Assembly Bill A4472

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

                                  4472

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 5, 2013
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED,  JAFFEE,  QUART  -- read once and
  referred to the Committee on Health

AN ACT to amend the public health law and the social  services  law,  in
  relation to long term home health care program enhancement

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

  Section 1. Section 3614 of the public health law is amended by  adding
a new subdivision 14 to read as follows:
  14.  (A)  NOTWITHSTANDING  ANY  INCONSISTENT PROVISION OF LAW OR REGU-
LATION AND SUBJECT TO THE  AVAILABILITY  OF  FEDERAL  FINANCIAL  PARTIC-
IPATION  AND  TO  THE  PROVISIONS  OF PARAGRAPH (G) OF THIS SUBDIVISION,
EFFECTIVE SIXTY DAYS AFTER THE EFFECTIVE DATE OF THIS SUBDIVISION OR  AS
SOON  AS  PRACTICABLE,  THEREAFTER,  PAYMENTS BY GOVERNMENT AGENCIES FOR
SERVICES PROVIDED BY LONG TERM HOME HEALTH CARE PROGRAMS SHALL BE  BASED
ON  EPISODIC  PAYMENTS,  EXCEPT  FOR  SUCH SERVICES PROVIDED TO CHILDREN
UNDER EIGHTEEN YEARS OF AGE. IN ESTABLISHING SUCH PAYMENTS, A  STATEWIDE
BASE PRICE SHALL BE ESTABLISHED, BASED ON THE STATEWIDE AVERAGE OF MEDI-
CAID  CLAIMS PAID IN THE BASE PERIOD, FOR EACH SIXTY DAY EPISODE OF CARE
AND ADJUSTED BY A REGIONAL WAGE INDEX FACTOR BASED ON THE DEPARTMENT  OF
LABOR'S  TEN  LABOR  MARKET  REGIONS  AND AN INDIVIDUAL PATIENT CASE MIX
INDEX; PROVIDED HOWEVER THAT THE COMMISSIONER MAY SET AN INTERVAL  OTHER
THAN SIXTY DAYS FOR SUCH EPISODIC PAYMENT IF THE COMMISSIONER DETERMINES
THAT  SUCH  INTERVAL  WOULD  MORE EFFECTIVELY ACCOMPLISH THE PURPOSES OF
THIS SECTION, SECTION THIRTY-SIX HUNDRED SIXTEEN  OF  THIS  ARTICLE  AND
SUBDIVISION  SIX-A  OF SECTION THREE HUNDRED SIXTY-SEVEN-C OF THE SOCIAL
SERVICES LAW. SUCH EPISODIC PAYMENTS MAY BE  FURTHER  ADJUSTED  FOR  AND
SHALL EXCLUDE LOW UTILIZATION CASES WHICH MAY BE REIMBURSED ON AN ALTER-
NATE  BASIS AND TO REFLECT A PERCENTAGE LIMITATION OF THE COST FOR HIGH-
UTILIZATION CASES THAT  EXCEED  OUTLIER  THRESHOLDS  OF  SUCH  PAYMENTS;
PROVIDED  HOWEVER  THAT  THE  OUTLIER  METHODOLOGY  SHALL  BE ALIGNED TO
PATIENT CASE MIX AND SHALL ALSO INCLUDE A MECHANISM FOR ADJUSTMENT WHERE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01608-01-3
              

