinman holds
more than 30 years of experience in the managed health care sector. A member of the New York
State Association of Healthcare Providers, Inc., Mr. Kleinman also serves as a board member of
the Maimonides Medical Center in New York City. He discusses recent changes to health care
reimbursement in New York.
Former New York Governor Eliot Spitzer, in his January 2008 State of the State address,
presented a proposal aimed at transforming the health care reimbursement system in place at the
time. Four years ago, many New Yorkers faced limited options regarding the choice of a primary
care physician or, in applicable cases, an organization certified to extend home health care
services. As Governor Spitzer pointed out, programs such as Family Health Plus failed to meet
the standards for acceptable payout rate held by a vast swath of general providers, highlighting
an issue that has plagued both taxpayers and the medical community since 1981, one of the last
times that any major updates were made to New York’s major managed care networks.
Recent changes in the state budget aim to address the issues that Mr. Spitzer brought forth during
his tenure, although many critics of the impending legislative shifts remain dissatisfied with the
New York government’s approach to resolving the health care crisis. Under the 2011-2012 state
budget stipulations, a new pricing methodology will be utilized to determine out-of-pocket costs
for individuals with managed care plans. Moreover, this legislation imposes additional living
wage mandates on home care agencies in some of the state’s most highly populated counties and
phases out HIV/AIDS payment add-ons for a large percentage of long-term home health care
programs. As tight profit margins and compromised resources remain a harsh reality, health care
providers in New York still face a considerable challenge regarding their ability to extend care to
the state’s citizen base.
A vocal consortium of patient advocates believes that New York’s government agencies can
formulate a mutually beneficial approach to reimbursing public and private health care providers
for both inexpensive and costly services, bolstering quality and accessibility of care across the
board.