S T A T E   O F   N E W   Y O R K
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                                  5179

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

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

AN ACT to amend the public health law,  the  social  services  law,  the
  education  law,  the  insurance  law  and  the  state  finance law, in
  relation to  enacting  the  Home  Care  Accessibility  and  Efficiency
  Improvement Act (HCA-EIA)

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

  Section 1. Short title. This act shall be known and may  be  cited  as
the "Home Care Accessibility and Efficiency Improvement Act" (HCA-EIA).
  S  2. Section 3616 of the public health law is amended by adding a new
subdivision 4 to read as follows:
  4. (A) THE COMMISSIONER, IN CONSULTATION WITH REPRESENTATIVES OF  HOME
CARE  PROVIDERS AND CONSUMERS, SHALL ESTABLISH AN ASSESSMENT INSTRUMENT,
OR SIMILARLY PURPOSED ELECTRONIC DATA-SET, FOR THE PURPOSE OF  IDENTIFY-
ING:
  (I) PATIENTS' INDIVIDUALIZED HOME CARE SERVICES NEEDS; AND
  (II)  BASED  ON  THESE  NEEDS, THE HOME CARE PROGRAM OR PROGRAMS WHICH
APPEAR TO MOST APPROPRIATELY AND COST-EFFECTIVELY  MEET  EACH  PATIENT'S
NEEDS  AND  TO  WHICH  A  REFERRAL  SHOULD  BE MADE, CONSISTENT WITH THE
PATIENT'S CONSENT.
  (B) SUCH ASSESSMENT OR DATA-SET SHALL ALSO DISTINGUISH,  FOR  PURPOSES
OF  SECTION THIRTY-SIX HUNDRED SIXTEEN-C OF THIS ARTICLE, THOSE PATIENTS
WHOSE COSTS OR SERVICE  USE  EXCEED,  RESPECTIVELY,  ONE  HUNDRED  FIFTY
PERCENT OF THE MEDICAL ASSISTANCE RATE FOR NURSING HOME CARE ON A MONTH-
LY  BASIS  IN  THE COUNTY IN WHICH THE PATIENT RESIDES OR SIXTY HOURS OF
PERSONAL CARE AIDE OR HOME HEALTH AIDE SERVICES ON A WEEKLY BASIS.
  (C) THE  INSTRUMENT  OR  DATA-SET  SHALL  UTILIZE  EXISTING  FEDERALLY
REQUIRED  ASSESSMENT  INSTRUMENTS OR DATA-SETS SO AS NOT TO DUPLICATE OR
ADD TO PROVIDERS'  AND  PATIENTS'  ASSESSMENT  REQUIREMENTS,  AND  SHALL
REPLACE  OR  INCORPORATE  ANY EXISTING NON-FEDERALLY REQUIRED ASSESSMENT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11541-01-9
              

S. 5179                             2

FOR HOME CARE SERVICES, PERSONAL CARE SERVICES OR SERVICES OF A  MANAGED
LONG  TERM  CARE  PLAN  OTHERWISE  REQUIRED BY THE DEPARTMENT, INCLUDING
INSTRUMENTS ESTABLISHED BY DEPARTMENTAL RULE, REGULATION OR  ADMINISTRA-
TIVE DIRECTIVE INCLUDING THE DMS-1, THE HOME ASSESSMENT ABSTRACT AND THE
SEMI-ANNUAL ASSESSMENT OF MEMBERS.
  (D)  THE COMMISSIONER SHALL COMPLETE WORK ON THE ASSESSMENT INSTRUMENT
OR DATA-SET SUFFICIENT TO FIELD TEST SUCH INSTRUMENT OR DATA-SET  BY  NO
LATER  THAN  SEPTEMBER  FIRST, TWO THOUSAND NINE. THE COMMISSIONER SHALL
COMPLETE THE FIELD TEST AND REPORT THE RESULTS TO THE GOVERNOR  AND  THE
LEGISLATURE  BY  NO  LATER  THAN  DECEMBER FIRST, TWO THOUSAND NINE. THE
COMMISSIONER SHALL MAKE ANY REVISIONS TO THE INSTRUMENT OR DATA-SET AS A
RESULT OF THE FIELD TEST AND IMPLEMENT SUCH INSTRUMENT OR DATA-SET BY NO
LATER THAN APRIL FIRST, TWO THOUSAND TEN. THE COMMISSIONER SHALL  REPORT
TO  THE  GOVERNOR AND THE LEGISLATURE, BY NO LATER THAN SEPTEMBER FIRST,
TWO THOUSAND TEN, ON THE INITIAL EXPERIENCES WITH THE ASSESSMENT INSTRU-
MENT OR DATA-SET, INCLUDING THE ABILITY OF SUCH INSTRUMENT  OR  DATA-SET
TO  EFFECTIVELY  IDENTIFY  PATIENTS'  NEEDS  AND IDENTIFY THOSE PROGRAMS
WHICH MOST APPROPRIATELY AND COST-EFFECTIVELY MEET PATIENTS' NEEDS.
  (E) BEGINNING TWO YEARS  AFTER  THE  DATE  OF  IMPLEMENTATION  OF  THE
PATIENT  ASSESSMENT  DEVELOPED PURSUANT TO THIS SUBDIVISION, THE COMMIS-
SIONER, IN CONSULTATION WITH REPRESENTATIVES OF HOME CARE PROVIDERS  AND
CONSUMERS,  SHALL UNDERTAKE A STUDY OF HOME CARE REIMBURSEMENT UNDER THE
MEDICAL ASSISTANCE PROGRAM. THE STUDY SHALL BE BASED ON THE DATA DERIVED
PURSUANT TO SUCH PATIENT ASSESSMENT IN COMBINATION WITH  AN  EXAMINATION
OF  PROVIDER  COSTS  REPORTED FOR THE PROVISION OF SERVICES ON CERTIFIED
COST REPORTS FOR THE MOST RECENT YEAR AVAILABLE. THE STUDY SHALL  DETER-
MINE  WHETHER ALTERNATE METHODS OF REIMBURSEMENT FOR SUCH SERVICES WOULD
RESULT IN IMPROVED: ADEQUACY OF PAYMENT; PATIENT ACCESS; QUALITY OF CARE
AND PERFORMANCE INCENTIVES;  RECRUITMENT  AND  RETENTION  OF  PERSONNEL;
PROVIDER FINANCIAL STABILITY; WORKING CAPITAL FOR HOME CARE CLINICAL AND
INFORMATION  TECHNOLOGY  INFRASTRUCTURE;  COST-EFFECTIVENESS;  AND  SUCH
OTHER ELEMENTS ESSENTIAL TO THE OPERATION  AND  DELIVERY  OF  HOME  CARE
SERVICES  IN  THE  STATE.  SUCH  ALTERNATIVE  METHODS  SHALL PROVIDE FOR
WEIGHTED REIMBURSEMENT LEVELS ACCORDING TO SEVERITY  AND  COMPLEXITY  OF
PATIENT NEEDS.
  THE  COMMISSIONER,  FOLLOWING REVIEW AND COMMENT BY REPRESENTATIVES OF
HOME CARE PROVIDERS AND CONSUMERS, SHALL REPORT TO THE GOVERNOR AND  THE
LEGISLATURE ON HIS OR HER FINDINGS RESULTING FROM SUCH STUDY.
  S  3.  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. (A) If a long term home health care program as defined under  arti-
cle  thirty-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 facility for a person  eligible  to  receive  services  under  this
title,  shall  notify  the  person  in writing of the provisions of this
section.
  (B) THE DEPARTMENT IN CONSULTATION WITH REPRESENTATIVES OF  HOME  CARE
PROVIDERS,  CONSUMERS,  LOCAL DEPARTMENTS OF SOCIAL SERVICES, HOSPITALS,
NURSING HOMES AND PHYSICIANS, SHALL  PRESCRIBE  THE  FORMS  AND  RELATED
COMMUNICATIONS,  WHICH  MAY BE IN ELECTRONIC FORMAT, REQUIRED TO PROVIDE
FOR THIS NOTIFICATION AND THE NOTIFICATION REQUIRED PURSUANT TO SUBDIVI-
SIONS TWO, THREE, FIVE AND SIX OF THIS SECTION, SUBJECT  TO  THE  AVAIL-
ABILITY  OF  SERVICES IN THE PATIENT'S AREA OF RESIDENCE. THE DEPARTMENT
SHALL MONITOR LOCAL SOCIAL SERVICES DISTRICTS AND OTHER APPLICABLE ENTI-
TIES AND PROCEDURES TO ENSURE COMPLIANCE WITH THESE REQUIREMENTS SO THAT

