S T A T E O F N E W Y O R K
________________________________________________________________________
7922
2013-2014 Regular Sessions
I N A S S E M B L Y
June 10, 2013
___________
Introduced by M. of A. HEVESI -- 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 the provision of services by long term home health care
programs; and to repeal certain provisions of the public health law
relating thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Legislative intent. The legislature finds that New York
State's Long Term Home Health Care ("Nursing Home Without Walls")
Program has for over three decades been an integral part of the state's
long term care system and an important service option for the state's
citizens with chronic illness, infirmity and disability. The program
provides quality care to long term care patients at home at approximate-
ly half the cost of institutional care.
As the state shifts to a managed care structure for the delivery of
health services, the legislature finds that this program should continue
to fulfill its vital role in the state's health care system. The legis-
lature finds however that, to effectively function in the new system,
certain changes are necessary to further align this program to the
evolving model of managed care, and concludes that these changes be
instituted simultaneously with managed care implementation.
S 2. The opening paragraph of subdivision 8 of section 3602 of the
public health law, as amended by chapter 622 of the laws of 1988, is
amended and a new paragraph d is added to read as follows:
"Long term home health care program" means a coordinated plan of care
and services provided at home to (I) invalid, infirm, or disabled
persons who are medically eligible for placement in a hospital or resi-
dential health care facility for an extended period of time if such
program were unavailable, OR (II) PERSONS REQUIRING HOME AND COMMUNITY-
BASED SERVICES WHO ARE ENROLLED IN A MANAGED CARE PLAN AS DEFINED UNDER
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11302-01-3
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PARAGRAPH (E) OF SUBDIVISION ONE OF SECTION THIRTY-SIX HUNDRED FOUR-
TEEN-C OF THIS ARTICLE.
D. A LONG TERM HEALTH CARE PROGRAM AS DEFINED IN THIS SUBDIVISION AND
AUTHORIZED UNDER SECTION THIRTY-SIX HUNDRED TEN OF THIS ARTICLE MAY BE
PROVIDED (I) DIRECTLY, IN ACCORDANCE WITH SECTION THIRTY-SIX HUNDRED
SIXTEEN OF THIS ARTICLE, OR (II) UNDER CONTRACT WITH A MANAGED CARE PLAN
AS DEFINED UNDER PARAGRAPH (E) OF SUBDIVISION ONE OF SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS ARTICLE.
S 3. Subdivision 10 of section 4403-f of the public health law, as
amended by section 41-b of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
10. Notwithstanding any inconsistent provision to the contrary, the
enrollment and disenrollment process and services provided or arranged
by all operating demonstrations or any program that receives designation
as a Program of All-Inclusive Care for the Elderly (PACE) as authorized
by federal public law 105-33, subtitle I of title IV of the Balanced
Budget Act of 1997, must meet all applicable federal requirements.
Services may include, but need not be limited to, housing, inpatient and
outpatient hospital services, nursing home care, home health care, adult
day care, assisted living services provided in accordance with article
forty-six-B of this chapter, adult care facility services, enriched
housing program services, hospice care, respite care, personal care,
homemaker services, diagnostic laboratory services, therapeutic and
diagnostic radiologic services, emergency services, emergency alarm
systems, home delivered meals, physical adaptations to the client's
home, physician care (including consultant and referral services),
ancillary services, case management services, transportation, and
related medical services. A PLAN MAY CONTRACT WITH LONG TERM HOME
HEALTH CARE PROGRAMS AUTHORIZED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER
OR HOME CARE AGENCIES CERTIFIED OR LICENSED PURSUANT TO SUCH ARTICLE FOR
THE PROVISION OF SERVICES, INCLUDING CASE MANAGEMENT SERVICES, TO PLAN
ENROLLEES; PROVIDED THAT SUCH PROGRAMS OR AGENCIES SHALL PROVIDE SUCH
SERVICES CONSISTENT WITH THE PROVISIONS OF THIS SECTION WHICH SHALL
SUPERSEDE ANY INCONSISTENT PROVISIONS OF ARTICLE THIRTY-SIX OF THIS
CHAPTER OR THE REGULATIONS OF THE DEPARTMENT PROMULGATED THERETO.
S 4. Subdivision 1 of section 367-c of the social services law, as
added by chapter 895 of the laws of 1977, is amended to read as follows:
1. EXCEPT WHEN LONG TERM HOME HEALTH CARE PROGRAM SERVICES ARE
PROVIDED PURSUANT TO A CONTRACT WITH A PLAN APPROVED PURSUANT TO SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW OR SECTION THREE
HUNDRED SIXTY-FOUR-J OF THIS TITLE, IN WHICH CASE LONG TERM HOME HEALTH
CARE PROGRAM SERVICES SHALL BE AUTHORIZED PURSUANT TO THE PROVISIONS OF
SUCH SECTIONS, LONG TERM HOME HEALTH CARE PROGRAM SERVICES SHALL BE
PROVIDED IN ACCORDANCE WITH THIS SECTION AND SECTION THIRTY-SIX HUNDRED
SIXTEEN OF THE PUBLIC HEALTH LAW.