A. 4472                             2

COST AND UTILIZATION NOT RECOGNIZED BY THE OUTLIER PAYMENT ARE NECESSARY
FOR THE SAFE AND ADEQUATE CARE OF  THE  PATIENT;  AND  PROVIDED  FURTHER
HOWEVER  THAT,  PRIOR  TO FINALIZATION, THE OUTLIER METHODOLOGY SHALL BE
PROVIDED  FOR  REVIEW AND CONSIDERATION OF ITS EFFECTS ON PATIENT ACCESS
TO CARE AND PROVIDER FISCAL  STABILITY  BY  THE  LEGISLATURE,  REPRESEN-
TATIVES  OF  CONSUMERS AND STATEWIDE ASSOCIATIONS REPRESENTATIVE OF LONG
TERM HOME HEALTH CARE PROGRAMS.
  (B) INITIAL BASE YEAR EPISODIC PAYMENTS SHALL  BE  BASED  ON  MEDICAID
PAID  CLAIMS  FOR  SERVICES  PROVIDED  BY ALL LONG TERM HOME HEALTH CARE
PROGRAMS IN THE BASE YEAR TWO THOUSAND TEN,  ADJUSTED  BY  ANNUAL  TREND
FACTORS  USING THE METHODOLOGY DESCRIBED IN PARAGRAPH (C) OF SUBDIVISION
TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF  THIS  CHAPTER;  PROVIDED
HOWEVER  THAT,  AS AN ALTERNATIVE TO THE TWO THOUSAND TEN BASE YEAR, THE
COMMISSIONER MAY ESTABLISH A PROSPECTIVE BASE FOR THE  EPISODIC  SYSTEM,
BASED  ON ANTICIPATED EXPENDITURE NEEDS FOR RATE PERIODS BEGINNING APRIL
FIRST, TWO THOUSAND THIRTEEN, OR AS SOON AS PRACTICABLE THEREAFTER,  AND
BEYOND,  IF  THE COMMISSIONER DETERMINES THAT SUCH PROSPECTIVE BASE MORE
EFFECTIVELY  ACCOMPLISHES  THE  PURPOSES  OF   THIS   SECTION,   SECTION
THIRTY-SIX  HUNDRED  SIXTEEN  OF  THIS  ARTICLE AND SUBDIVISION SIX-A OF
SECTION THREE HUNDRED SIXTY-SEVEN-C OF THE SOCIAL SERVICES LAW.   SUBSE-
QUENT BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID PAID CLAIMS
FOR  SERVICES  PROVIDED  BY ALL LONG TERM HOME HEALTH CARE PROGRAMS IN A
SUBSEQUENT BASE YEAR,  AS  DETERMINED  BY  THE  COMMISSIONER,  PROVIDED,
HOWEVER, THAT SUCH BASE YEAR ADJUSTMENT SHALL BE MADE NOT LESS FREQUENT-
LY  THAN  EVERY THREE YEARS. IN DETERMINING CASE MIX, EACH PATIENT SHALL
BE CLASSIFIED USING A SYSTEM BASED ON MEASURES WHICH  MAY  INCLUDE,  BUT
NOT  LIMITED  TO,  CLINICAL  AND FUNCTIONAL MEASURES, AS REPORTED ON THE
FEDERAL OUTCOME AND  ASSESSMENT  INFORMATION  SET  (OASIS),  AS  MAY  BE
AMENDED,  OR  AS  SUCCEEDED  AND  REPORTED  ON A UNIFORM ASSESSMENT TOOL
APPROVED BY THE COMMISSIONER, WHICH SHALL ADEQUATELY CAPTURE THE SERVICE
REQUIREMENTS OF POST-ACUTE, REHABILITATIVE, CHRONICALLY ILL AND DISABLED
PERSONS IN THE LONG TERM HOME HEALTH CARE PROGRAM.
  (C) THE COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND  SUBMIT  DATA
REQUIRED  TO IMPLEMENT THIS SUBDIVISION. THE COMMISSIONER MAY PROMULGATE
REGULATIONS TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
  (D) THE COMMISSIONER IS AUTHORIZED TO  FURTHER  ADJUST  THE  STATEWIDE
BASE  YEAR  AMOUNT, OR TO OTHERWISE ADJUST THE PAYMENT, AS MAY BE NECES-
SARY, TO REFLECT ACTUAL OR PROJECTED INCREASES IN THE COST OF DELIVERING
SERVICES IN THE RATE YEAR WHICH ARE NOT  REFLECTED  IN  THE  BASE  YEAR,
INCLUDING COSTS ASSOCIATED WITH: (I) PATIENT POPULATIONS OR SERVICES NOT
INCLUDED IN THE BASE YEAR EXPENDITURES, INCLUDING SUCH ADDITIONAL INSTI-
TUTIONAL  OR  COMMUNITY BASED SERVICES AS THE COMMISSIONER DETERMINES TO
BE NECESSARY FOR THE COORDINATED AND EFFICIENT CARE OF  LONG  TERM  HOME
HEALTH  CARE  PROGRAM  RECIPIENTS IN THE MOST INTEGRATED SETTING FOR THE
PERSON; (II) NEW GOVERNMENTAL MANDATES  AND  REGULATIONS;  (III)  LABOR;
(IV)  DISEASE  OUTBREAK;  (V)  SEVERE  SPIKES IN FUEL AND TRANSPORTATION
COSTS FOR DIRECT CARE STAFF; OR (VI) SUCH OTHER VARIABLES AS THE COMMIS-
SIONER DETERMINES APPROPRIATE.
  (E) IN ADDITION, TO ADJUSTMENTS PROVIDED PURSUANT TO PARAGRAPH (D)  OF
THIS  SUBDIVISION, THE COMMISSIONER IS AUTHORIZED TO PROVIDE A MECHANISM
FOR AGENCY SPECIFIC ADJUSTMENTS IN PAYMENT  AS  ARE  NECESSARY  FOR  THE
DELIVERY  OF SERVICES OR THE QUALITY, COST-EFFECTIVENESS OR OPERATION OF
THE SYSTEM, INCLUDING ADJUSTMENTS FOR: (I) LABOR COSTS FOR  DIRECT  CARE
STAFF  IN  THE PARTICULAR MARKET AREA SERVED BY THE AGENCY; (II) CAPITAL
COSTS NECESSARY FOR THE AGENCY'S  TECHNOLOGY  INFRASTRUCTURE,  INCLUDING
BUT  NOT  LIMITED TO ELECTRONIC HEALTH RECORDS, POINT OF CARE TECHNOLOGY

