senate Bill S6447

2013-2014 Legislative Session

Provides for the exclusion of certain costs associated with home health care and the formula for calculating state reimbursements to such programs

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Senate Actions - UPPERCASE
Jan 24, 2014 referred to health

S6447 - Bill Details

See Assembly Version of this Bill:
A5353A
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd ยง3614, Pub Health L

S6447 - Bill Texts

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Provides for the exclusion of certain costs associated with home health care and the formula for calculating state reimbursements to such programs.

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BILL NUMBER:S6447

TITLE OF BILL: An act to amend the public health law, in relation to
rate of payment for home health care programs using statewide average
calculation excluding certain costs

PURPOSE OR GENERAL IDEA OF BILL:

To clarify that the home care administrative and general cost cap does
not include certain costs related to patient care.

SUMMARY OF SPECIFIC PROVISIONS:

Amend section 3614 of the public health law to clarify that patient
care related costs (e.g., patient outreach, assessment, case
management, family support) should not be included in the calculation
of the administrative and general (A&G) cost cap applied to certified
home health agencies, long term home health care programs and AIDS
home care programs. The bill also requires the Department to provide a
uniform rate computation form for reporting the exempted costs.

JUSTIFICATION:

The A&G cap on home care providers has long been controversial, since
the various home care programs face other caps as well. For example,
the long term home health care programs (LTHHCP) are capped at 753/4
of the cost of nursing home care. This legislation ensures that the
A&G cap on certified home health agency services, long term home
health care programs and AIDS home care programs does not
inadvertently limit or - discourage essential patient care related
activities, including essential provider investments in technology and
patient management staff time.

PRIOR LEGISLATIVE HISTORY:

2007: a similar bill, A8390 reported to Rules committee
2008: A8390-c reported to Ways and Means committee
2009-2010: A.10724 - referred to Health committee
2011: A.3683 reported to Ways and Means committee
2012: A.3683-A referred to Health committee

FISCAL IMPLICATIONS:

The bill would remove approximately $6.5 million in costs from the A&G
caps. However, it will produce Medicaid savings by improving outcomes
and avoiding hospitalization an institutionalization.

EFFECTIVE DATE:

The bill would take effect April 1, succeeding the date it shall have
become law.

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

                                  6447

                            I N  S E N A T E

                            January 24, 2014
                               ___________

Introduced  by  Sen.  RIVERA -- 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  of  payment
  for  home  health  care  programs  using statewide average calculation
  excluding certain costs

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

  Section  1. Subdivision 7 of section 3614 of the public health law, as
added by chapter 41 of the  laws  of  1992,  the  opening  paragraph  as
amended  by section 18 of part C of chapter 109 of the laws of 2006, the
second undesignated paragraph as added by chapter 170  of  the  laws  of
1994 and the third undesignated paragraph as added and the closing para-
graph  as  amended by chapter 59 of the laws of 1993, is amended to read
as follows:
  7. (A) Notwithstanding any inconsistent  provision  of  law  or  regu-
lation,  for  purposes  of establishing rates of payment by governmental
agencies for certified home health agencies for the period April  first,
nineteen  hundred  ninety-five  through  December thirty-first, nineteen
hundred ninety-five and for rate periods beginning on or  after  January
first,  nineteen hundred ninety-six, the reimbursable base year adminis-
trative and general costs of a provider of services shall not exceed the
statewide average of total reimbursable  base  year  administrative  and
general costs of such providers of services; PROVIDED, HOWEVER, THAT FOR
PURPOSES  OF ESTABLISHING SUCH RATES OF PAYMENT FOR PERIODS ON AND AFTER
APRIL FIRST, TWO THOUSAND FIFTEEN, SUCH  STATEWIDE  AVERAGE  CALCULATION
SHALL  EXCLUDE  ANY  OTHERWISE  REIMBURSABLE  COSTS, INCLUDING STEP DOWN
COSTS, REPORTED AND ALLOCABLE AS ADMINISTRATIVE AND GENERAL BUT  ATTRIB-
UTABLE  TO  THE  PROVISION AND MANAGEMENT OF PATIENT CARE INCLUDING, BUT
NOT LIMITED TO, COSTS ATTRIBUTABLE  TO:  PATIENT  OUTREACH;  ASSESSMENT;
COORDINATION  AND MANAGEMENT OF SERVICES; TELEPHONE AND OTHER TELEHEALTH
MONITORING AND COMMUNICATION; MEDICAL SUPPLIES; STAFF TRANSPORTATION AND
ESCORT SERVICES; FAMILY  AND/OR  INFORMAL  CAREGIVER  SUPPORT  SERVICES;
PATIENT  RECORDKEEPING;  AND  TECHNOLOGY  INVESTMENTS  FOR PATIENT CARE.
SUCH EXCLUDED COSTS SHALL BE CONVEYED BY  THE  PROVIDER  AS  A  SEPARATE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01599-04-4

