S T A T E   O F   N E W   Y O R K
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                                  7530

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              May 23, 2013
                               ___________

Introduced by M. of A. BRINDISI -- read once and referred to the Commit-
  tee on Health

AN  ACT to amend the public health law, the insurance law and the public
  authorities law, in relation to payments to home care services provid-
  ers and authorizing the commissioner of health to establish a  program
  to  provide  loans,  through  the dormitory authority, to home care to
  finance health care reform efforts

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

  Section  1.  Section  4406-c  of  the  public health law is amended by
adding a new subdivision 9 to read as follows:
  9. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW,  CONTRACTS  WITH
CERTIFIED  HOME  HEALTH  AGENCIES,  LONG TERM HOME HEALTH CARE PROGRAMS,
LICENSED HOME CARE SERVICES PROGRAMS OR FISCAL INTERMEDIARIES  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW TO PROVIDE HOME CARE AIDE SERVICES AS DEFINED IN SECTION  THIRTY-SIX
HUNDRED  FOURTEEN-C  OF  THIS  CHAPTER,  OR  CONSUMER  DIRECTED PERSONAL
ASSISTANCE SERVICES AS AUTHORIZED  PURSUANT  TO  SECTION  THREE  HUNDRED
SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW SHALL AT A MINIMUM ENSURE THAT
THE RESOURCES MADE AVAILABLE BY SUCH  CONTRACTS  SHALL  SUPPORT  COMPEN-
SATION  FOR  PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES AND CONSUMER
DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUAL-
IFIED WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS  OF
SUCH SERVICES CONSISTENT WITH THE PROVISIONS OF SUCH SECTION.
  S 2. Subsection (a) of section 3224-a of the insurance law, as amended
by chapter 237 of the laws of 2009, is amended to read as follows:
  (a)  Except  in a case where the obligation of an insurer or an organ-
ization or corporation licensed or certified pursuant to article  forty-
three or forty-seven of this chapter or article forty-four of the public
health  law to pay a claim submitted by a policyholder or person covered
under such policy ("covered person") or make a payment to a health  care