A. 4472                             3

AND TELEHEALTH  CARE;  (III)  HEALTH  SYSTEMS  IMPROVEMENT  INITIATIVES,
INCLUDING  CARE TRANSITIONS, PROVIDER COLLABORATION FOR IMPROVED PATIENT
OUTCOMES AND REDUCED AVOIDABLE HOSPITALIZATIONS, READMISSIONS, EMERGENCY
ROOM USE AND OTHER HIGH COST HEALTH CARE SERVICES USE; (IV) ENHANCEMENTS
TO  THE  AGENCY'S CARE MANAGEMENT CAPACITY, INCLUDING THE INTEGRATION OF
BEHAVIORAL HEALTH SERVICES, SPECIALTY  NURSING  CARE,  PRIMARY  CARE  OR
OTHER CARE MANAGEMENT ENHANCEMENTS AS MAY BE APPROVED BY THE COMMISSION-
ER;  AND (V) SUCH OTHER PURPOSES AS THE COMMISSIONER MAY DETERMINE TO BE
NECESSARY.
  (F) THE EPISODIC SYSTEM SHALL PROVIDE FOR A  REQUEST  FOR  ANTICIPATED
PAYMENT  (RAP),  CONSISTENT  WITH  THE RAP PROVISIONS UNDER THE EPISODIC
PAYMENT SYSTEM APPLICABLE TO LONG TERM HOME HEALTH CARE  PROGRAMS  UNDER
THE FEDERAL MEDICARE PROGRAM.
  (G)  PRIOR  TO  STATEWIDE  IMPLEMENTATION  OF THE EPISODIC SYSTEM, THE
COMMISSIONER SHALL CONDUCT A  PILOT  TEST  OF  THE  SYSTEM  BY  SELECTED
PROVIDERS PARTICIPATING ON A VOLUNTARY BASIS. THE PILOT SHALL ASSESS THE
EFFECTS  OF  THE SYSTEM ON PATIENT CARE AND ACCESS AND ON PROVIDER OPER-
ATIONS AND FISCAL STATUS. THE COMMISSIONER, IN CONJUNCTION  WITH  REPRE-
SENTATIVES  OF PILOT PROVIDERS, STATEWIDE ASSOCIATIONS REPRESENTATIVE OF
HOME CARE PROVIDERS  AND  CONSUMER  REPRESENTATIVES,  SHALL  ASSESS  THE
RESULTS  OF THE PILOT AND REPORT TO THE LEGISLATURE, INCLUDING THE IDEN-
TIFICATION OF ANY ADJUSTMENTS NECESSARY FOR THE OPERATION OF THE EPISOD-
IC SYSTEM FOR STATEWIDE IMPLEMENTATION. UPON THE IMPLEMENTATION OF  SUCH
ADJUSTMENTS,  THE  COMMISSIONER  SHALL  PROCEED TO FURTHER IMPLEMENT THE
EPISODIC SYSTEM.
  (H) THE COMMISSIONER, IN CONSULTATION  WITH  REPRESENTATIVES  OF  LONG
TERM HOME HEALTH CARE PROGRAMS AND STATEWIDE ASSOCIATIONS REPRESENTATIVE
OF LONG TERM HOME HEALTH CARE PROGRAMS, SHALL REVIEW THE EPISODIC SYSTEM
AFTER  THE  FIRST  FULL  YEAR OF IMPLEMENTATION, AND, WITHIN NINETY DAYS
FOLLOWING THE COMPLETION OF SUCH PERIOD, SHALL REPORT  TO  THE  LEGISLA-
TURE, INCLUDING THE IDENTIFICATION OF AND PLAN FOR EXECUTING ADJUSTMENTS
AS MAY BE NECESSARY FOR THE OPERATION OF THE EPISODIC SYSTEM.
  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 to read as follows:
  "Long  term home health care program" means a coordinated plan of care
and  services  provided  at  home  TO   PERSONS   REQUIRING   HOME   AND
COMMUNITY-BASED  SERVICES,  INCLUDING  to  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; PROVIDED, HOWEVER,  THAT  SUCH  PROGRAM  SHALL
PROVIDE  OR  ARRANGE  FOR,  AND COORDINATE SUCH SERVICES, INCLUDING SUCH
COMMUNITY AND INSTITUTIONAL SERVICES,  AS  THE  COMMISSIONER  DETERMINES
NECESSARY FOR THE PROVISION OF A COORDINATED, INTEGRATED PLAN OF CARE IN
THE MOST INTEGRATED SETTING FOR THE PERSON.
  S  3.  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,  ON  AND AFTER SIXTY DAYS AFTER THE EFFECTIVE DATE OF
THIS SUBDIVISION, AUTHORIZATION UNDER THIS TITLE FOR  RECIPIENT  PARTIC-
IPATION  IN  A LONG TERM HOME HEALTH CARE PROGRAM SHALL BE IN ACCORDANCE
WITH THIS SUBDIVISION.
  IF A PERSON WHO REQUIRES HOME AND COMMUNITY BASED SERVICES,  INCLUDING
A  PERSON  WHO REQUIRES CARE IN A NURSING FACILITY, DESIRES TO REMAIN AT
HOME AND IS DEEMED BY HIS OR HER PHYSICIAN ABLE TO RECEIVE CARE AT HOME,
SUCH PERSON SHALL HAVE THE OPTION TO ENROLL IN A LONG TERM  HOME  HEALTH