S. 6447                             2

DOCUMENT  OF  SUPPLEMENTAL  INFORMATION  ATTACHED TO THE PROVIDER'S COST
REPORT, AS SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL  PROVIDE  A
RATE  COMPUTATION  SHEET  TO  EACH  CERTIFIED  HOME  HEALTH  AGENCY WITH
DISTINCT LINES FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
  (I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
  (II)  THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT ALLOCABLE
TO THE RATE FOR THE SERVICE;
  (III) SUCH TOTAL ADMINISTRATIVE AND GENERAL AMOUNT  EXCLUSIVE  OF  THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (V)  ANY  ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE RATE BASED
ON SUCH LIMITATION; AND
  (VI) THE ADJUSTED RATE BASED ON THE APPLICATION OF THE  ADMINISTRATIVE
AND GENERAL COST LIMITATION.
  The  amount of such reduction in certified home health agency rates of
payments made during the period April first,  nineteen  hundred  ninety-
five  through  March  thirty-first, nineteen hundred ninety-six shall be
adjusted in the nineteen hundred ninety-six rate period  on  a  pro-rata
basis,  if  it  is  determined upon post-audit review by June fifteenth,
nineteen hundred ninety-six and reconciliation that the savings for  the
state  share,  excluding  the  federal  and  local government shares, of
medical assistance payments pursuant to title eleven of article five  of
the social services law based on the limitation of such payment pursuant
to  this  subdivision  is in excess of one million five hundred thousand
dollars or is less than one million five hundred  thousand  dollars  for
payments  made on or before March thirty-first, nineteen hundred ninety-
six to reflect the amount by which such savings  are  in  excess  of  or
lower  than  one million five hundred thousand dollars. For rate periods
on and after January first, two thousand five through  December  thirty-
first,  two  thousand  six, there shall be no such reconciliation of the
amount of savings in excess of or lower than one  million  five  hundred
thousand dollars.
  (B)  No  such  limit  shall be applied to a provider of services reim-
bursed on an initial budget basis, or a new provider, excluding  changes
in ownership or changes in name, who begins operations in the year prior
to  the  year  which  is  used  as  a  base year in determining rates of
payment.
  (C) For the purposes of this subdivision, reimbursable base year oper-
ational costs shall mean those base  year  operational  costs  remaining
after  application of all other efficiency standards, including, but not
limited to, peer group cost ceilings or guidelines.
  (D) The limitation on reimbursement for  provider  administrative  and
general  expenses  provided  by this subdivision shall be expressed as a
percentage reduction for the rate promulgated  by  the  commissioner  to
each certified home health agency and long term home health care program
provider; PROVIDED, HOWEVER, THAT SUCH REDUCTION PERCENTAGE SHALL NOT BE
INCREASED  FOR  ANY PROVIDER AS A CONSEQUENCE OF THE EXCLUSIONS PROVIDED
FOR IN PARAGRAPH (A) OF THIS SUBDIVISION.
  S 2. The opening paragraph of subdivision 7 of  section  3614  of  the
public  health  law,  as  amended by chapter 170 of the laws of 1994, is
amended to read as follows:
  (A) Notwithstanding any inconsistent provision of law or regulation to
the contrary, for purposes of establishing rates of payment  by  govern-