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11074-01-3
              

A. 7530                             2

provider  is  not  reasonably clear, or when there is a reasonable basis
supported by specific information available for  review  by  the  super-
intendent  that such claim or bill for health care services rendered was
submitted  fraudulently,  such  insurer  or  organization or corporation
shall pay the claim to a  policyholder  or  covered  person  or  make  a
payment  to  a  health  care provider within thirty days of receipt of a
claim or bill for services rendered that is transmitted via the internet
or electronic mail, or forty-five days of receipt of a claim or bill for
services rendered that is submitted by other means,  such  as  paper  or
facsimile.  PROVIDED,  HOWEVER,  ANY PAYMENT FOR SERVICES TO HEALTH CARE
PROVIDERS LICENSED UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW  OR
FISCAL  INTERMEDIARIES  OPERATING  PURSUANT  TO  SECTION  THREE  HUNDRED
SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW SHALL  BE  PAID  WITHIN  FIFTEEN
DAYS  OF  THE  RECEIPT OF A CLAIM OR A BILL FOR SERVICES RENDERED DURING
THE TRANSITION PERIOD FROM FEE FOR SERVICE TO MEDICAID MANAGED LONG TERM
CARE CONSISTENT WITH THE  STATE  MEDICAID  PLAN  FOR  SUCH  HEALTH  CARE
PROVIDERS AND FOR THE TWELVE MONTH PERIOD BEYOND THE FINAL TRANSITION OF
MEDICAID  BENEFICIARIES  IN  THAT  COUNTY. IN ADDITION, PAYMENTS FOR ANY
DISPUTED CLAIM OR BILL FOR SERVICES SHALL BE PAID TO  SUCH  HEALTH  CARE
PROVIDERS  BY  AN  INSURER OR AN ORGANIZATION OR CORPORATION LICENSED OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER
OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW WITHIN TWENTY DAYS OF THE
RECEIPT OF A CLAIM OR A BILL FOR SERVICES; PROVIDED THAT AT  THE  OPTION
OF  SUCH  INSURER  OR  ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW, SUCH CLAIM OR BILL FOR SERVICES
SHALL  SUBSEQUENTLY BE SUBJECT TO ARBITRATION PURSUANT TO ARTICLE SEVEN-
TY-FIVE OF THE CIVIL PRACTICE LAW AND RULES.
  S 3. Section 2801-a of the public health law is amended  by  adding  a
new subdivision 17 to read as follows:
  17.  (A)  THE  COMMISSIONER  IS  AUTHORIZED  TO ESTABLISH A PROGRAM TO
ASSIST IN RESTRUCTURING LONG TERM HOME HEALTH CARE DELIVERY  SYSTEMS  BY
PROVIDING  CREDIT ENHANCEMENT TO HEALTH CARE PROVIDERS LICENSED PURSUANT
TO ARTICLE THIRTY-SIX OF THIS CHAPTER THAT  LACK  THE  CREDIT  RESOURCES
NECESSARY  TO  TRANSITION FROM FEE FOR SERVICE TO MANAGED LONG TERM CARE
CONSISTENT WITH THE GOALS OF THE  STATE'S  MEDICAID  PROGRAM  MULTI-YEAR
ACTION AS ADOPTED BY THE MEDICAID REDESIGN TEAM. THE PROGRAM SHALL APPLY
TO  HEALTH CARE PROVIDERS WHO CAN DEMONSTRATE FINANCIAL NEED AND ADVANCE
THE STATE'S HEALTH REFORM AGENDA OF BETTER CARE, BETTER HEALTH FOR POPU-
LATIONS, LOWER COSTS, AND  TRANSITIONING  THE  STATE'S  LONG  TERM  CARE
SYSTEM.
  (B)  APPLICANTS MUST COMMIT THAT THE USES OF THE CREDIT-ENHANCED LOANS
WILL PROMOTE AGREED UPON GOALS  OF  TRANSITIONING  THE  LONG  TERM  HOME
HEALTH  CARE  DELIVERY  SYSTEMS. APPLICANTS SHALL SUBMIT A COMPREHENSIVE
PROGRAM AND BUSINESS PLAN, AND SUCH PLAN MUST PROMOTE AGREED  OBJECTIVES
OF  TRANSITION.  LOAN  DOCUMENTS  SHALL CONTAIN HEALTH REFORM COVENANTS,
MILESTONE DATES AND STATISTICAL TARGETS TO BE ATTAINED BY THE  BORROWER.
THE  APPLICATION  MUST  ADDRESS  HOW  THE  APPLICANT  WILL UNDERTAKE THE
IMPROVEMENTS IN FORMAL OR INFORMAL COOPERATION WITH  OTHER  HEALTH  CARE
PROVIDERS  IN  THE  REGION.  TO  THE  EXTENT  REQUIRED  TO PROVIDE LEGAL
PROTECTION FOR SUCH COOPERATIVE ENDEAVORS, THE COMMISSIONER SHALL  EXER-
CISE  ALL  NECESSARY  POWERS  PURSUANT  TO ARTICLE TWENTY-NINE-F OF THIS
CHAPTER AND ANY FEES ASSOCIATED WITH SUCH OVERSIGHT MAY BE  INCLUDED  IN
THE PROJECT FINANCING COSTS.
  (C) THE CREDIT ENHANCEMENT PROGRAM SHALL BE ADMINISTERED BY THE DORMI-
TORY AUTHORITY, OR A NOT-FOR-PROFIT CORPORATION DESIGNATED BY THE DORMI-