S. 5179                             3

PERSONS ARE NOT DISCHARGED TO, OR OTHERWISE ADMITTED TO, NURSING FACILI-
TIES OR OTHER INSTITUTIONAL SETTINGS WITHOUT FIRST BEING NOTIFIED OF THE
OPTION FOR CARE AT HOME AND REFERRED FOR ASSESSMENT, PROVIDED  THAT  THE
PERSON'S PHYSICIAN DEEMS THAT HOME CARE IS AN APPROPRIATE OPTION FOR THE
PERSON  AND  THE  PERSON  DESIRES SUCH CARE. IN ADDITION, THE DEPARTMENT
SHALL ESTABLISH PERFORMANCE STANDARDS FOR LOCAL DISTRICTS FOR SUCH NURS-
ING HOME DIVERSION PURSUANT TO THIS SECTION  AND  SUBPARAGRAPH  (II)  OF
PARAGRAPH  (B-1)  OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FOUR
OF THIS CHAPTER.
  S 4. Section 367-c of the social services law is amended by  adding  a
new subdivision 6-a to read as follows:
  6-A.  NOTWITHSTANDING  THE PROVISIONS OF SUBDIVISIONS ONE THROUGH FIVE
OF THIS SECTION, AND SUBJECT TO FEDERAL FINANCIAL PARTICIPATION, ON  AND
AFTER  APRIL FIRST, TWO THOUSAND NINE, THE MAXIMUM BUDGETED EXPENDITURES
FOR PERSONS RECEIVING CARE UNDER THE PROVISIONS OF THIS SECTION SHALL BE
AS FOLLOWS:
  (A) TOTAL MONTHLY EXPENDITURES MADE UNDER  THIS  TITLE  FOR  ALL  SUCH
PERSONS  SERVED BY EACH PROVIDER OF A LONG TERM HOME HEALTH CARE PROGRAM
SHALL NOT, BASED ON REASONABLE EXPECTATIONS, EXCEED A MAXIMUM OF  SEVEN-
TY-FIVE PERCENT OF THE AVERAGE OF THE RATES PAYABLE UNDER THIS TITLE FOR
A  COMPARABLE  LEVEL OF CARE IN A NURSING FACILITY OR A NURSING FACILITY
FOR CHILDREN, AS APPLICABLE, FOR SUCH PERSONS WITHIN THE SOCIAL SERVICES
DISTRICT, WHEN CALCULATED OVER THE SAME PERIOD;
  (B) PROVIDED HOWEVER THAT, SUBJECT TO FEDERAL FINANCIAL PARTICIPATION,
IN THE CASE OF PERSONS WITH SPECIAL  NEEDS  AS  DEFINED  IN  SUBDIVISION
THREE  OF  THIS  SECTION,  SUCH  MAXIMUM  AGGREGATE EXPENDITURE SHALL BE
ADJUSTED TO REFLECT A LIMITATION OF ONE HUNDRED PERCENT  OF  SUCH  RATES
FOR THE PROPORTION OF SUCH PERSONS; AND
  (C)  PROVIDED  FURTHER,  HOWEVER,  THAT  SUBJECT  TO FEDERAL FINANCIAL
PARTICIPATION THE COMMISSIONER SHALL IDENTIFY INDIVIDUALS  AND/OR  POPU-
LATIONS  WITH  CONDITIONS  OR  CIRCUMSTANCES FOR WHOM EXEMPTION FROM THE
AGGREGATE MAXIMUM EXPENDITURE LIMITATIONS PROVIDED FOR PURSUANT TO  THIS
SECTION  IS  NECESSARY TO PERMIT THE MOST APPROPRIATE AND COST-EFFECTIVE
CARE OF SUCH INDIVIDUALS THROUGH THE LONG TERM HOME HEALTH CARE PROGRAM.
  S 5. Subdivision 2 of section  3616  of  the  public  health  law,  as
amended  by  chapter  622  of  the  laws  of 1988, is amended to read as
follows:
  2. Continued provision of a long term home health care  program,  AIDS
home  care  program or certified home health agency services paid for by
government funds shall be based upon a comprehensive assessment  of  the
medical,  social  and  environmental  needs  of  the  recipient  of  the
services. Such assessment shall be performed at least every one  hundred
[twenty]  EIGHTY  days  by  the provider of a long term home health care
program, AIDS home care program or  the  certified  home  health  agency
providing  services  for  the patient and the local department of social
services, and shall be reviewed by a physician charged with the  respon-
sibility by the commissioner. The commissioner shall prescribe the forms
on which the assessment will be made.
  S  5-a.  Discontinuation  of  local social services districts' role in
assessment and authorization for  home  care.  1.  The  commissioner  of
health shall report to the governor and the legislature on the feasibil-
ity,  appropriateness and cost-effectiveness of eliminating the involve-
ment of local social services districts in the assessment  and  authori-
zation  for  home care services, and consolidating such responsibilities
within home care providers and programs as well  as  managed  long  term
care plans, considering:

S. 5179                             4

  (a) The capacity of the assessment implemented pursuant to subdivision
5 of section 3616 of the public health law to identify patient needs and
to direct referrals toward the most appropriate home care programs based
on those needs;
  (b)  The  capacity  of  modifications to the reimbursement methodology
recommended pursuant to paragraph (e) of such subdivision 5  to  provide
for adequate cost controls;
  (c)  The capacity for adequate oversight of home care providers by the
department of health given the  modification  of  the  local  districts'
role;
  (d)  Duplicative expenses in the medical assistance expenditures asso-
ciated with the local social services  district's  responsibilities  and
the responsibilities of home care agencies, and the opportunity for cost
savings  to  the  medical  assistance program by eliminating such dupli-
cation;
  (e) Opportunity for more efficient and streamlined access to care  and
more efficient use of home care personnel resources; and
  (f) Such other factors as the commissioner of health shall deem neces-
sary to consider.
  2. As applicable, the report shall include a process and timetable for
the  discontinuation  of local social services districts' involvement in
home care services assessment and authorization.
  3. In the interim, in accordance with sections six and seven  of  this
act,  the commissioner of health shall establish and enforce performance
standards for local district responsibilities with regard to  home  care
services.
  S  6.  Subdivision  2  of  section  364  of the social services law is
amended by adding a new paragraph (b-1) to read as follows:
  (B-1) ESTABLISHING, MAINTAINING AND AUDITING TO ENSURE COMPLIANCE WITH
PERFORMANCE STANDARDS FOR LOCAL SOCIAL SERVICES DISTRICTS FOR ANY STATU-
TORILY REQUIRED DUTIES IN THE ASSESSMENT AND AUTHORIZATION OF HOME  CARE
SERVICES TO ENSURE THAT:
  (I)  SUCH  ASSESSMENTS AND AUTHORIZATIONS ARE TIMELY AND DO NOT OTHER-
WISE OBSTRUCT ACCESS TO HOME CARE SERVICES OR PROGRAMS;
  (II) LOCAL DISTRICT PERFORMANCE DOES NOT RESULT IN  EXTENDED  HOSPITAL
OR  NURSING  FACILITY  STAYS OR IN AVOIDABLE NURSING HOME PLACEMENTS AND
THAT LOCAL SOCIAL SERVICES DISTRICTS ACHIEVE AND MAINTAIN  STANDARDS  IN
FULFILLMENT  OF  THE  PATIENT  NOTIFICATION  AND  NURSING HOME DIVERSION
PROVISIONS  PURSUANT  TO  SUBDIVISION  ONE  OF  SECTION  THREE   HUNDRED
SIXTY-SEVEN-C OF THIS CHAPTER;
  (III)  DETERMINATIONS AND DIRECTIVES BY LOCAL DISTRICTS ARE CONSISTENT
WITH STATE REQUIREMENTS; AND
  (IV) IN THE  CASE  OF  PERSONAL  CARE  PROGRAM  SERVICES,  THAT  LOCAL
DISTRICT  MANAGEMENT OF SUCH SERVICES MEETS THE DEPARTMENT'S PERFORMANCE
GOALS FOR APPROPRIATENESS AND COST-EFFECTIVENESS OF SERVICES AUTHORIZED.
  S 7. Notwithstanding any inconsistent provision of  law,  the  commis-
sioner  shall  establish  annual  medical assistance savings targets for
each local social services district based on the district's adherence to
performance standards for nursing  home  avoidance  in  accordance  with
subparagraph  (ii) of paragraph (b-1) of subdivision 2 of section 364 of
the social services law and  the  district's  adherence  to  performance
standards  for  personal  care  services  established in accordance with
subparagraph (iv) of such paragraph (b-1). The department is  authorized
to  audit  and  intercept  funds,  otherwise  payable  to a local social
services district, for failure to meet the district's savings target, in

