S T A T E O F N E W Y O R K
________________________________________________________________________
4473
2013-2014 Regular Sessions
I N A S S E M B L Y
February 5, 2013
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Introduced by M. of A. GOTTFRIED, CAHILL, SWEENEY, JAFFEE, BENEDETTO,
WEPRIN, GUNTHER, ROSENTHAL, LAVINE, SCHIMEL -- read once and referred
to the Committee on Health
AN ACT to amend the public health law, in relation to rate increases
payable for certified home health agency services for purposes of
improving recruitment and retention of non-supervisory workers and
providing standards for settlement of claims for payment for certain
long term care services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (iii) of paragraph (b) of subdivision 8 of
section 3614 of the public health law, as added by section 54 of part J
of chapter 82 of the laws of 2002, is amended to read as follows:
(iii) In the case of services provided by such providers through
contracts with licensed home care services agencies, rate increases
received by such providers pursuant to this subdivision shall be
reflected, consistent with the purposes of subparagraph (i) of this
paragraph, in either the fees paid or benefits or other supports
provided to non-supervisory home care services workers or any worker
with direct patient care responsibility of such contracted licensed home
care services agencies and such fees, benefits or other supports shall
be proportionate to the contracted volume of services attributable to
each contracted agency AND SUCH RATE INCREASES SHALL BE MADE UPON
RECEIPT OF SUCH RECRUITMENT AND RETENTION FUNDS. Such agencies shall
submit to providers with which they contract written certifications
attesting that such funds will be used solely for the purposes of
recruitment and retention of non-supervisory home care services workers
or any worker with direct patient care responsibility and shall maintain
in their files expenditure plans specifying how such funds will be used
for such purposes. PROVIDERS SHALL REPORT TO THE COMMISSIONER ANNUALLY
ON THE AMOUNT OF SUCH FUNDS PROVIDED THROUGH CONTRACTS. SUCH REPORTS
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01607-01-3
A. 4473 2
SHALL LIST THE AMOUNT OF FUNDS BY LICENSED HOME CARE SERVICES AGENCIES.
The commissioner is authorized to audit such agencies to ensure compli-
ance with such certifications and expenditure plans and shall recoup any
funds determined to have been used for purposes other than those set
forth in this subdivision. Such recoupment will be in addition to any
other penalties provided by law.
S 2. Paragraph (c) of subdivision 10 of section 3614 of the public
health law, as amended by section 5 of part C of chapter 109 of the laws
of 2006, is amended to read as follows:
(c) In the case of services provided by such agencies or programs
through contracts with licensed home care services agencies, rate
increases received by such agencies or programs pursuant to this subdi-
vision shall be reflected, consistent with the purposes of this subdivi-
sion, in either the fees paid or benefits or other supports, including
training, provided to non-supervisory home health aides or any other
personnel with direct patient care responsibility of such contracted
licensed home care services agencies and such fees, benefits or other
supports shall be proportionate to the contracted volume of services
attributable to each contracted agency AND SUCH RATE INCREASES SHALL BE
MADE UPON RECEIPT OF SUCH RECRUITMENT AND RETENTION FUNDS. Such agencies
or programs shall submit to providers with which they contract written
certifications attesting that such funds will be used solely for the
purposes of recruitment, training and retention of non-supervisory home
health aides or other personnel with direct patient care responsibility
and shall maintain in their files expenditure plans specifying how such
funds will be used for such purposes. PROVIDERS SHALL REPORT TO THE
COMMISSIONER ANNUALLY ON THE AMOUNT OF SUCH FUNDS PROVIDED THROUGH
CONTRACTS. SUCH REPORTS SHALL LIST THE AMOUNT OF FUNDS BY LICENSED HOME
CARE SERVICES AGENCY. The commissioner is authorized to audit such agen-
cies or programs to ensure compliance with such certifications and
expenditure plans and shall recoup any funds determined to have been
used for purposes other than those set forth in this subdivision. Such
recoupment shall be in addition to any other penalties provided by law.
S 3. The public health law is amended by adding a new section 3614-d
to read as follows:
S 3614-D. STANDARDS FOR PROMPT, FAIR AND EQUITABLE SETTLEMENT OF
CLAIMS FOR PAYMENTS FOR PERSONAL CARE, HOME HEALTH CARE SERVICES OR
OTHER LONG TERM CARE SERVICES. IN THE PROCESSING OF CLAIMS SUBMITTED
UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO OR BETWEEN CERTI-
FIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, LICENSED
HOME CARE SERVICES PROGRAMS, INSURERS, MANAGED LONG TERM CARE PLANS,
MANAGED CARE PLANS OR ORGANIZATIONS LICENSED OR OPERATED PURSUANT TO THE
PROVISIONS OF THE PUBLIC HEALTH, SOCIAL SERVICES, OR INSURANCE LAW AND
FOR ALL BILLS FOR PERSONAL CARE, HOME HEALTH CARE SERVICES OR OTHER LONG
TERM CARE SERVICES RENDERED BY LICENSED HOME CARE SERVICES PROGRAMS,
CERTIFIED HOME HEALTH AGENCIES OR LONG TERM HOME HEALTH CARE PROGRAMS
PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME HEALTH CARE
AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, INSURER, MANAGED LONG TERM
CARE PLANS, MANAGED CARE PLAN, OR ORGANIZATIONS LICENSED OR OPERATED
PURSUANT TO THE PROVISIONS OF THE PUBLIC HEALTH, SOCIAL SERVICES, EXECU-
TIVE OR INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STANDARDS:
(1) SHALL PAY THE BILL OR CLAIM TO A LICENSED HOME CARE SERVICES
PROGRAM, CERTIFIED HOME HEALTH AGENCY OR LONG TERM HOME HEALTH CARE
PROGRAM WITHIN THIRTY DAYS OF RECEIPT OF A CLAIM OR BILL FOR SERVICES
RENDERED THAT IS TRANSMITTED VIA THE INTERNET OR ELECTRONIC MAIL, OR
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FORTY-FIVE DAYS OF RECEIPT OF A CLAIM OR BILL FOR SERVICES RENDERED THAT
IS SUBMITTED BY OTHER MEANS, SUCH AS PAPER OR FACSIMILE.
(2) EACH BILL, CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION OF
THIS SECTION SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE
PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
FAILS TO ADHERE TO THE STANDARDS CONTAINED IN THIS SECTION SHALL BE
OBLIGATED TO PAY TO THE LICENSED HOME HEALTH CARE PROGRAM IN FULL
SETTLEMENT OF THE BILL, CLAIM OR PAYMENT PLUS INTEREST ON THE AMOUNT OF
SUCH BILL, CLAIM OR PAYMENT OF THE GREATER OF THE RATE EQUAL TO THE RATE
SET BY THE COMMISSIONER OF TAXATION AND FINANCE FOR CORPORATE TAXES
PURSUANT TO PARAGRAPH ONE OF SUBSECTION (E) OF SECTION ONE THOUSAND
NINETY-SIX OF THE TAX LAW OR TWELVE PERCENT PER ANNUM, TO BE COMPUTED
FROM THE DATE THE BILL, CLAIM OR PAYMENT WAS REQUIRED TO BE MADE.
S 4. This act shall take effect immediately.