senate Bill S5671

Amended

Relates to the provision of services by long term home health care programs; repealer

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 03 / Jun / 2013
    • REFERRED TO HEALTH
  • 17 / Jun / 2013
    • AMEND AND RECOMMIT TO HEALTH
  • 17 / Jun / 2013
    • PRINT NUMBER 5671A
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Relates to the provision of services by long term home health care programs.

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Bill Details

Versions:
S5671
S5671A
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §§3602, 4403-f, & 3616, rpld §3610 sub 5 ¶(b), Pub Health L; amd §367-c, Soc Serv L

Sponsor Memo

BILL NUMBER:S5671

TITLE OF BILL: An act to amend the public health law and the social
services law, in relation to the provision of services by long term
home health care programs; and to repeal certain provisions of the
public health law relating thereto

PURPOSE OR GENERAL IDEA OF BILL:

To make conforming amendments to the LTHHCP statute to further align
the LTHHCP to State Medicaid redesign policies, so as to facilitate
LTHHCP functionality, operation and continuity under the state's new
policies.

SUMMARY OF SPECIFIC PROVISIONS:

Section one expresses the intent of the Legislature to further align
the LTHHCP to function within the evolving model of managed care.

Section two amends the eligibility for the LTHHCP to align it with
managed care plan eligibility.

Section two also amends the LTHHCP definition to make explicit its
ability to function as a contractor to a managed care plan.

Section three makes a conforming amendment to the Managed Long Term
Care (MLTC) statute to make explicit the ability of MLTCs to contract
with LTHHCP for LTHHCP services and to stipulate that the MLTC statute
(4403-f)supersedes any inconsistent provisions between 4403-f and
article 36 for LTHHCP services contracted to MLTC.

Sections 4 and 5 amend the social services law and public health law
Provisions for authorization and provision of LTHHCP services. The
amendments stipulate that these respective provisions of law govern
LTHHCP except when LTHHCP services are provided and authorized under
MLTC, in which case, the MLTC statute governs.

Section 6 repeals provisions of article 36 that impose patient "slot"
limits on LTHMCPs.

Section 7 addresses the changing status of waivers for LTHHCP, further
reinforcing existing law to underscore that provision or operation of
LTHHCP is not contingent upon the authority to authorize reimbursement
for optional waivered services under a federal 1915(c) waiver.

Section 8 establishes an immediate effective date for the bill.

JUSTIFICATION:

New York State's Long Term Home Health Care ("Nursing Home Without
Walls") Program has for over three decades been an integral part of
the state's long term care system and an important service option for
the state's citizens with chronic illness, infirmity and disability.
The program provides quality care to long term care patients at home
at approximately half the cost of institutional care.


As the state shifts to a managed care structure.for the delivery of
health services, this program should continue to fulfill its vital
role in the state's health care system. To effectively function in the
new system, however, certain changes are necessary to further align
this program to the evolving delivery structure.

This legislation provides for the series of conforming changes
necessary to facilitate LTHHCP functionality, operation, contracting
and continuity in this evolving system.

These changes provide for sensibility and rationality of structure for
MLTCLTHHCP contracting and partnering in the provision of care.

The legislation will promote achievement of the state's Medicaid
redesign goals, continuity of patient care, and continuity of the
LTHHCP as a vital component of the needed long term care
infrastructure.

PRIOR LEGISLATIVE HISTORY:

None.

FISCAL IMPLICATIONS:

This bill helps ensure efficiency and savings in the state Medicaid
program by facilitating the functionality, operation and contracting
of the LTHHCP within the evolving infrastructure. The LTHHCP has
provided a cost-effective alternative to institutionalization for 35
years, with patient care costs under the LTHHCP averaging
approximately 50 percent of nursing home costs.

EFFECTIVE DATE:

The bill would take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5671

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 3, 2013
                               ___________

Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the social  services  law,  in
  relation  to  the  provision of services by long term home health care
  programs; and to repeal certain provisions of the  public  health  law
  relating thereto

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Legislative intent. The legislature  finds  that  New  York
State's  Long  Term  Home  Health  Care  ("Nursing  Home Without Walls")
Program has for over three decades been an integral part of the  state's
long  term  care  system and an important service option for the state's
citizens with chronic illness, infirmity  and  disability.  The  program
provides quality care to long term care patients at home at approximate-
ly half the cost of institutional care.
  As  the  state  shifts to a managed care structure for the delivery of
health services, the legislature finds that this program should continue
to fulfill its vital role in the state's health care system.  The legis-
lature finds however that, to effectively function in  the  new  system,
certain  changes  are  necessary  to  further  align this program to the
evolving model of managed care, and  concludes  that  these  changes  be
instituted simultaneously with managed care implementation.
  S  2.  The  opening  paragraph of subdivision 8 of section 3602 of the
public health law, as amended by chapter 622 of the  laws  of  1988,  is
amended and a new paragraph d is added to read as follows:
  "Long  term home health care program" means a coordinated plan of care
and services provided at  home  to  (I)  invalid,  infirm,  or  disabled
persons  who are medically eligible for placement in a hospital or resi-
dential health care facility for an extended  period  of  time  if  such
program  were unavailable, OR (II) PERSONS REQUIRING HOME AND COMMUNITY-
BASED SERVICES WHO ARE ENROLLED IN A MANAGED CARE PLAN AS DEFINED  UNDER