S. 5179                             5

an amount up to the difference between the target and any savings toward
the target that the district has achieved.
  S  8. The social services law is amended by adding a new section 367-v
to read as follows:
   S 367-V. BENCHMARKS FOR PERSONAL CARE SERVICES. 1.  THE  COMMISSIONER
SHALL  ESTABLISH  BENCHMARKS FOR PERSONAL CARE SERVICES HOURS TO PROMOTE
THE EFFICIENCY   AND ACCESSIBILITY OF SUCH  SERVICES  AND  TO  ELIMINATE
UNJUSTIFIED VARIATION IN AUTHORIZED HOURS.
  2.  BENCHMARKS  SHALL  INITIALLY  BE  ESTABLISHED BASED ON THE AVERAGE
AUTHORIZED PERSONAL CARE HOURS PER PATIENT ON A COUNTY-TO-COUNTY  BASIS.
IN  ESTABLISHING  AND  APPLYING  SUCH BENCHMARKS, THE COMMISSIONER SHALL
CONSIDER DIFFERENCES IN LOCAL HEALTH DELIVERY SYSTEMS AS WELL  AS  OTHER
FACTORS  WHICH MAY RESULT IN JUSTIFIABLE VARIATION. THE COMMISSIONER MAY
ESTABLISH COUNTY PEER GROUPS FOR PURPOSES OF ESTABLISHING REGIONAL AVER-
AGES AND MAY ALSO UTILIZE A METHODOLOGY WHICH SELECTS AN  AVERAGE  AT  A
SPECIFIED PERCENTILE.
  3.  LOCAL  DISTRICTS  SHALL  BE MONITORED AND ANNUALLY COMPARED TO THE
ESTABLISHED BENCHMARKS FOR PURPOSES OF STATE SHARE REIMBURSEMENT.
  4. AFTER INITIALLY ESTABLISHING BENCHMARKS BASED ON  COUNTY  AVERAGES,
THE COMMISSIONER SHALL EXPLORE AND REPORT TO THE GOVERNOR AND THE LEGIS-
LATURE  ON  THE  FEASIBILITY AND ADVISABILITY OF ESTABLISHING AND IMPLE-
MENTING BENCHMARKS BASED ON CASE-SENSITIVE CRITERIA.
  S 9. Subdivision 1 of section  3614  of  the  public  health  law,  as
amended  by  chapter  622  of  the  laws  of 1988, is amended to read as
follows:
  1. No government agency shall purchase, pay for or make  reimbursement
or grants-in-aid for services provided by a home care services agency, a
provider  of  a  long  term home health care program or a provider of an
AIDS home care program unless, at the time the services  were  provided,
the  home care services agency possessed a valid certificate of approval
or the provider of a long term home health care  program  or  AIDS  home
care  program  had  been  authorized by the commissioner to provide such
program.   However, contractual arrangements between  a  certified  home
health agency, provider of a long term home health care program, provid-
er  of an AIDS home care program, or government agency and any home care
services agency shall not be prohibited,  provided  that  the  certified
home  health  agency,  provider of a long term home health care program,
provider of an AIDS home care program, or  government  agency  maintains
full  responsibility for the plan of treatment and the care rendered AND
CONTRACTS ARE CONSISTENT WITH THE TERMS PROVIDED FOR IN SECTION  THIRTY-
SIX HUNDRED SIXTEEN-B OF THIS ARTICLE.
  S  10. The public health law is amended by adding a new section 3616-b
to read as follows:
  S 3616-B. CONTRACTS BETWEEN HOME CARE SERVICES AGENCIES. 1.  CONTRACTS
BETWEEN  CERTIFIED  HOME  HEALTH  AGENCIES,  LONG  TERM HOME HEALTH CARE
PROGRAMS OR AIDS HOME CARE PROGRAMS  AND  LICENSED  HOME  CARE  SERVICES
AGENCIES  FOR  THE  PROVISION  OF HOME HEALTH AIDE OR PERSONAL CARE AIDE
SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO THE FOLLOWING ASSURANCES OR
PROVISIONS:
  (A) AUDITS BY CERTIFIED HOME HEALTH AGENCIES, LONG  TERM  HOME  HEALTH
CARE  PROGRAMS  AND  AIDS  HOME  CARE PROGRAMS TO ENSURE THAT CONTRACTED
LICENSED HOME CARE SERVICES AGENCIES ARE IN COMPLIANCE  WITH  CONTRACTED
CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR AIDS
HOME  CARE  PROGRAM  PROVIDER  POLICIES  AND  PROCEDURES,  AND  CONTRACT
REQUIREMENTS, AS WELL AS APPLICABLE FEDERAL AND STATE LAWS; INCLUDING:

S. 5179                             6

  (I)  ONSITE  AUDIT  REVIEW  OF  PERSONNEL  RECORDS,   PARAPROFESSIONAL
PROFILES,  SCHEDULING  COORDINATOR  KNOWLEDGE  OF  PATIENT  REFERRAL AND
CONTRACT GUIDELINES AND ADHERENCE TO PARAPROFESSIONAL  VISIT  DOCUMENTA-
TION STANDARDS;
  (II) ESTABLISHMENT OF AUDIT AREA THRESHOLDS AND STIPULATION THAT FAIL-
URE  TO  ACHIEVE  THE  ESTABLISHED THRESHOLDS IN ANY AREA WILL RESULT IN
FOLLOW-UP FOCUSED AUDITS TO ENSURE THAT THERE IS IMPROVEMENT;
  (III) REQUIREMENT FOR CORRECTIVE  ACTION  PLANS  WHEN  THE  CONTRACTED
LICENSED HOME CARE SERVICES AGENCY DOES NOT MEET THE ESTABLISHED THRESH-
OLDS.
  (B) A CALL-IN OR OTHER TRACKING SYSTEM REQUIRING THAT:
  (I)  CONTRACTED LICENSED HOME CARE SERVICES AGENCIES REQUIRE HOME CARE
AIDES TO COMMUNICATE TELEPHONICALLY,  ELECTRONICALLY  OR  THROUGH  OTHER
MEANS FOR PATIENT CARE VISIT VERIFICATION;
  (II)  THE  TRACKING  SYSTEM RECORDS THE START OF THE VISIT, END OF THE
VISIT AND EACH OF THE SPECIFIC TASKS  PERFORMED  DURING  THE  HOME  CARE
AIDE'S  VISIT  OR THE PERSONAL CARE AIDE'S VISIT AND, WHEN NEW TASKS ARE
ADDED TO THE TRACKING SYSTEM, THE CONTRACTED LICENSED HOME CARE SERVICES
AGENCIES ARE MANDATED TO TRAIN ALL OF THEIR HOME CARE AIDES ON  THE  NEW
TASKS;
  (III)  BILLING  AUDITS  ARE  CONDUCTED  REGULARLY  AT  EACH CONTRACTED
LICENSED HOME CARE SERVICES AGENCY TO ENSURE COMPLIANCE  WITH  STANDARDS
FOR  PATIENTS  WITHOUT  PHONES OR FOR THOSE SITUATIONS WHEN THE TRACKING
SYSTEM IS UNAVAILABLE AND A MANUAL VISIT ENTRY IS REQUIRED.
  (C) TRAINING PROGRAM AUDITS, INCLUDING:
  (I) CONFIRMATION THAT THE CONTRACTED LICENSED HOME CARE AGENCY  TRAIN-
ING  PROGRAM IS ON THE APPROVED LISTS REGULARLY PUBLISHED ON THE DEPART-
MENT'S HEALTH PROVIDER NETWORK AND/OR THE DEPARTMENT OF EDUCATION;
  (II) EXAMINATION OF THE PROGRAM'S MOST RECENT DEPARTMENTAL SURVEY  AND
ANY PLAN OF CORRECTION;
  (III) AUDIT OF THE ADMINISTRATION OF THE CONTRACTED LICENSED HOME CARE
AGENCY  TRAINING PROGRAM TO ENSURE THAT SUCH AGENCIES HAVE DEVELOPED AND
ARE FOLLOWING POLICY AND PROCEDURE AS IT RELATES TO TRAINING CERTIFICATE
SECURITY AND TRACKING AND TRAINING PROGRAM ATTENDANCE;
  (IV) REQUIREMENT FOR CONTRACTED LICENSED  HOME  CARE  AGENCY  CONTRACT
MANAGERS  OR  AGENCY  ADMINISTRATORS  TO  ATTEND,  ON  A PERIODIC BASIS,
MANAGEMENT MEETINGS AT THE CONTRACTING  CERTIFIED  HOME  HEALTH  AGENCY,
LONG  TERM HOME HEALTH CARE PROGRAM OR AIDS HOME CARE PROGRAM RELATED TO
THE CONTRACTED SERVICES;
  (D) TRAINING  PROGRAMS  FOR  IN-SERVICE  REQUIREMENTS  COVERING  STATE
MANDATED  TRAINING  REQUIREMENTS AND INCLUDING THOSE ADDRESSING PRIORITY
AREAS RELATED TO QUALITY OF CARE, PATIENT REHABILITATION, REDUCED HOSPI-
TALIZATION AND INFECTION CONTROL;
  (E) PERFORMANCE REVIEW  AND  IMPROVEMENT  PROCESS  OF  THE  CONTRACTED
LICENSED  HOME CARE SERVICES AGENCY, INCLUDING PERFORMANCE MONITORING AT
LEAST BIANNUALLY:
  (F) VISIT VERIFICATION SYSTEM THAT INCLUDES A STANDARDIZED PROCESS FOR
VISIT VERIFICATION THROUGH RANDOM ATTENDANCE CHECKS  VIA  TELEPHONE  AND
RANDOM VISITS TO THE HOME DURING HOME CARE AIDE SERVICE DELIVERY;
  (G) BENCHMARKING FOR PURPOSES OF MEASUREMENT AND IMPROVEMENT OF QUALI-
TY CARE AMONG CONTRACTED AGENCIES;
  (H)  A  THEFT-INVESTIGATION AND REPAYMENT PROCESS TO ENSURE CONSISTENT
RESPONSE TO REPORTS  OF  THEFT  BY  HOME  CARE  PERSONNEL,  INCLUDING  A
REQUIREMENT  TO  HAVE A THEFT LIAISON TO RESPOND TO AGENCY-RELATED THEFT
ALLEGATIONS, AND RESPONSIBILITY FOR COST SHARING ASSOCIATED WITH  INVES-
TIGATIONS AND REPAYMENT; AND

