S T A T E O F N E W Y O R K
________________________________________________________________________
5252
2011-2012 Regular Sessions
I N S E N A T E
May 3, 2011
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to rate increases
payable for certified home health agency services for purposes of
improving recruitment and retention of non-supervisory workers and
providing standards for settlement of claims for payment for certain
long term care services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (iii) of paragraph (b) of subdivision 8 of
section 3614 of the public health law, as added by section 54 of part J
of chapter 82 of the laws of 2002, is amended to read as follows:
(iii) In the case of services provided by such providers through
contracts with licensed home care services agencies, rate increases
received by such providers pursuant to this subdivision shall be
reflected, consistent with the purposes of subparagraph (i) of this
paragraph, in either the fees paid or benefits or other supports
provided to non-supervisory home care services workers or any worker
with direct patient care responsibility of such contracted licensed home
care services agencies and such fees, benefits or other supports shall
be proportionate to the contracted volume of services attributable to
each contracted agency AND SUCH RATE INCREASES SHALL BE MADE UPON
RECEIPT OF SUCH RECRUITMENT AND RETENTION FUNDS. IF FUNDS ARE MADE
AVAILABLE AND A PROVIDER FAILS TO PROVIDE A LICENSED HOME CARE SERVICE
AGENCY RATE INCREASES CONSISTENT WITH THE PROVISIONS OF THIS PARAGRAPH
THE COMMISSIONER SHALL DEDUCT AN AMOUNT EQUAL TO SUCH RATE INCREASE FROM
SUCH PROVIDER AND PAY SUCH FUNDS DIRECTLY TO THE LICENSED HOME CARE
SERVICE AGENCY OR THROUGH A MANDATORY PASS THROUGH CONTRACT WITH SUCH
PROVIDER. Such agencies shall submit to providers with which they
contract written certifications attesting that such funds will be used
solely for the purposes of recruitment and retention of non-supervisory
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10978-03-1
S. 5252 2
home care services workers or any worker with direct patient care
responsibility and shall maintain in their files expenditure plans spec-
ifying how such funds will be used for such purposes. PROVIDERS SHALL
REPORT TO THE COMMISSIONER ANNUALLY ON THE AMOUNT OF SUCH FUNDS PROVIDED
THROUGH CONTRACTS. SUCH REPORTS SHALL LIST THE AMOUNT OF FUNDS BY
LICENSED HOME CARE SERVICES AGENCIES. The commissioner is authorized to
audit such agencies to ensure compliance with such certifications and
expenditure plans and shall recoup any funds determined to have been
used for purposes other than those set forth in this subdivision. Such
recoupment will be in addition to any other penalties provided by law.
S 2. Paragraph (c) of subdivision 10 of section 3614 of the public
health law, as amended by section 5 of part C of chapter 109 of the laws
of 2006, is amended to read as follows:
(c) In the case of services provided by such agencies or programs
through contracts with licensed home care services agencies, rate
increases received by such agencies or programs pursuant to this subdi-
vision shall be reflected, consistent with the purposes of this subdivi-
sion, in either the fees paid or benefits or other supports, including
training, provided to non-supervisory home health aides or any other
personnel with direct patient care responsibility of such contracted
licensed home care services agencies and such fees, benefits or other
supports shall be proportionate to the contracted volume of services
attributable to each contracted agency AND SUCH RATE INCREASES SHALL BE
MADE UPON RECEIPT OF SUCH RECRUITMENT AND RETENTION FUNDS. IF FUNDS ARE
MADE AVAILABLE AND A PROVIDER FAILS TO PROVIDE A LICENSED HOME CARE
SERVICE AGENCY RATE INCREASES CONSISTENT WITH THE PROVISIONS OF THIS
PARAGRAPH THE COMMISSIONER SHALL DEDUCT AN AMOUNT EQUAL TO SUCH RATE
INCREASE FROM SUCH PROVIDER AND PAY SUCH FUNDS DIRECTLY TO THE LICENSED
HOME CARE SERVICE AGENCY OR THROUGH A MANDATORY PASS THROUGH CONTRACT
WITH SUCH PROVIDER. Such agencies or programs shall submit to providers
with which they contract written certifications attesting that such
funds will be used solely for the purposes of recruitment, training and
retention of non-supervisory home health aides or other personnel with
direct patient care responsibility and shall maintain in their files
expenditure plans specifying how such funds will be used for such
purposes. PROVIDERS SHALL REPORT TO THE COMMISSIONER ANNUALLY ON THE
AMOUNT OF SUCH FUNDS PROVIDED THROUGH CONTRACTS. SUCH REPORTS SHALL LIST
THE AMOUNT OF FUNDS BY LICENSED HOME CARE SERVICES AGENCY. The commis-
sioner is authorized to audit such agencies or programs to ensure
compliance with such certifications and expenditure plans and shall
recoup any funds determined to have been used for purposes other than
those set forth in this subdivision. Such recoupment shall be in addi-
tion to any other penalties provided by law.