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11302-01-3

S. 5671                             2

PARAGRAPH  (E)  OF  SUBDIVISION  ONE OF SECTION THIRTY-SIX HUNDRED FOUR-
TEEN-C OF THIS ARTICLE.
  D.  A LONG TERM HEALTH CARE PROGRAM AS DEFINED IN THIS SUBDIVISION AND
AUTHORIZED UNDER SECTION THIRTY-SIX HUNDRED TEN OF THIS ARTICLE  MAY  BE
PROVIDED  (I)  DIRECTLY,  IN  ACCORDANCE WITH SECTION THIRTY-SIX HUNDRED
SIXTEEN OF THIS ARTICLE, OR (II) UNDER CONTRACT WITH A MANAGED CARE PLAN
AS DEFINED UNDER PARAGRAPH (E) OF SUBDIVISION ONE OF SECTION  THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS ARTICLE.
  S  3.  Subdivision  10  of section 4403-f of the public health law, as
amended by section 41-b of part H of chapter 59 of the laws of 2011,  is
amended to read as follows:
  10.  Notwithstanding  any  inconsistent provision to the contrary, the
enrollment and disenrollment process and services provided  or  arranged
by all operating demonstrations or any program that receives designation
as  a Program of All-Inclusive Care for the Elderly (PACE) as authorized
by federal public law 105-33, subtitle I of title  IV  of  the  Balanced
Budget  Act  of  1997,  must  meet  all applicable federal requirements.
Services may include, but need not be limited to, housing, inpatient and
outpatient hospital services, nursing home care, home health care, adult
day care, assisted living services provided in accordance  with  article
forty-six-B  of  this  chapter,  adult  care facility services, enriched
housing program services, hospice care,  respite  care,  personal  care,
homemaker  services,  diagnostic  laboratory  services,  therapeutic and
diagnostic radiologic  services,  emergency  services,  emergency  alarm
systems,  home  delivered  meals,  physical  adaptations to the client's
home, physician  care  (including  consultant  and  referral  services),
ancillary   services,  case  management  services,  transportation,  and
related medical services.   A PLAN MAY  CONTRACT  WITH  LONG  TERM  HOME
HEALTH CARE PROGRAMS AUTHORIZED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER
OR HOME CARE AGENCIES CERTIFIED OR LICENSED PURSUANT TO SUCH ARTICLE FOR
THE  PROVISION  OF SERVICES, INCLUDING CASE MANAGEMENT SERVICES, TO PLAN
ENROLLEES; PROVIDED THAT SUCH PROGRAMS OR AGENCIES  SHALL  PROVIDE  SUCH
SERVICES  CONSISTENT  WITH  THE  PROVISIONS  OF THIS SECTION WHICH SHALL
SUPERSEDE ANY INCONSISTENT PROVISIONS  OF  ARTICLE  THIRTY-SIX  OF  THIS
CHAPTER OR THE REGULATIONS OF THE DEPARTMENT PROMULGATED THERETO.
  S  4.  Subdivision  1  of section 367-c of the social services law, as
added by chapter 895 of the laws of 1977, is amended to read as follows:
  1. EXCEPT WHEN  LONG  TERM  HOME  HEALTH  CARE  PROGRAM  SERVICES  ARE
PROVIDED PURSUANT TO A CONTRACT WITH A PLAN APPROVED PURSUANT TO SECTION
FORTY-FOUR  HUNDRED  THREE-F  OF  THE PUBLIC HEALTH LAW OR SECTION THREE
HUNDRED SIXTY-FOUR-J OF THIS TITLE, IN WHICH CASE LONG TERM HOME  HEALTH
CARE  PROGRAM SERVICES SHALL BE AUTHORIZED PURSUANT TO THE PROVISIONS OF
SUCH SECTIONS, LONG TERM HOME HEALTH  CARE  PROGRAM  SERVICES  SHALL  BE
PROVIDED  IN ACCORDANCE WITH THIS SECTION AND SECTION THIRTY-SIX HUNDRED
SIXTEEN OF THE PUBLIC HEALTH LAW.
  If a long term home health care program as defined under article thir-
ty-six of the public health law  is  provided  in  the  social  services
district for which he has authority, the local social services official,
before he authorizes care in a nursing home or intermediate care facili-
ty  for  a  person  eligible to receive services under this title, shall
notify the person in writing of the provisions of this section.
  S 5. Subdivision 1 of section  3616  of  the  public  health  law,  as
amended  by  chapter  622  of  the  laws  of 1988, is amended to read as
follows:
  1. A long term home health care program shall be  provided  [only]  to
those  patients who REQUIRE HOME AND COMMUNITY BASED SERVICES, INCLUDING