S. 5179                             7

  (I)  PROVISIONS  FOR  PAYMENTS BETWEEN THE CERTIFIED HOME CARE AGENCY,
LONG TERM HOME HEALTH CARE PROGRAM OR AIDS HOME  CARE  PROGRAM  AND  THE
CONTRACTED LICENSED HOME CARE SERVICES AGENCY THAT EFFECTIVELY ALLOW FOR
PROMPT PAYMENT ACCORDING TO NEGOTIATED CONTRACT PAYMENT TERMS.
  2. THE COMMISSIONER SHALL CONSIDER AGENCY CASELOAD SIZE IN DETERMINING
THE  APPLICABILITY TO AGENCIES OF SOME OR ALL OF THE REQUIREMENTS SPECI-
FIED IN THIS SECTION TO THE EXTENT THAT THE FULFILLMENT OF SUCH REQUIRE-
MENTS WOULD NOT BE PRACTICABLE OR WOULD BE BURDENSOME DUE TO SMALL AGEN-
CY SIZE.
  S 11. The public health law is amended by adding a new section  3616-c
to read as follows:
  S  3616-C.  TARGETED  INTERVENTION  TO  PATIENTS  WITH  HIGH COST/HIGH
SERVICE USE. 1. THE DEPARTMENT SHALL ASSIST, THROUGH SHARED  DATA,  BEST
PRACTICES,  REIMBURSEMENT  AND  OTHER MEANS, CERTIFIED HOME HEALTH AGEN-
CIES, LONG TERM HOME HEALTH CARE PROGRAMS AND  MANAGED  LONG  TERM  CARE
PROGRAMS TO IMPROVE AND CUSTOMIZE INTERVENTIONS RELATING TO THE CARE AND
MANAGEMENT  OF  POPULATIONS  IDENTIFIED  PURSUANT  TO SECTION THIRTY-SIX
HUNDRED SIXTEEN OF THIS ARTICLE IN ORDER TO PROMOTE THE HIGHEST QUALITY,
ACCESSIBLE AND COST-EFFECTIVE CARE FOR SUCH INDIVIDUALS.
  2. IN ADDITION, THE DEPARTMENT SHALL  ASSIST  PROVIDERS  TO  UNDERTAKE
EFFORTS  TO  FACILITATE  COLLABORATION BETWEEN LEVELS OF CARE, INCLUDING
HOSPITAL, PHYSICIAN AND HOME CARE, AS WELL AS FIELDS OF CARE,  INCLUDING
MEDICAL,  MENTAL  HEALTH  AND ALCOHOL AND DRUG TREATMENT, TO PROMOTE THE
COORDINATED MANAGEMENT AND CARE OF SUCH PATIENTS.
  3. AS MAY BE NECESSARY  TO  FACILITATE  THE  ENROLLMENT  AND  CARE  IN
PROGRAMS  DETERMINED  BY  THE  ASSESSMENT  TO  BE  MOST  APPROPRIATE AND
COST-EFFECTIVE TO MEET THE NEEDS OF SUCH PATIENTS, THE DEPARTMENT  SHALL
IDENTIFY  PROGRAM  AND  SYSTEM  BARRIERS TO SUCH ENROLLMENT AND CARE AND
SHALL BE AUTHORIZED TO WAIVE PROVISIONS OF THIS CHAPTER AND  THE  SOCIAL
SERVICES  LAW,  AS  WELL AS THE RESPECTIVE REGULATION, FOR SUCH PURPOSE.
THE DEPARTMENT SHALL REPORT TO THE LEGISLATURE WITH REGARD TO SUCH WAIV-
ERS IN ORDER THAT THE LEGISLATURE MAY CONSIDER  STATUTORY  REVISIONS  AS
NECESSARY.
  4.  TO  THE EXTENT THAT FUNDS ARE MADE AVAILABLE THEREFOR, THE DEPART-
MENT SHALL MAKE GRANTS TO FACILITATE THE PURPOSES OF THIS SECTION.
  S 12. Clause (iii) of paragraph a of subdivision 1 of section 6908  of
the  education  law,  as  amended by chapter 160 of the laws of 2003, is
amended to read as follows:
  (iii) the providing of care by a person  acting  in  the  place  of  a
person  exempt  under  clause  (i)  of this paragraph, but who does hold
himself or herself out as one who accepts employment for performing such
care, where nursing services are under the  instruction  of  a  licensed
nurse,  or  under  the  instruction  of a patient or family or household
member determined by a registered professional nurse to be  self-direct-
ing  and  capable of providing such instruction, and any remuneration is
provided under section three hundred sixty-five-f of the social services
law OR FOR SERVICES UNDER AN  ENTITY  CERTIFIED,  APPROVED  OR  LICENSED
UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW; or
  S  13. The public health law is amended by adding a new section 3621-a
to read as follows:
  S 3621-A. HOME TELEHEALTH MEDICAL ASSISTANCE EFFICIENCY INITIATIVE. 1.
THE COMMISSIONER IS HEREBY AUTHORIZED AND DIRECTED TO ESTABLISH  A  HOME
TELEHEALTH  CARE INITIATIVE FOR THE PURPOSE OF APPLYING SUCH SERVICES IN
A MANNER TO ACHIEVE EFFICIENCIES  IN  THE  MEDICAL  ASSISTANCE  PROGRAM.
PURSUANT  TO  SUCH INITIATIVE, HOME TELEHEALTH SERVICES SHALL BE APPLIED
IN TECHNIQUES AND  TO  TARGETED  POPULATIONS  TO  IMPROVE  PATIENT  CARE

