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Schumer, Clinton Win Huge Victory for Upstate NY Health Clinics Facing Devastating $65 Million Cuts from Proposed Federal Rule - Final Regulation Leaves Freestanding Clinics Untouched

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Hundreds of Thousands of New Yorkers Who Rely on Health Clinics across NYS Could Have Had the Rug Pulled Out From Under Them with a Proposed Medicaid Regulation

In an Effort to Keep Valuable Upstate NY Health Clinics Open - Dental, Dialysis, Mental Health Centers - Schumer, Clinton Pushed Via Letters, Phone Calls, and Legislation to Ensure Critical Funding Would Remain Intact

After an intense lobbying effort, U.S. Senators Charles E. Schumer and Hillary Rodham Clinton today announced that they were successfully able to save freestanding health clinics across Upstate New York from losing a devastating $65 million in critical funding due to a federal plan that would have reduced Medicaid reimbursements to health clinics. The proposed changes would have severely endangered a wide range of health care providers, such as dialysis centers, dental care health centers, family planning clinics, and substance abuse counseling and mental health clinics. Hundreds of thousands of Upstate New Yorkers who rely on the clinics could have lost access to necessary health services if the legislators' effort was not successful.

"This is a great example of ‘If you don't succeed at first, try, try, try again.' We secured a significant victory today and now hundreds of thousands of New Yorkers will continue to have access to vital health services," Schumer said. "The war is not finished over this health regulation, but we certainly won this battle. I am thrilled that our efforts are bearing fruit and that the Administration has seen how unwise and damaging these cuts would have been."

"This is a great victory for thousands of New Yorkers who rely on essential freestanding health clinics for critical health care," Clinton said. "The original regulation was misguided and would have been devastating to the ability of New Yorkers to access needed dental, mental health, family planning, and other health services for adults and children. I will continue to fight to make sure all New Yorkers and all Americans have access to quality, affordable health care."

Last year, the Centers for Medicare and Medicaid Services (CMS) proposed a new regulation, the "Medicaid Outpatient Clinic and Hospital Services Rule" that would reduce federal Medicaid funding to states for freestanding health clinics that provide dental care, physical therapy, renal dialysis, family planning, mental health and addiction counseling. This rule would have drastically changed the definition of what medical services Medicaid could pay for. These changes mean lower or no payment for care like pediatric dental check ups, dialysis for patients with kidney disease, prenatal care and family planning services and preventative care and vaccinations for children.
The proposed rule would have reduced the Medicaid payments to New York State by capping them at the Medicare payment amount, which is substantially less (for most services) than freestanding clinics facilities currently receive from Medicaid. It also would have prohibited states from paying more than Medicare pays, even for services that Medicare doesn't cover. As a result, the rule will lower federal Medicaid funding for New York State and will eliminate federal funding altogether for many important services performed in these clinics, such as dialysis services, psychiatric rehabilitation, family planning services, primary care for children, vision services, dental services and vaccinations.

If this part of the rule had been implemented, it would have resulted in the slashing of $65 million from over 120 Upstate New York health clinics who rely on the funding to continue services for children, seniors, the disabled, dialysis patients, families struggling with rising costs and more. The cuts would have required many of these health clinics to cut services to those who need it most and, in some cases, it would have forced clinics to shut their doors altogether.

To ensure Upstate New York health clinics continued to receive this necessary funding and provide critical patient services, Senators Schumer and Clinton wrote a letter to President Bush to urge his delay of the proposed regulation. Schumer also personally called CMS Director Kerry Weems and demanded an immediate suspension of the proposed rule. Schumer also introduced legislation, which Clinton co-sponsored, to put a moratorium on the rule.

As a result of the legislators' lobbying, CMS' final rule removes these vital freestanding health clinics from the new reimbursement rates that are arbitrarily capped at the Medicare payment amount. The payment change would have resulted in catastrophic losses for freestanding clinics, reducing or eliminating the payments it could receive from states for vital healthcare services. Schumer and Clinton will continue fighting for legislation to place a moratorium on the rule in order to save hospitals that will still be affected by the new regulation.

Schumer and Clinton's victory will have a significant impact on Upstate New York health clinics. Below is a region-by-region breakdown of how much money would have been lost if the rule would have gone into effect:

· In the Capital Region, the rule would have slashed $10.3 million from 13 clinics.
· In Central New York, the rule would have slashed $9.6 million from 17 clinics.
· In the Hudson Valley, the rule would have slashed $20.9 million from 31 clinics.
· In the North Country, the rule would have slashed $3.7 million from 14 clinics.
· In the Rochester-Finger Lakes, the rule would have slashed $10.3 million from 25 clinics.
· In the Southern Tier, the rule would have slashed $1.2 million from 8 clinics.
· In Western New York, the rule would have slashed $8.6 million from 18 clinics.

For example, data collected by Governor Paterson and the New York State Health Department estimated that the North Country Children's Clinic in Watertown could have lost up to $566,000, which could have forced them to stop serving its Medicaid population and severely cut back on services for other patients. In 2007, this clinic provided key health care services to over 32,000 children and young adults. Without this crucial funding, North Country Children's clinic could have been unable to continue to provide the quality care that so many upstate residents have come to rely on.

The impact on New York State patients would also have been significant. For Karen Gillette, who suffers from cerebral palsy, the clinical services that she receives from Enable, a clinic for disabled children and adults in Syracuse, allows her to receive the physical therapy and critical care she needs to remain an independent member of society. Enable has been providing these crucial services for Karen for over 40 years; however the proposed rule would jeopardize Enable's ability to provide this care for Karen and hundreds of others in Central New York.

In Buffalo, Aspire of Western New York has operated a freestanding clinic servicing over 1700 disabled adults, as well as providing services for women's health, mental health services, neurology and podiatry. The proposed CMS regulation, which Schumer and Clinton helped to deny, would have put the clinic in danger with a negative impact of over $1.2 million.

This rule also would have jeopardized health services to children.New York State currently has a health program for children's day treatment services, which provides essential care to elementary and high school students in need of mental health services. Medicaid reimburses $76 per day, but if the rule is implemented, it is likely that Medicaid will no longer pay for these services, leaving students and families with nowhere to turn.

"Thousands of clinic patients across New York State have benefited from the efforts of Senator Schumer and Senator Clinton to prevent the proposed regulation from being implemented. As a direct result of his efforts, people with disabilities and other community members served at our clinics are assured that they will continue to have access to needed health services that otherwise would not be available to them. We thank the Senators for taking on and winning this fight which was so crucial to New York's health care delivery system" said Susan Constantino, President and CEO of Cerebral Palsy Associations of NYS.

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