S. 5671                             3

PERSONS WHO are medically eligible for placement in a hospital or  resi-
dential  health  care  facility.  An  AIDS  home  care  program shall be
provided  [only]  to  PERSONS  WHO  REQUIRE  HOME  AND  COMMUNITY  BASED
SERVICES,  INCLUDING persons who are medically eligible for placement in
a hospital or residential health care facility and who (a) are diagnosed
by a physician as having acquired immune deficiency syndrome, or (b) are
deemed by a physician, within his judgment,  to  be  infected  with  the
etiologic  agent  of  acquired  immune  deficiency  syndrome,  and whose
illness, infirmity or disability can be  reasonably  ascertained  to  be
associated  with such infection.  EXCEPT WHEN LONG TERM HOME HEALTH CARE
PROGRAM SERVICES ARE  PROVIDED  PURSUANT  TO  A  CONTRACT  WITH  A  PLAN
APPROVED  PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER
OR SECTION THREE HUNDRED SIXTY-FOUR-J OF THE  SOCIAL  SERVICES  LAW,  IN
WHICH  CASE LONG TERM HOME HEALTH CARE PROGRAM SERVICES SHALL BE AUTHOR-
IZED PURSUANT TO THE PROVISIONS OF SUCH SECTIONS, LONG TERM HOME  HEALTH
CARE PROGRAM SERVICES SHALL BE PROVIDED IN ACCORDANCE WITH THIS SECTION.
Provision  of  certified  home  health agency services, a long term home
health care program or an AIDS home care program paid for by  government
funds  shall  be based upon, but not limited to, a comprehensive assess-
ment that shall include, but not be limited to,  an  evaluation  of  the
medical,  social  and  environmental  needs  of  each applicant for such
services or program. This assessment shall also serve as the  basis  for
the  development  and  provision  of an appropriate plan of care for the
applicant. In cases in which the applicant is a patient in a hospital or
residential health care facility, the assessment shall be  completed  by
persons  designated  by the commissioner, including, but not limited to,
the applicant's physician, the discharge coordinator of the hospital  or
residential  health  care  facility referring the applicant, a represen-
tative of the local department of social services, and a  representative
of  the provider of a long term home health care program, AIDS home care
program, or the certified home health agency that will provide  services
for  the patient.  In cases in which the applicant is not a patient in a
hospital or residential health care facility, the  assessment  shall  be
completed  by  persons designated by the commissioner including, but not
limited to, the applicant's physician, a  representative  of  the  local
department  of social services and a representative of the provider of a
long term home health care program, AIDS home care program or the certi-
fied home health agency that will provide services for the patient.  The
assessment  shall  be completed prior to or within thirty days after the
provision of services begins. Payment for services provided prior to the
completion of the assessment shall be made only  if  it  is  determined,
based  upon  such  assessment,  that  the  recipient  qualifies for such
services. The commissioner  shall  prescribe  the  forms  on  which  the
assessment will be made.
  S  6.  Paragraph  (b)  of  subdivision 5 of section 3610 of the public
health law is REPEALED.
  S 7. Subdivision 6 of section 367-c of the  social  services  law,  as
added  by  chapter  263 of the laws of 1979 and as renumbered by chapter
854 of the laws of 1987, is amended to read as follows:
  6. Notwithstanding any inconsistent provision of law  but  subject  to
expenditure  limitations  of  this section, the commissioner, subject to
the approval of the state director of  the  budget,  may  authorize  the
utilization  of medical assistance funds to pay for services provided by
specified long term home health  care  programs  in  addition  to  those
services  included in the medical assistance program under section three
hundred sixty-five-a of this  chapter,  so  long  as  federal  financial

S. 5671                             4

participation  is  available  for  such  services; PROVIDED HOWEVER THAT
AUTHORIZATION OF MEDICAL ASSISTANCE FUNDS FOR SUCH  ADDITIONAL  SERVICES
PURSUANT  TO  A  WAIVER  UNDER SECTION NINETEEN HUNDRED FIFTEEN-C OF THE
FEDERAL SOCIAL SECURITY ACT SHALL NOT BE CONSTRUED AS REQUISITE FOR LONG
TERM  HOME  HEALTH CARE PROGRAM AUTHORIZATION OR OPERATION. Expenditures
made under this subdivision shall be deemed payments for medical assist-
ance for needy persons and shall be  subject  to  reimbursement  by  the
state  in accordance with the provisions of section three hundred sixty-
eight-a of this chapter.
  S 8. This act shall take effect immediately; provided that the  amend-
ments  to subdivision 10 of section 4403-f of the public health law made
by section three of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.

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