S. 6447                             3

mental  agencies  for  certified home health agencies and long term home
health care programs for rate [period] PERIODS  beginning  on  or  after
January  first,  nineteen  hundred ninety-five, the department of health
may  not by rule or regulation limit the reimbursable base year adminis-
trative and general costs of a provider  of  services  to  a  percentage
which is other than thirty percent of total reimbursable base year oper-
ational  costs of such provider of services; PROVIDED, HOWEVER, THAT FOR
PURPOSES OF ESTABLISHING SUCH RATES OF PAYMENT FOR PERIODS ON AND  AFTER
APRIL  FIRST,  TWO  THOUSAND FIFTEEN, SUCH STATEWIDE AVERAGE CALCULATION
SHALL EXCLUDE ANY OTHERWISE  REIMBURSABLE  COSTS,  INCLUDING  STEP  DOWN
COSTS,  REPORTED AND ALLOCABLE AS ADMINISTRATIVE AND GENERAL BUT ATTRIB-
UTABLE TO THE PROVISION AND MANAGEMENT OF PATIENT  CARE  INCLUDING,  BUT
NOT  LIMITED  TO,  COSTS  ATTRIBUTABLE TO: PATIENT OUTREACH; ASSESSMENT;
COORDINATION AND MANAGEMENT OF SERVICES; TELEPHONE AND OTHER  TELEHEALTH
MONITORING AND COMMUNICATION; MEDICAL SUPPLIES; STAFF TRANSPORTATION AND
ESCORT  SERVICES;  FAMILY  AND/OR  INFORMAL  CAREGIVER SUPPORT SERVICES;
PATIENT RECORDKEEPING; AND  TECHNOLOGY  INVESTMENTS  FOR  PATIENT  CARE.
SUCH  EXCLUDED  COSTS  SHALL  BE  CONVEYED BY THE PROVIDER AS A SEPARATE
DOCUMENT OF SUPPLEMENTAL INFORMATION ATTACHED  TO  THE  PROVIDER'S  COST
REPORT,  AS  SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL PROVIDE A
RATE COMPUTATION  SHEET  TO  EACH  CERTIFIED  HOME  HEALTH  AGENCY  WITH
DISTINCT LINES FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
  (I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
  (II)  THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT ALLOCABLE
TO THE RATE FOR THE SERVICE;
  (III) SUCH TOTAL ADMINISTRATIVE AND GENERAL AMOUNT  EXCLUSIVE  OF  THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (V)  ANY  ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE RATE BASED
ON SUCH LIMITATION; AND
  (VI) THE ADJUSTED RATE BASED ON THE APPLICATION OF THE  ADMINISTRATIVE
AND GENERAL COST LIMITATION.
  S  3.  Subdivision  7-a  of  section 3614 of the public health law, as
amended by section 89 of part C of chapter 58 of the laws  of  2007  and
the  opening  paragraph as amended by section 18 of part B of chapter 56
of the laws of 2013, is amended to read as follows:
  7-a. (A) Notwithstanding any inconsistent provision of  law  or  regu-
lation,  for  the  purposes  of establishing rates of payment by govern-
mental agencies for long term home health care programs for  the  period
April first, two thousand five, through December thirty-first, two thou-
sand  five,  and  for the period January first, two thousand six through
March thirty-first, two thousand seven, and on and  after  April  first,
two thousand seven through March thirty-first, two thousand nine, and on
and after April first, two thousand nine through March thirty-first, two
thousand  eleven,  and  on  and  after  April first, two thousand eleven
through March thirty-first, two thousand thirteen and on and after April
first, two thousand thirteen through March  thirty-first,  two  thousand
fifteen,  the reimbursable base year administrative and general costs of
a provider of services shall not exceed the statewide average  of  total
reimbursable  base year administrative and general costs of such provid-
ers of services[.]; PROVIDED, HOWEVER, THAT FOR THE PURPOSES  OF  ESTAB-
LISHING  SUCH RATES OF PAYMENT FOR PERIODS ON AND AFTER APRIL FIRST, TWO
THOUSAND FIFTEEN, SUCH STATEWIDE AVERAGE CALCULATION SHALL  EXCLUDE  ANY