S. 5179                             8

MANAGEMENT,  TREATMENT COMPLIANCE, OUTCOMES AND/OR PREVENTION OF FURTHER
ILLNESS OR INJURY SO AS TO SPECIFICALLY REDUCE OR OFFSET  THE  NEED  FOR
OTHER, MORE COSTLY MEDICAL ASSISTANCE SERVICES.
  2.  THE  COMMISSIONER  SHALL CONSULT WITH REPRESENTATIVES OF HOME CARE
PROVIDERS, CONSUMERS AND OTHER INDIVIDUALS WITH EXPERTISE IN HOME  TELE-
HEALTH  CARE  TO DETERMINE THE POPULATIONS AND/OR CONDITIONS MOST LIKELY
TO BENEFIT AND ACHIEVE COST-EFFECTIVE RESULTS PURSUANT TO THIS  SECTION,
AS  WELL  AS  THE  SPECIFIC TECHNOLOGY AND APPROACHES TO HOME TELEHEALTH
WHICH CONSTITUTE THE BEST PRACTICES TO EMPLOY FOR SUCH GOALS.
  3. THE COMMISSIONER SHALL EXPEDITIOUSLY CONSIDER PROVIDER APPLICATIONS
FOR PARTICIPATION IN SUCH INITIATIVE BY HOME CARE AGENCIES AND PROGRAMS.
  4. THE  COMMISSIONER  SHALL  PROVIDE  REIMBURSEMENT  TO  PARTICIPATING
PROVIDERS  PURSUANT TO SUBDIVISION THREE-A OF SECTION THIRTY-SIX HUNDRED
FOURTEEN OF THIS ARTICLE AND SUCH  OTHER  METHODS  AS  THE  COMMISSIONER
DEEMS  APPROPRIATE  TO ACHIEVE THE PURPOSES OF THIS SECTION. THE COMMIS-
SIONER MAY ALSO PROVIDE OTHER POSITIVE FINANCIAL INCENTIVES FOR PROVIDER
PARTICIPATION IN SUCH INITIATIVE  INCLUDING  GRANTS  TO  FACILITATE  THE
DEVELOPMENT AND OPERATION OF SUCH INITIATIVES.
  S  14. The public health law is amended by adding a new section 3616-d
to read as follows:
  S 3616-D. LOW VISION ASSESSMENT AND INTERVENTION. 1. THERE  IS  HEREBY
ESTABLISHED  A  PROGRAM  TO ASSESS HOME CARE PATIENTS FOR LOW VISION AND
THE NEED FOR INTERVENTION TO ENABLE THEIR SAFE AND  OPTIMAL  FUNCTIONING
AT HOME, INCLUDING THEIR REDUCED RISK OF ACCIDENTS, INJURY AND PREVENTA-
BLE  HIGH  COST HEALTH SERVICES UTILIZATION, INCLUDING INSTITUTIONALIZA-
TION.
  2. PURSUANT TO SUCH PROGRAM, THE COMMISSIONER  SHALL  INCORPORATE,  AS
PART  OF  THE BASIC HOME CARE ASSESSMENT PROCESS, CRITERIA FOR SCREENING
FOR LOW VISION AS WELL AS CRITERIA WHICH INDICATE THE  NEED  FOR  INTER-
VENTION.   IN ESTABLISHING SUCH CRITERIA, THE COMMISSIONER SHALL CONSULT
WITH REPRESENTATIVES OF HOME  CARE  SERVICES  PROVIDERS,  CONSUMERS  AND
PROFESSIONALS  WITH  EXPERTISE IN THE SCREENING, DIAGNOSIS AND TREATMENT
OF VISION LOSS AND IN VISION REHABILITATION.
  3. UPON A DETERMINATION THAT INTERVENTION IS WARRANTED,  PROVIDERS  OF
HOME  CARE  SERVICES  SHALL,  WITH  THE PATIENT'S CONSENT AND SUBJECT TO
AVAILABILITY, ARRANGE FOR THE NECESSARY SERVICES  WITH  AGENCIES  ESTAB-
LISHED TO ASSIST THE VISUALLY IMPAIRED. SUCH SERVICES SHALL BE REFLECTED
WITHIN THE PATIENT'S PLAN OF CARE APPROVED BY THE PHYSICIAN.
  4. THE COMMISSIONER, IN CONSULTATION WITH THE AFOREMENTIONED REPRESEN-
TATIVES,  SHALL  ISSUE ANY GUIDELINES AS MAY BE REASONABLY NECESSARY FOR
THE IMPLEMENTATION OF THIS PROGRAM.
  S 15. Federal-state Medicare shared savings  partnership  program.  1.
Notwithstanding  any  provision of law to the contrary, the commissioner
of health shall seek federal approval for the establishment of a  feder-
al-state Medicare shared savings partnership program. Such program shall
provide  an  incentive through shared savings to the state for achieving
federal cost-savings and efficiencies to Medicare, such as from  reduced
expenditures  for  hospital  and  other  medical care, which result from
state initiatives in the care and management of Medicare  beneficiaries.
Such  incentive shall provide for a reinvestment of a proportion of such
federal savings into the state's health care system.
  2. The commissioner of health shall provide at least  forty-five  days
notice to the legislature prior to the submission of any formal proposal
to federal officials for such program in order to afford the legislature
an opportunity for input.

S. 5179                             9

  S 16. The state finance law is amended by adding a new section 97-jjjj
to read as follows:
  S  97-JJJJ.  FEDERAL-STATE MEDICARE SHARED SAVINGS PARTNERSHIP PROGRAM
FUND. 1. THERE IS HEREBY ESTABLISHED IN THE SOLE CUSTODY  OF  THE  STATE
COMPTROLLER  A  FUND  TO  BE KNOWN AS THE "FEDERAL-STATE MEDICARE SHARED
SAVINGS PARTNERSHIP PROGRAM FUND".
  2. THE FUND SHALL CONSIST OF THOSE MONIES RECEIVED  FROM  THE  FEDERAL
GOVERNMENT  FOR SAVINGS ACHIEVED UNDER THE FEDERAL-STATE MEDICARE SHARED
SAVINGS PARTNERSHIP PROGRAM RESULTING FROM STATE INITIATIVES IN THE CARE
AND MANAGEMENT OF MEDICARE BENEFICIARIES.
  3. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, WHERE AND  TO
THE  EXTENT  THAT  FEDERAL  REVENUES OR SAVINGS UNDER SUBDIVISION TWO OF
THIS SECTION ARE MADE AVAILABLE TO THE STATE, SUCH REVENUES  OR  SAVINGS
SHALL BE DEPOSITED IN THE FUND WHICH SHALL BE USED TO SUPPORT THE HEALTH
CARE SYSTEM IN THE STATE.
  4.  ALL  MONIES  SHALL  REMAIN IN SUCH FUND UNLESS OTHERWISE DISBURSED
PURSUANT TO APPROPRIATION BY THE LEGISLATURE.
  S 17. 1. Notwithstanding any provision of law  or  regulation  to  the
contrary,  the commissioner of education, in consultation with the state
board for nursing and the state  board  of  pharmacy,  shall  promulgate
guidelines  which allow for the prefill of up to a fifteen day supply of
medication prescribed by a physician or  other  authorized  practitioner
and  provided  to  an  individual by a registered professional nurse for
individuals receiving home care services ordered by an authorized  prac-
titioner and provided under the supervision of a registered professional
nurse.
  2.  The  commissioner  of  education,  in consultation with such state
boards, shall examine the experiences pursuant to such  guidelines  and,
on  or  before April 1, 2010, recommend to the governor and the legisla-
ture any changes as may be necessary to this section.
  S 18. 1. The superintendent of insurance shall examine the feasibility
and benefit of establishing a mechanism to ensure  voluntary  access  to
long  term  care  insurance  coverage through the state's long term care
insurance partnership program  for  individuals  unable  to  access  the
voluntary  market. In conducting such examination, the superintendent of
insurance shall consider similar mechanisms utilized by New  York  state
or  other states to provide access to insurance coverage when the volun-
tary market is inaccessible due to price or underwriting, including  the
model  provided through the medical malpractice insurance program imple-
mented by the state department of insurance.
  2. In considering the benefits of such a mechanism, the superintendent
of insurance shall examine the  benefit  of  long  term  care  insurance
access  for the potentially covered population as well as the benefit to
the state's medical assistance program resulting from  the  increase  in
private  financing  of such care through such mechanism. The superinten-
dent of insurance shall also consider the impact of such a mechanism  on
the  voluntary  long term care insurance market in the state. The super-
intendent of insurance shall submit his written findings  and  proposals
to the governor and the legislature no later than June 1, 2009.
  S  19. Subparagraphs (C), (D) and (E) of paragraph 1 of subsection (k)
of section 3221 of the insurance  law,  subparagraphs  (C)  and  (D)  as
amended  by  chapter  557  of  the  laws of 2000, are amended to read as
follows:
  (C) Home care means the care and treatment of a covered person who  is
under the care of a physician but only if hospitalization or confinement
in  a  nursing  facility  as  defined in subchapter XVIII of the federal

