BILL NUMBER:S2390

TITLE OF BILL:  An act to amend the public health law, in relation to
certified home health agencies

PURPOSE:
To allow special needs certified home health agencies to enroll any
patient determined to require certified home health agency services
under certain circumstances and thereby achieve state Medicaid savings
through market efficiencies.

SUMMARY OF PROVISIONS:
Amends section 3608 of the public health law to provide that a
certified home health agency (CHHA's) which has been issued a
certificate of approval for the purpose of serving individuals
eligible for care in a facility or program licensed by the Office of
Mental Health or the Office of Mental Retardation and Developmental
Disabilities may enroll any patient determined to require certified
home health agency services if such agency:

- possesses demonstrated clinical expertise in the required treatment;
- continues to market, accept and treat members of the special needs
population;
- contracts with the Department of Health to maintain rates at
specified levels.

              

JUSTIFICATION:
Special-needs CHHAs provide high quality care at lower rates than
CHHAs that serve the general population. Currently by, DOH policy,
special needs CHHAs are restricted in their outreach and marketing
efforts to special-needs individuals, but may service the general
public. The result is a bifurcated, confusing marketplace that has
negatively influenced competition with the effect of a substantial
percentage of the Medicaid population not utilizing the lower-cost
model of care.

Expanding the scope of the population that they serve will result in
significant Medicaid savings.

Special-needs CHHAs were established for the special purpose of
delivering Medicaid covered home care services to individuals who
otherwise would require more costly institutionalized services by the
Office of Mental Health ("OMH") or by the Office of Mental Retardation
Developmental Disabilities ("OMRDD"). In this legislation, special
needs CHHAs will continue to be required to develop and maintain
special care protocols, training and vendor relationships tailored to
the population that such CHHA was originally established to service.

Allowing special-needs CHHAs to compete with general-purpose CHHAs
without restriction, will yield millions of dollars in savings to the
State Medicaid budget effective immediately. Special-needs CHHAs have
demonstrated that they have a formula whether measured either from the
prospective of low rates, operational efficiencies or compassionate
care. The State should make this model available to the general public
without restriction or delay.


PRIOR LEGISLATIVE HISTORY:
2010: A.11581/S.8393 Held in Rules

FISCAL IMPLICATIONS:
Fiscal year 2010/2011 state Medicaid savings of $1 million to $3
million; Fiscal year 2001/2012 savings could approach $10 million.

EFFECTIVE DATE:
Immediately.