If a long term home health care program as defined under article thir-
ty-six of the public health law is provided in the social services
district for which he has authority, the local social services official,
before he authorizes care in a nursing home or intermediate care facili-
ty for a person eligible to receive services under this title, shall
notify the person in writing of the provisions of this section.
S 5. Subdivision 1 of section 3616 of the public health law, as
amended by chapter 622 of the laws of 1988, is amended to read as
follows:
1. A long term home health care program shall be provided [only] to
those patients who REQUIRE HOME AND COMMUNITY BASED SERVICES, INCLUDING
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PERSONS WHO are medically eligible for placement in a hospital or resi-
dential health care facility. An AIDS home care program shall be
provided [only] to PERSONS WHO REQUIRE HOME AND COMMUNITY BASED
SERVICES, INCLUDING persons who are medically eligible for placement in
a hospital or residential health care facility and who (a) are diagnosed
by a physician as having acquired immune deficiency syndrome, or (b) are
deemed by a physician, within his judgment, to be infected with the
etiologic agent of acquired immune deficiency syndrome, and whose
illness, infirmity or disability can be reasonably ascertained to be
associated with such infection. EXCEPT WHEN LONG TERM HOME HEALTH CARE
PROGRAM SERVICES ARE PROVIDED PURSUANT TO A CONTRACT WITH A PLAN
APPROVED PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER
OR SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, IN
WHICH CASE LONG TERM HOME HEALTH CARE PROGRAM SERVICES SHALL BE AUTHOR-
IZED PURSUANT TO THE PROVISIONS OF SUCH SECTIONS, LONG TERM HOME HEALTH
CARE PROGRAM SERVICES SHALL BE PROVIDED IN ACCORDANCE WITH THIS SECTION.
Provision of certified home health agency services, a long term home
health care program or an AIDS home care program paid for by government
funds shall be based upon, but not limited to, a comprehensive assess-
ment that shall include, but not be limited to, an evaluation of the
medical, social and environmental needs of each applicant for such
services or program. This assessment shall also serve as the basis for
the development and provision of an appropriate plan of care for the
applicant. In cases in which the applicant is a patient in a hospital or
residential health care facility, the assessment shall be completed by
persons designated by the commissioner, including, but not limited to,
the applicant's physician, the discharge coordinator of the hospital or
residential health care facility referring the applicant, a represen-
tative of the local department of social services, and a representative
of the provider of a long term home health care program, AIDS home care
program, or the certified home health agency that will provide services
for the patient. In cases in which the applicant is not a patient in a
hospital or residential health care facility, the assessment shall be
completed by persons designated by the commissioner including, but not
limited to, the applicant's physician, a representative of the local
department of social services and a representative of the provider of a
long term home health care program, AIDS home care program or the certi-
fied home health agency that will provide services for the patient. The
assessment shall be completed prior to or within thirty days after the
provision of services begins. Payment for services provided prior to the
completion of the assessment shall be made only if it is determined,
based upon such assessment, that the recipient qualifies for such
services. The commissioner shall prescribe the forms on which the
assessment will be made.
S 6. Paragraph (b) of subdivision 5 of section 3610 of the public
health law is REPEALED.
S 7. Subdivision 6 of section 367-c of the social services law, as
added by chapter 263 of the laws of 1979 and as renumbered by chapter
854 of the laws of 1987, is amended to read as follows:
6. Notwithstanding any inconsistent provision of law but subject to
expenditure limitations of this section, the commissioner, subject to
the approval of the state director of the budget, may authorize the
utilization of medical assistance funds to pay for services provided by
specified long term home health care programs in addition to those
services included in the medical assistance program under section three
hundred sixty-five-a of this chapter, so long as federal financial
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participation is available for such services; PROVIDED HOWEVER THAT
AUTHORIZATION OF MEDICAL ASSISTANCE FUNDS FOR SUCH ADDITIONAL SERVICES
PURSUANT TO A WAIVER UNDER SECTION NINETEEN HUNDRED FIFTEEN-C OF THE
FEDERAL SOCIAL SECURITY ACT SHALL NOT BE CONSTRUED AS REQUISITE FOR LONG
TERM HOME HEALTH CARE PROGRAM AUTHORIZATION OR OPERATION. Expenditures
made under this subdivision shall be deemed payments for medical assist-
ance for needy persons and shall be subject to reimbursement by the
state in accordance with the provisions of section three hundred sixty-
eight-a of this chapter.
S 8. This act shall take effect immediately; provided that the amend-
ments to subdivision 10 of section 4403-f of the public health law made
by section three of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.