S. 5179                            10

Social Security Act, 42 U.S.C. SS 1395 et seq, would otherwise have been
required if home care was not provided, OR IF THE PROVISION OF HOME CARE
IS NECESSARY FOR THE PERSON'S CONDITION IN ORDER TO PREVENT HOSPITALIZA-
TION  OR  NURSING  FACILITY  CONFINEMENT, and the plan covering the home
health service is established and approved in writing by such physician.
  (D) Home care shall be  provided  by  an  agency  possessing  a  valid
certificate of approval or license issued pursuant to article thirty-six
of the public health law and shall consist of one or more of the follow-
ing:
  (i) Part-time or intermittent home nursing care by or under the super-
vision of a registered professional nurse (R.N.).
  (ii) Part-time or intermittent home health aide services which consist
primarily of caring for the patient.
  (iii)  Physical,  occupational or speech therapy, SOCIAL WORK, RESPIR-
ATORY THERAPY AND NUTRITIONAL COUNSELING, if provided by the home health
service or agency.
  (iv) Medical supplies, drugs and medications prescribed  by  a  physi-
cian, and laboratory services by or on behalf of a certified home health
agency  or  licensed  home care services agency to the extent such items
would have been covered under the contract if  the  covered  person  had
been  hospitalized  or confined in a skilled nursing facility as defined
in subchapter XVIII of the federal Social Security  Act,  42  U.S.C.  SS
1395 et seq.
  (E)  For  the purpose of determining the benefits for home care avail-
able to a covered person, each visit by a member of  a  home  care  team
shall  be  considered as one home care visit; the contract may contain a
limitation on the number of home care visits, but not less than  [forty]
ONE  HUNDRED  FOUR such visits in any calendar year or in any continuous
period of twelve months, for each person  covered  under  the  contract;
four  hours  of home health aide service shall be considered as one home
care visit.
  S 20. Paragraph 3 of subsection (a) of section 4303 of  the  insurance
law,  subparagraphs  (A),  (B)  and (C) as amended by chapter 557 of the
laws of 2000 and subparagraph (D) as amended by chapter 21 of  the  laws
of 1990, is amended to read as follows:
  (3)  For home care to residents in this state. Such home care coverage
shall be included at the  inception  of  all  new  contracts  and,  with
respect  to  all  other  contracts, added at any anniversary date of the
contract subject to evidence  of  insurability.  Such  coverage  may  be
subject  to an annual deductible of not more than fifty dollars for each
covered person and may be  subject  to  a  coinsurance  provision  which
provides  for  coverage  of  not  less  than seventy-five percent of the
reasonable cost of services for which  payment  may  be  made.  No  such
corporation need provide such coverage to persons eligible for medicare.
  (A)  Home  care  shall mean the care and treatment of a covered person
who is under the care of a physician but only if:
  (i) hospitalization or confinement in a nursing facility as defined in
subchapter XVIII of the Social Security Act, 42 U.S.C. S  1395  et  seq,
would  otherwise have been required if home care was not provided, OR IF
THE PROVISION OF HOME CARE IS NECESSARY FOR THE  PERSON'S  CONDITION  IN
ORDER TO PREVENT HOSPITALIZATION OR NURSING FACILITY CONFINEMENT, and
  (ii)  the  plan  covering  the  home health service is established and
approved in writing by such physician.
  (B) Home care shall be  provided  by  an  agency  possessing  a  valid
certificate of approval or license issued pursuant to article thirty-six
of the public health law.

S. 5179                            11

  (C) Home care shall consist of one or more of the following:
  (i) part-time or intermittent home nursing care by or under the super-
vision of a registered professional nurse (R.N.),
  (ii) part-time or intermittent home health aide services which consist
primarily of caring for the patient,
  (iii)  physical,  occupational or speech therapy, SOCIAL WORK, RESPIR-
ATORY THERAPY AND NUTRITIONAL COUNSELING, if provided by the home health
service or agency, and
  (iv) medical supplies, drugs and medications prescribed  by  a  physi-
cian, and laboratory services by or on behalf of a certified home health
agency  or  licensed  home care services agency to the extent such items
would have been covered or provided under the contract  if  the  covered
person  had  been hospitalized or confined in a skilled nursing facility
as defined in subchapter XVIII of the Social Security Act, 42  U.S.C.  S
1395 et seq.
  (D)  For  the purpose of determining the benefits for home care avail-
able to a covered person, each visit by a member of  a  home  care  team
shall  be  considered as one home care visit. The contract may contain a
limitation on the number of home care visits, but not less than  [forty]
ONE  HUNDRED  FOUR such visits in any calendar year or in any continuous
period of twelve months, for each covered person.  Four  hours  of  home
health  aide  service  shall be considered as one home care visit. Every
contract issued by a hospital  service  corporation  or  health  service
corporation  which  provides coverage supplementing part A and part B of
subchapter XVIII of the Social Security Act, 42 U.S.C. S  1395  et  seq,
must  make  available and, if requested by a subscriber holding a direct
payment contract or by all subscribers in a group remittance group or by
the contract holder in the case of group contracts  issued  pursuant  to
section four thousand three hundred five of this article, provide cover-
age of supplemental home care visits beyond those provided by part A and
part  B,  sufficient  to  produce an aggregate coverage of three hundred
sixty-five home care visits per contract year. Such  coverage  shall  be
provided pursuant to regulations prescribed by the superintendent. Writ-
ten  notice  of  the availability of such coverage shall be delivered to
the group remitting agent or group contract holder prior to inception of
such contract and annually thereafter[, except that  this  notice  shall
not  be  required where a policy covers two hundred or more employees or
where the benefit structure was the  subject  of  collective  bargaining
affecting persons who are employed in more than one state.
  The provisions of this subsection shall not apply to a contract issued
pursuant  to  section  four  thousand three hundred five of this article
which covers persons employed in more than  one  state  or  the  benefit
structure  of  which  was the subject of collective bargaining affecting
persons who are employed in more than one state].
  S 21. Paragraph c of subdivision 8  of  section  3602  of  the  public
health law, as amended by chapter 622 of the laws of 1988, is amended to
read as follows:
  c.  Approved long term home health care program providers may include,
as part of their long term home health care program,  upon  approval  by
the  commissioner,  a discrete AIDS home care program as defined in this
section; SUCH PROVIDERS MAY ALSO  COORDINATE  WITH  A  HOSPICE  APPROVED
UNDER  ARTICLE  FORTY  OF  THIS CHAPTER FOR THE PROVISION OF HOSPICE AND
PALLIATIVE CARE SERVICES IN CONJUNCTION WITH THE LONG TERM  HOME  HEALTH
CARE PROGRAM.
  S  22. The public health law is amended by adding a new section 3616-e
to read as follows:

S. 5179                            12

  S 3616-E. COLLABORATIVE CARE OF SELF-DIRECTING PATIENTS. 1.   NOTWITH-
STANDING  ANY  INCONSISTENT  PROVISION  OF THIS CHAPTER OR SECTION THREE
HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW RELATED TO THE  CONSUMER
DIRECTED  PERSONAL ASSISTANCE PROGRAM, ANY CERTIFIED HOME HEALTH AGENCY,
LONG  TERM HOME HEALTH CARE PROGRAM OR MANAGED LONG TERM CARE PLAN OPER-
ATING PURSUANT TO THIS CHAPTER SHALL BE PERMITTED TO COLLABORATE FOR THE
PROVISION OF PATIENT CARE WITH  CONSUMER  DIRECTED  PERSONAL  ASSISTANCE
PROVIDERS.
  2.  ANY SERVICES PROVIDED BY A CERTIFIED HOME HEALTH AGENCY, LONG TERM
HOME HEALTH CARE PROGRAM OR MANAGED LONG TERM CARE  PLAN  TO  A  PATIENT
COLLABORATIVELY  SERVED  WITH  A  CONSUMER  DIRECTED PERSONAL ASSISTANCE
PROGRAM PROVIDER SHALL NOT BE  DUPLICATIVE.  THE  PROVIDER  OF  CONSUMER
DIRECTED  PERSONAL  ASSISTANCE SERVICES TOGETHER WITH THE SELF-DIRECTING
PATIENT OR DIRECTING CAREGIVER SHALL, CONSISTENT WITH THE PROVISIONS  OF
SECTION  THREE  HUNDRED  SIXTY-FIVE-F  OF  THE  SOCIAL  SERVICES LAW, BE
RESPONSIBLE FOR ANY CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES  THAT
ARE  PROVIDED.  THE  CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME HEALTH
CARE PROGRAM OR MANAGED LONG TERM CARE PLAN SHALL BE RESPONSIBLE FOR ALL
OTHER SERVICES AS REQUIRED PURSUANT TO THIS ARTICLE AND THE  REGULATIONS
OF THE DEPARTMENT.
  3.  THE  COMMISSIONER  IS AUTHORIZED TO PROMULGATE SUCH REGULATIONS OR
GUIDELINES AS MAY BE NECESSARY TO ENSURE THE APPROPRIATENESS OF  MEDICAL
ASSISTANCE EXPENDITURES PURSUANT TO THIS SECTION.
  S  23.  Notwithstanding  any  provision  of  law  or regulation to the
contrary, the commissioner  of  health  shall  establish  procedures  to
permit  long  term  home  health  care  programs  and providers of other
services covered pursuant to  federal  waivers  or  which  provide  case
management services to collaborate to jointly serve individuals when the
services  of  both  entities  are necessary to meet such an individual's
needs; provided, however, that the two entities shall maintain  distinct
yet  coordinated  service and case management responsibilities and shall
not duplicate benefits.
  S 24. The commissioner of health shall provide that  as  part  of  the
terms of the department of health's contracts for managed long term care
plans and Medicaid Advantage Plus plans that such plans shall be permit-
ted  to  contract  with providers of long term home health care programs
for the provision of home and community based  services  to  the  plan's
enrollees.    Notwithstanding  any provision of law or regulation to the
contrary, the commissioner  may  waive  the  patient  service  budgeting
requirements  and expenditure limits applicable to the care of long term
home health care program patients in order to avoid conflict  or  dupli-
cation with the capitation provisions of managed long term care plans or
Medicaid Advantage Plus plans.
  S  25.  Paragraph  (c) of subdivision 3 of section 364-j of the social
services law is amended by adding a new subparagraph (vii)  to  read  as
follows:
  (VII)  A PERSON RECEIVING SERVICES PROVIDED BY A LONG TERM HOME HEALTH
CARE PROGRAM.
  S 26. Subparagraph (ix) of paragraph (e) of subdivision 3  of  section
364-j  of the social services law, as amended by chapter 648 of the laws
of 1999, is amended to read as follows:
  (ix) HIV COBRA case management; [and]
  S 27. Subparagraph (x) of paragraph (e) of subdivision  3  of  section
364-j  of the social services law, as amended by chapter 648 of the laws
of 1999, is renumbered (xi) and a new subparagraph (x) is added to  read
as follows:

S. 5179                            13

  (X) SERVICES PROVIDED PURSUANT TO A LONG TERM HOME HEALTH CARE PROGRAM
PURSUANT  TO  ARTICLE  THIRTY-SIX  OF  THE PUBLIC HEALTH LAW AND SECTION
THREE HUNDRED SIXTY-SEVEN-C OF THIS TITLE; AND
  S  28.  Subparagraph  (i) of paragraph (d) of subdivision 3 of section
364-j of the social services law, as amended by section 67 of part A  of
chapter 1 of the laws of 2002, is amended to read as follows:
  (i)  [a  person receiving services provided by a long term home health
care program, or] a person receiving inpatient services in a state-oper-
ated psychiatric facility or a residential treatment facility for  chil-
dren and youth;
  S 29. Subdivisions 1 and 3 of section 2807-h of the public health law,
as  amended  by  chapter 255 of the laws of 1994, are amended to read as
follows:
  1. The commissioner shall authorize health occupation development  and
workplace  demonstration  programs  and is directed to make rate adjust-
ments, subject to the availability of funds therefor, to cover the costs
of such programs; PROVIDED THAT THE COMMISSIONER MAY ALSO AUTHORIZE SUCH
PROGRAMS WITHOUT SUCH RATE ADJUSTMENTS, UPON APPLICATION  BY  PROVIDERS,
TO  PROMOTE  THE HEALTH OCCUPATION DEVELOPMENT AND WORKPLACE IMPROVEMENT
PURPOSES SPECIFIED IN THIS SECTION.   Providers shall  be  eligible  for
rate adjustments to develop, implement and evaluate programs to test new
models  of  organization  and  delivery  of services, and the use of new
technologies to improve  efficiency,  utilization  and  productivity  of
existing  health  care personnel; to reduce time that patient care staff
spend meeting documentation requirements; and to improve the recruitment
and retention of health personnel. Eligible providers shall consult with
staff, professional associations, unions and  other  affected  organiza-
tions in the development of proposals. The commissioner is authorized to
waive,  modify  or  suspend the respective provisions of rules and regu-
lations promulgated pursuant to this chapter OR THE SOCIAL SERVICES  LAW
if the commissioner determines that such waiver, modification or suspen-
sion  is  necessary for the successful implementation of a demonstration
program and provided that the commissioner determines that  the  health,
safety  and  general  welfare of people receiving health care under such
demonstration program will not be impaired as a result of  such  waiver,
modification  or  suspension.  The  commissioner  shall consult with the
professional associations appropriate to the rule or regulation proposed
for waiver, modification or suspension prior to approval or  disapproval
of  the  program. Such waiver, modification or suspension may be granted
for up to two years, OR SUCH  LONGER  PERIOD  AS  MAY  BE  NECESSARY  TO
SUPPORT  THE  PURPOSES OF THE DEMONSTRATION PROGRAM.  Waivers, modifica-
tions and suspensions granted under this subdivision must be specific to
the program approved by this subdivision.
  3. The commissioner shall conduct evaluations of the health occupation
development and workplace demonstration programs and  shall  report  his
findings  to  the  governor  and  the  chairs of the senate and assembly
committees on health. Such evaluations shall include an  examination  of
the  effectiveness  of  the program to improve productivity, efficiency,
development and utilization of personnel. Such report shall  be  due  on
April  thirtieth,  nineteen  hundred  ninety-five, ON JANUARY FIRST, TWO
THOUSAND ELEVEN, AND BIENNIALLY THEREAFTER. TO  FACILITATE  THE  COMMIS-
SIONER'S  EVALUATIONS AND REPORTS, PROVIDERS IMPLEMENTING HEALTH OCCUPA-
TION DEVELOPMENT AND WORKPLACE DEMONSTRATION PROGRAMS SHALL EXAMINE  THE
EFFECTIVENESS  OF  THEIR  PROGRAM  AND  REPORT  THEIR EXPERIENCES TO THE
COMMISSIONER.

S. 5179                            14

  S 30. Subdivision 6 of section 3614  of  the  public  health  law,  as
amended  by  chapter  255  of  the  laws  of 1994, is amended to read as
follows:
  6.  Subject to the [availability of funds] PROVISIONS OF SECTION TWEN-
TY-EIGHT HUNDRED SEVEN-H OF THIS CHAPTER, the commissioner shall author-
ize health occupation development and workplace  demonstration  programs
[pursuant  to  the provisions of section twenty-eight hundred seven-h of
this chapter] for certified home health agencies, long term home  health
care  programs  [and],  AIDS  home  care programs AND LICENSED HOME CARE
SERVICES AGENCIES, and,  SUBJECT  TO  THE  AVAILABILITY  OF  FUNDS,  the
commissioner  is  hereby  directed to make rate adjustments to cover the
cost of such programs.
  S 31. The public health law is amended by adding a new section  3606-b
to read as follows:
  S  3606-B.  SPECIAL  PROVISIONS  FOR  ESTABLISHMENT OR CONSTRUCTION OF
CERTIFIED HOME HEALTH AGENCIES AND LONG TERM HOME HEALTH CARE  PROGRAMS.
1.  PRIORITY  ESTABLISHMENT AND CONSTRUCTION. APPLICATIONS FOR HOME CARE
CONSTRUCTION OR ESTABLISHMENT SHALL BE PROCESSED AS A  PRIORITY  BY  THE
DEPARTMENT,  THE  STATE  HOSPITAL  REVIEW  AND  PLANNING COUNCIL AND THE
PUBLIC HEALTH COUNCIL, AS APPLICABLE, WHEN THE APPLICATION IS:
  (A) FILED FOR AN EXPANSION OF A LONG TERM  HOME  HEALTH  CARE  PROGRAM
WHEN THE APPLICANT'S PATIENT CENSUS IS AT SEVENTY-FIVE PERCENT OF CAPAC-
ITY  OR  GREATER,  NOTWITHSTANDING THE CENSUS TO CAPACITY RATIO OF OTHER
PROVIDERS IN THE SERVICE AREA;
  (B) FILED BY AN APPLICANT TO MEET  AN  EXPANDED  NEED  FOR  HOME  CARE
CREATED  BY  AN AGENCY OR FACILITY CLOSURE OR SERVICE CAPACITY REDUCTION
IMPACTING THE NEED FOR HOME CARE;
  (C) FILED PURSUANT TO THE RURAL HOME CARE FLEXIBILITY PROGRAM PURSUANT
TO SECTION THIRTY-SIX HUNDRED TWENTY-TWO OF THIS ARTICLE; OR
  (D) FILED PURSUANT TO SUCH OTHER CRITERIA AS THE  COMMISSIONER  DETER-
MINES MEET THE NEED FOR PRIORITY CONSIDERATION.
  2.  FACILITATION OF MULTILEVEL SERVICE PROVIDERS. (A) THE COMMISSIONER
SHALL ENCOURAGE AND FACILITATE THE PROVISION OF HOME  CARE  SERVICES  BY
MULTILEVEL  SERVICE  PROVIDERS  FOR THE PURPOSES OF PROMOTING EFFICIENCY
AND CONTINUITY OF CARE. FOR PURPOSES OF THIS SECTION, MULTILEVEL SERVICE
PROVIDERS SHALL MEAN PROVIDERS WITH EXISTING APPROVAL OR  LICENSURE  FOR
TWO  OR  MORE  OPERATING  CERTIFICATES PURSUANT TO ARTICLE TWENTY-EIGHT,
THIRTY-SIX OR FORTY OF THIS CHAPTER WHICH INCLUDE A GENERAL HOSPITAL,  A
NURSING  FACILITY,  A  CERTIFIED  HOME  HEALTH  AGENCY, A LONG TERM HOME
HEALTH CARE PROGRAM, A HOSPICE OR A MANAGED LONG TERM CARE PLAN.
  (B) THE PROVISION OF HOME CARE BY MULTILEVEL SERVICE PROVIDERS MAY  BE
THROUGH DIRECT MEANS OR THROUGH THE FORMATION OF NETWORKS OR OTHER CLIN-
ICAL OR CORPORATE AFFILIATIONS AMONG EXISTING PROVIDERS.
  (C)  THE  DEPARTMENT AND, AS APPLICABLE, THE STATE HOSPITAL REVIEW AND
PLANNING COUNCIL AND THE PUBLIC HEALTH COUNCIL, SHALL BE  AUTHORIZED  TO
GIVE  PRIORITY  CONSIDERATION  IN OR OTHERWISE MODIFY THE CERTIFICATE OF
NEED PROCESS, EXPAND LONG TERM HOME HEALTH CARE PROGRAM CAPACITY, INSTI-
TUTE POSITIVE FINANCIAL INCENTIVES OR TAKE SUCH OTHER STEPS THAT FULFILL
THE PURPOSES OF THIS SECTION IN FACILITATING EFFICIENCY  AND  CONTINUITY
OF CARE THROUGH MULTILEVEL SERVICE PROVIDERS.
  S  32. Section 3622 of the public health law, as renumbered by section
22 of part C of chapter 58 of the laws of 2004,  is  renumbered  section
3623 and a new section 3622 is added to read as follows:
  S  3622.  RURAL  HOME  HEALTH  FLEXIBILITY PROGRAM. 1. THE LEGISLATURE
FINDS AND DECLARES THAT THE PROVISION AND ACCESSIBILITY OF  HOME  HEALTH
CARE  AND  LONG  TERM  HOME  HEALTH CARE PROGRAM SERVICES IN RURAL AREAS