S. 6447                             4

OTHERWISE  REIMBURSABLE  COSTS,  INCLUDING STEP DOWN COSTS, REPORTED AND
ALLOCABLE  AS  ADMINISTRATIVE  AND  GENERAL  BUT  ATTRIBUTABLE  TO   THE
PROVISION  AND MANAGEMENT OF PATIENT CARE INCLUDING, BUT NOT LIMITED TO,
COSTS  ATTRIBUTABLE  TO:  PATIENT OUTREACH; ASSESSMENT; COORDINATION AND
MANAGEMENT OF SERVICES; TELEPHONE AND OTHER  TELEHEALTH  MONITORING  AND
COMMUNICATION;   MEDICAL   SUPPLIES;  STAFF  TRANSPORTATION  AND  ESCORT
SERVICES; FAMILY AND/OR INFORMAL  CAREGIVER  SUPPORT  SERVICES;  PATIENT
RECORDKEEPING;  AND  TECHNOLOGY  INVESTMENTS  FOR  PATIENT  CARE.   SUCH
EXCLUDED COSTS SHALL BE CONVEYED BY THE PROVIDER AS A SEPARATE  DOCUMENT
OF  SUPPLEMENTAL  INFORMATION ATTACHED TO THE PROVIDER'S COST REPORT, AS
SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL PROVIDE A RATE  COMPU-
TATION  SHEET  TO  EACH CERTIFIED HOME HEALTH AGENCY WITH DISTINCT LINES
FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
  (I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
  (II) THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT  ALLOCABLE
TO THE RATE FOR THE SERVICE;
  (III)  SUCH  TOTAL  ADMINISTRATIVE AND GENERAL AMOUNT EXCLUSIVE OF THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
  (V) ANY ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE  RATE  BASED
ON SUCH LIMITATION; AND
  (VI)  THE ADJUSTED RATE BASED ON THE APPLICATION OF THE ADMINISTRATIVE
AND GENERAL COST LIMITATION.
  (B) No such limit shall be applied to a  provider  of  services  reim-
bursed  on an initial budget basis, or a new provider, excluding changes
in ownership or changes in name, who begins operations in the year prior
to the year which is used  as  a  base  year  in  determining  rates  of
payment.
  (C) For the purposes of this subdivision, reimbursable base year oper-
ational  costs  shall  mean  those base year operational costs remaining
after application of all other efficiency standards, including, but  not
limited to, cost guidelines.
  (D)  The  limitation  on reimbursement for provider administrative and
general expenses provided by this subdivision shall be  expressed  as  a
percentage  reduction  for  the  rate promulgated by the commissioner to
each long term home health care  program  provider;  PROVIDED,  HOWEVER,
THAT  SUCH  REDUCTION PERCENTAGE SHALL NOT BE INCREASED FOR ANY PROVIDER
AS A CONSEQUENCE OF THE EXCLUSIONS PROVIDED FOR IN PARAGRAPH (A) OF THIS
SUBDIVISION.
  S 4. This act shall take effect on the first of April next  succeeding
the  date on which it shall have become law; provided, however, that the
amendments to the opening paragraph of subdivision 7 of section 3614  of
the  public  health law made by section one of this act shall be subject
to the expiration and reversion of such opening  paragraph  pursuant  to
section  64-b  and  subdivision  5-a of section 246 of chapter 81 of the
laws of 1995, as amended, when upon such date the provisions of  section
two of this act shall take effect.

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