A. 7530                             3

TORY  AUTHORITY.    THE  COMMISSIONER SHALL CHAIR THE CREDIT ENHANCEMENT
APPLICATION AND APPROVAL COMMITTEE.  THE  COMMISSIONER  SHALL  DESIGNATE
THREE  OR  MORE  MEMBERS  OF  THE  MEDICAID  REDESIGN TEAM AS ADDITIONAL
MEMBERS  OF  THE  CREDIT ENHANCEMENT APPLICATION AND APPROVAL COMMITTEE.
THE CHAIR OF THE DORMITORY AUTHORITY SHALL ALSO SERVE AS A MEMBER OF THE
COMMITTEE, AND SHALL DETERMINE ALL RULES  FOR  REVIEWING  AND  APPROVING
APPLICATIONS,  AND ADMINISTERING APPROVED CREDIT ENHANCEMENTS.  NOTWITH-
STANDING ANY OTHER LAW, NO PERSON SERVING AS  A  MEMBER  OF  THE  CREDIT
ENHANCEMENT  APPLICATION  AND APPROVAL COMMITTEE SHALL HAVE ANY PERSONAL
LIABILITY, OR INCUR LIABILITY FOR THEIR EMPLOYER,  BY  VIRTUE  OF  THEIR
ROLE OR VOTE IN THE CREDIT ENHANCEMENT APPLICATION AND APPROVAL PROCESS.
  (D) A DEBT SERVICE RESERVE FUND MAY BE CREATED TO FACILITATE THE CRED-
IT ENHANCEMENT.
  (E)(I) IN THE EVENT OF A DEFAULT BY A BORROWER TO A LENDER, THE AMOUNT
OF  THE DEFAULTED PAYMENT SHALL BE PAID BY THE COMMISSIONER TO THE LEND-
ER.  TO  FINANCE  THE  COMMISSIONER'S  REMITTANCE  OF  THOSE   DEFAULTED
PAYMENTS,  THE  COMMISSIONER  SHALL  FIRST DRAW UPON FUNDS ALLOCATED FOR
SUCH POTENTIAL DEFAULTS, INCLUDING BUT NOT LIMITED TO FUNDS MADE  AVAIL-
ABLE FOR THAT PURPOSE PURSUANT TO THE STATE'S AUGUST SIXTH, TWO THOUSAND
TWELVE  SECTION  1115 PARTNERSHIP PLAN WAIVER APPLICATION AND ADDITIONAL
FEDERAL FUNDS MADE  AVAILABLE  THROUGH  IMPLEMENTATION  OF  THE  FEDERAL
AFFORDABLE CARE ACT (HEALTH REFORM).
  (II)  ALL  PAYMENTS OF DEFAULTED AMOUNTS SHALL BE MADE SOLELY FROM THE
ALLOCATED FUNDS AND AS SUCH AMOUNTS  ARE  ACTUALLY  COLLECTED  AND  MADE
AVAILABLE  TO  THE  COMMISSIONER  FOR  REMITTANCE TO LENDERS PURSUANT TO
SUBPARAGRAPH (I) OF THIS PARAGRAPH. NEITHER THE STATE, THE COMMISSIONER,
THE DEPARTMENT, THE DORMITORY AUTHORITY, NOR ANY  OTHER  INSTRUMENTALITY
OF  THE STATE, SHALL BE LEGALLY RESPONSIBLE FOR PAYMENT OF THE DEFAULTED
AMOUNTS, OTHER THAN PURSUANT TO  THE  PROCESS  AND  FINANCIAL  RESOURCES
DESCRIBED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH.  NO ASSETS OR RESOURCES
OF  THE STATE SHALL BE PLEDGED, OR CONSIDERED TO BE PLEDGED OR OBLIGATED
IN ANY FORM, TO PAYMENT OF THE DEFAULTS,  OTHER  THAN  PURSUANT  TO  THE
PROCESS  AND  FINANCIAL  RESOURCES DESCRIBED IN SUBPARAGRAPH (I) OF THIS
PARAGRAPH, AS ACTUALLY COLLECTED AND MADE AVAILABLE TO THE  COMMISSIONER
FOR  THE  PURPOSES  OF PAYING DEFAULTED AMOUNTS PURSUANT TO SUBPARAGRAPH
(I) OF THIS PARAGRAPH.
  S 4. Paragraph (b) of subdivision 2 of  section  1676  of  the  public
authorities  law  is  amended  by adding a new undesignated paragraph to
read as follows:
  SUCH HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX  OF
THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
PURSUANT  TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A
OF THE PUBLIC HEALTH LAW.
  S 5. Subdivision 1 of section 1680 of the public  authorities  law  is
amended by adding a new undesignated paragraph to read as follows:
  SUCH  HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX OF
THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
PURSUANT TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED  ONE-A
OF THE PUBLIC HEALTH LAW.
  S 6. This act shall take effect immediately.