S. 5179                            15

NECESSITATES REGULATORY FLEXIBILITY IN ORDER FOR LIMITED RESOURCES TO BE
BEST UTILIZED AND MAXIMIZED TO MEET THE HEALTH CARE NEEDS OF RURAL CITI-
ZENS AND TO PROMOTE THE EFFICIENCY OF THE DELIVERY OF SERVICES IN  RURAL
AREAS.  THE LEGISLATURE THEREFORE ESTABLISHES A RURAL HOME HEALTH FLEXI-
BILITY PROGRAM FOR SUCH PURPOSES.
  2. PURSUANT  TO  THE  PURPOSES  OF  THIS  SECTION,  THE  COMMISSIONER,
NOTWITHSTANDING  ANY  INCONSISTENT PROVISION OF LAW OR REGULATION, SHALL
CONSIDER FOR APPROVAL PROPOSALS  FROM  PROVIDERS  OPERATING  UNDER  THIS
ARTICLE AND SERVING RURAL COUNTIES TO:
  (A) CREATE AND OPERATE A LONG TERM HOME HEALTH CARE PROGRAM WHICH DOES
NOT  PROVIDE  ALL  THE REQUIRED SERVICES SPECIFIED IN REGULATIONS OF THE
DEPARTMENT, PROVIDED THAT:
  (I) THERE IS DEMONSTRATED NEED FOR SUCH PROGRAM IN THE  SERVICE  AREA;
AND
  (II) THE APPLICANT TO PROVIDE SUCH PROGRAM DEMONSTRATES TO THE COMMIS-
SIONER'S  SATISFACTION  THAT  SUCH  APPLICANT HAS MADE, AND CONTINUES TO
MAKE, ALL APPROPRIATE EFFORTS TO PROVIDE ALL REQUIRED SERVICES BUT  THAT
THE  LACK  OF  AVAILABLE  HEALTH PERSONNEL WITHIN THE SERVICE AREA IS AN
OBSTACLE;
  (B) ESTABLISH OR OPERATE A CERTIFIED HOME HEALTH AGENCY OR  LONG  TERM
HOME  HEALTH  CARE  PROGRAM  WHICH SERVES A GEOGRAPHIC AREA LESS THAN AN
ENTIRE PLANNING AREA WHEN:
  (I) NO OTHER PROVIDER OTHERWISE SERVES THE ENTIRE PLANNING AREA;
  (II) COLLABORATIVE APPROACHES TO THE SERVICE OF CITIZENS IN THE  PLAN-
NING AREA IS APPROPRIATE FOR FEASIBILITY AND EFFICIENCY; AND
  (III)  THE DEPARTMENT IS SATISFIED THAT SUCH COLLABORATION WILL RESULT
IN ACCESSIBLE AND ECONOMICALLY-FEASIBLE  SERVICES  WITHIN  THE  PLANNING
AREA;
  (C) QUALIFY FOR HOME TELEHEALTH REIMBURSEMENT, OR FOR THE PROVISION OF
TELEMEDICINE  SERVICES,  PURSUANT TO THIS ARTICLE WHEN ALL OF THE CONDI-
TIONS ORDINARILY REQUIRED FOR SUCH REIMBURSEMENT OR SERVICES ARE  UNABLE
TO  BE  MET,  PROVIDED THAT THE APPLICANT DEMONSTRATES, AND CONTINUES TO
UNDERTAKE, BEST EFFORTS TO MEET SUCH REQUIREMENTS AND THAT  THE  QUALITY
OR SAFETY OF PATIENT CARE WILL NOT BE DIMINISHED AS A RESULT;
  (D)  BE EXEMPTED FROM THE APPLICABILITY OF NEW REGULATORY REQUIREMENTS
THAT ARE IDENTIFIED AS BURDENSOME TO RURAL PROVIDERS BY  THE  DEPARTMENT
IN  ITS  SMALL BUSINESS, REGULATORY IMPACT OR RURAL FLEXIBILITY ANALYSES
FILED IN ACCORDANCE WITH THE STATE ADMINISTRATIVE PROCEDURE ACT; AND
  (E) RECEIVE APPROVAL FOR  SUCH  OTHER  AREAS  OF  FLEXIBILITY  AS  THE
COMMISSIONER  DEEMS APPROPRIATE TO THE PURPOSES OF THIS SECTION, INCLUD-
ING PROPOSALS TO ENHANCE THE ADMINISTRATION,  SERVICES  AND  QUALITY  OF
CARE PROVIDED BY A HOME CARE AGENCY OR PROGRAM, PROVIDED THAT SUCH FLEX-
IBILITY DOES NOT COMPROMISE THE QUALITY AND SAFETY OF SERVICES PROVIDED.
  3. IN EFFECTUATING THE PROVISIONS OF SUBPARAGRAPH (E) OF THIS SECTION,
THE COMMISSIONER SHALL CONVENE A TEMPORARY WORKGROUP COMPRISED OF REPRE-
SENTATIVES OF CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE
PROGRAMS  AND  LICENSED  HOME CARE SERVICES AGENCIES SERVING RURAL COUN-
TIES, AS WELL AS RURAL CONSUMERS AND RURAL WORKFORCE REPRESENTATIVES, TO
ASSIST IN IDENTIFYING ADDITIONAL AREAS FOR FLEXIBILITY  IN  THE  DEPART-
MENT'S  RULES,  REGULATIONS  AND ADMINISTRATIVE REQUIREMENTS, CONSISTENT
WITH THE PURPOSES OF THIS SECTION.
  S 33. This act shall take effect immediately, provided that:
  1. section ten of this act shall take effect January 1, 2010  or  upon
the  renewal date of contacts regulated pursuant to such section, which-
ever is later;

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  2. sections nineteen and twenty of this act shall take effect  January
1,  2010  or  upon  the  renewal date of contracts or policies regulated
pursuant to such sections;
  3.  the amendments to section 364-j of the social services law made by
sections twenty-five, twenty-six, twenty-seven and twenty-eight of  this
act  shall  not affect the repeal of such section and shall be deemed to
repeal therewith;
  4. the amendments to subdivisions 1 and 3 of  section  2807-h  of  the
public  health  law,  made  by section twenty-nine of this act shall not
affect the expiration of such subdivisions and shall be deemed to expire
therewith;
  5. the amendments to subdivision 6  of  section  3614  of  the  public
health law made by section thirty of this act shall not affect the expi-
ration of such subdivision and shall be deemed to expire therewith; and
  6.  for  purposes  of  section  ten  of  this act, the commissioner of
health, and for purposes of sections nineteen and twenty  of  this  act,
the superintendent of insurance shall notify the legislative bill draft-
ing  commission  of  the  renewal  date of such contracts or policies in
order that the commission may maintain an accurate and timely  effective
data  base  of the official text of the laws of the state of New York in
furtherance of effectuating the provisions of section 44 of the legisla-
tive law and section 70-b of the public officers law.