A. 4472                             4

CARE  PROGRAM  IN  ACCORDANCE  WITH  THE PROVISIONS OF THIS SUBDIVISION,
SECTION THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW AND APPLICA-
BLE REGULATIONS OF THE DEPARTMENT.  TO  ENROLL  IN  SUCH  PROGRAM,  SUCH
PERSON  OR  SUCH PERSON'S REPRESENTATIVE SHALL SO INFORM A PROVIDER OF A
LONG TERM HOME HEALTH CARE PROGRAM.  THE  LONG  TERM  HOME  HEALTH  CARE
PROGRAM  PROVIDER  SHALL  INFORM  THE  LOCAL SOCIAL SERVICES OFFICIAL OR
OTHER PERSON OR ENTITY DESIGNATED BY THE DEPARTMENT AND SHALL CONDUCT  A
COMPREHENSIVE  ASSESSMENT  OF  THE  PATIENT'S  NEEDS  IN ACCORDANCE WITH
SECTION THIRTY-SIX HUNDRED SIXTEEN OF THE  PUBLIC  HEALTH  LAW.  IF  THE
RESULTS  OF  THE  ASSESSMENT  INDICATE  THAT  THE PERSON CAN RECEIVE THE
APPROPRIATE LEVEL OF CARE AT HOME, A REPRESENTATIVE  OF  THE  LONG  TERM
HOME  HEALTH  CARE PROGRAM, WITH THE INPUT OF THE PERSON OR THE PERSON'S
REPRESENTATIVE, SHALL PREPARE FOR SUCH PERSON A PLAN OF CARE SUBJECT  TO
THE  APPROVAL  OF SUCH PERSON'S PHYSICIAN. IF THE PLAN OF CARE INDICATES
THAT THE PERSON CAN BE CARED FOR APPROPRIATELY AT HOME BY THE LONG  TERM
HOME HEALTH CARE PROGRAM, THE PERSON MAY BE ADMITTED TO THE PROGRAM. THE
LONG  TERM  HOME  HEALTH  CARE  PROGRAM  SHALL  NOTIFY  THE LOCAL SOCIAL
SERVICES OFFICIAL OR ALTERNATE ENTITY DESIGNATED BY  THE  DEPARTMENT  OF
THE  PERSON'S  ADMISSION  TO THE LONG TERM HOME HEALTH CARE PROGRAM. THE
PERSON'S ELIGIBILITY FOR THE LONG TERM HOME HEALTH  CARE  PROGRAM  ALONG
WITH  THE  PLAN  OF CARE THAT HAS BEEN PREPARED FOR SUCH PERSON SHALL BE
SUBJECT TO AUDIT BY THE LOCAL  SOCIAL  SERVICES  OFFICIAL  OR  ALTERNATE
ENTITY IDENTIFIED BY THE DEPARTMENT. SUCH PERSON SHALL RECEIVE A COMPRE-
HENSIVE REASSESSMENT AT LEAST EVERY ONE HUNDRED EIGHTY DAYS, PURSUANT TO
SECTION THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW, WHICH SHALL
BE THE BASIS FOR DETERMINING THE PERSON'S CONTINUED ELIGIBILITY AND CARE
UNDER  THE  LONG  TERM HOME HEALTH CARE PROGRAM.  THE COMMISSIONER SHALL
SUBMIT THE APPROPRIATE WAIVERS AND STATE PLAN  AMENDMENTS  NECESSARY  TO
EFFECTUATE THIS SUBDIVISION.
  S  4.  Subdivisions  1 and 2 of section 3616 of the public health law,
subdivision 1 as amended by chapter 622 of the laws of 1988 and subdivi-
sion 2 as amended by section 33 of part B of chapter 109 of the laws  of
2010, are 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
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. Provision of certified home health agen-
cy 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 limit-
ed to, a comprehensive assessment 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