S 3. The public health law is amended by adding a new section 3614-d
to read as follows:
S 3614-D. STANDARDS FOR PROMPT, FAIR AND EQUITABLE SETTLEMENT OF
CLAIMS FOR PAYMENTS FOR PERSONAL CARE, HOME HEALTH CARE SERVICES OR
OTHER LONG TERM CARE SERVICES. IN THE PROCESSING OF CLAIMS SUBMITTED
UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO OR BETWEEN CERTI-
FIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, LICENSED
HOME CARE SERVICES PROGRAMS, INSURERS, MANAGED LONG TERM CARE PLANS,
MANAGED CARE PLANS OR ORGANIZATIONS LICENSED OR OPERATED PURSUANT TO THE
PROVISIONS OF THE PUBLIC HEALTH, SOCIAL SERVICES, OR INSURANCE LAW AND
FOR ALL BILLS FOR PERSONAL CARE, HOME HEALTH CARE SERVICES OR OTHER LONG
TERM CARE SERVICES RENDERED BY LICENSED HOME CARE SERVICES PROGRAMS
PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME HEALTH CARE
S. 5252 3
AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, INSURER, MANAGED LONG TERM
CARE PLANS, MANAGED CARE PLAN, OR ORGANIZATIONS LICENSED OR OPERATED
PURSUANT TO THE PROVISIONS OF THE PUBLIC HEALTH, SOCIAL SERVICES, EXECU-
TIVE OR INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STANDARDS:
(1) SHALL PAY THE BILL OR CLAIM TO A LICENSED HOME CARE SERVICES
PROGRAM WITHIN TWENTY-FIVE DAYS OF RECEIPT OF A CLAIM OR BILL FOR
SERVICES RENDERED THAT IS TRANSMITTED VIA THE INTERNET OR ELECTRONIC
MAIL, OR THIRTY DAYS OF RECEIPT OF A CLAIM OR BILL FOR SERVICES RENDERED
THAT IS SUBMITTED BY OTHER MEANS, SUCH AS PAPER OR FACSIMILE.
(2) EACH BILL, CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION OF
THIS SECTION SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE
PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
FAILS TO ADHERE TO THE STANDARDS CONTAINED IN THIS SECTION SHALL BE
OBLIGATED TO PAY TO THE LICENSED HOME HEALTH CARE PROGRAM IN FULL
SETTLEMENT OF THE BILL, CLAIM OR PAYMENT PLUS INTEREST ON THE AMOUNT OF
SUCH BILL, CLAIM OR PAYMENT OF THE GREATER OF THE RATE EQUAL TO THE RATE
SET BY THE COMMISSIONER OF TAXATION AND FINANCE FOR CORPORATE TAXES
PURSUANT TO PARAGRAPH ONE OF SUBSECTION (E) OF SECTION ONE THOUSAND
NINETY-SIX OF THE TAX LAW OR TWELVE PERCENT PER ANNUM, TO BE COMPUTED
FROM THE DATE THE BILL, CLAIM OR PAYMENT WAS REQUIRED TO BE MADE. IN
ADDITION TO THE PROVISIONS OF THIS SECTION, ANY LICENSED HOME CARE
SERVICES PROGRAM MAY COMMENCE AN ACTION IN A COURT OF COMPETENT JURIS-
DICTION ON HIS OR HER OWN BEHALF AGAINST ANY CERTIFIED HOME HEALTH AGEN-
CIES, LONG TERM HOME HEALTH CARE PROGRAMS, LICENSED HOME CARE SERVICES
PROGRAMS, INSURERS, MANAGED LONG TERM CARE PLANS, MANAGED CARE PLANS OR
ORGANIZATIONS LICENSED OR OPERATED PURSUANT TO THE PROVISIONS OF THE
PUBLIC HEALTH, SOCIAL SERVICES, EXECUTIVE OR INSURANCE LAW AND FOR ALL
BILLS FOR PERSONAL CARE, HOME HEALTH CARE SERVICES OR OTHER LONG TERM
CARE SERVICES RENDERED BY LICENSED HOME CARE SERVICES PROGRAMS PURSUANT
TO SUCH CONTRACTS OR AGREEMENTS FOR FAILURE TO COMPLY WITH ANY OF THE
PROVISIONS OF THIS SUBSECTION. SUCH ACTION SHALL BE BROUGHT IN THE COUN-
TY IN WHICH THE ALLEGED VIOLATION OCCURRED OR WHERE THE COMPLAINANT
RESIDES. THE COURT MAY IMPOSE A CIVIL PENALTY FOR VIOLATIONS OF THIS
SECTION. ANY FINAL ORDER ISSUED PURSUANT TO THIS SUBSECTION MAY AWARD
COSTS OF LITIGATION, INCLUDING REASONABLE ATTORNEYS' FEES, TO THE
PREVAILING PARTY WHENEVER THE COURT DEEMS SUCH AWARD IS APPROPRIATE. IN
ANY ACTION BROUGHT PURSUANT TO THIS SECTION, THE COMMISSIONER MAY INTER-
VENE AS A MATTER OF RIGHT.
S 4. This act shall take effect immediately.