A. 4472                             5

representative of the local department of social services,] and a repre-
sentative  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  assess-
ment  shall  be  completed  by  persons  designated  by the commissioner
including, but not limited to, the applicant's physician[,  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. [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 quali-
fies for such services.] The commissioner shall prescribe the  forms  on
which the assessment will be made.
  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
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 responsibility by
the commissioner. The commissioner shall prescribe the  forms  on  which
the assessment will be made.
  S  5.  The  closing  paragraph of subdivision 2 of section 3610 of the
public health law, as amended by section 65 of part A of chapter  58  of
the laws of 2010, is amended to read as follows:
  If  the application is approved, the applicant shall be so notified in
writing. The commissioner's written approval of  the  application  shall
constitute  authorization  to  provide  a  long  term  home  health care
program. [In making his or her  authorization,  the  commissioner  shall
stipulate  the maximum number of persons which a provider of a long term
home health care program may serve.] If  the  commissioner  proposes  to
disapprove  the  application,  he  or  she shall notify the applicant in
writing, stating his or her reasons  for  disapproval,  and  afford  the
applicant an opportunity for a public hearing.
  S  6.  Subdivision  5  of  section  3610  of the public health law, as
amended by chapter 636 of the laws  of  1980,  is  amended  to  read  as
follows:
  5.  (a)  Notwithstanding  the  provisions  of subdivision four of this
section, the commissioner shall suspend, limit or  revoke  the  authori-
zation  of  a  provider  of  a  long term home health care program after
taking into consideration the public need for the program and the avail-
ability of other services which may serve  as  alternatives  or  substi-
tutes,  and  after  finding  that  suspending, limiting, or revoking the
authorization of such provider would be within the  public  interest  in
order  to conserve health resources by restricting the level of services
to those which are actually needed.
  (b) [Notwithstanding  the  provisions  of  subdivision  four  of  this
section, the commissioner may reduce the maximum number of persons which
a  provider  of  a  long  term home health care program is authorized to
serve after finding  that  the  number  stipulated  in  such  provider's
authorization  is  not  being  effectively  utilized.  In  addition, the

A. 4472                             6

commissioner may increase the number of persons which a  provider  of  a
long  term home health care program is authorized to serve after finding
that the number stipulated in such provider's authorization is  insuffi-
cient  to  serve  persons eligible to receive long term home health care
who reside in the area served by such provider.
  (c)] Whenever any finding as described in paragraph (a) of this subdi-
vision is under consideration with respect to any particular provider of
a long term home health care program, the commissioner shall cause to be
published, in a newspaper of general circulation in the geographic  area
of such provider, at least thirty days prior to making such a finding an
[annnouncement]  ANNOUNCEMENT that such a finding is under consideration
and an address to which interested persons can write to make their views
known. The commissioner shall take all public  comments  into  consider-
ation in making such a finding.
  [(d)] (C) The commissioner shall, upon making any finding described in
paragraph (a) of this subdivision with respect to any provider of a long
term  home  health care program, cause such provider and the appropriate
health systems agency to be notified of the finding at least thirty days
in advance of taking the proposed  action.  Upon  receipt  of  any  such
notification and before the expiration of the thirty days or such longer
period  as may be specified in the notice, the provider or the appropri-
ate health systems agency may request a public hearing to be held in the
county in which the provider is located. In no event shall  the  revoca-
tion,  suspension  or  limitation take effect prior to the thirtieth day
after the date of the notice, or prior to the effective  date  specified
in the notice or prior to the date of the hearing decision, whichever is
later.
  [(e)]  (D)  Except  as  otherwise  provided by law, all appeals from a
finding of the commissioner made  pursuant  to  paragraph  (a)  of  this
subdivision  shall  be directly to the appellate division of the supreme
court in the third department. Except as otherwise expressly provided by
law, such appeals shall have preference over all issues in all courts.
  S 7. This act shall take effect immediately.