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

                                   379

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 7, 2015
                               ___________

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

AN ACT to amend the public health law, in relation to enacting the "home
  care  stabilization  act";  and  providing  for  the repeal of certain
  provisions upon expiration thereof

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

  Section  1.  Short  title. This act shall be known and may be cited as
the "home care stabilization act".
  S 2. Section 3622 of the public health law, as renumbered  by  section
22  of  part  C of chapter 58 of the laws of 2004, is renumbered section
3625 and two new sections 3614-d and 3622 are added 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. 1. 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, FISCAL INTERMEDIARIES OPERATING PURSUANT TO
SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW, INSURERS,
MANAGED LONG TERM  CARE  PLANS,  MANAGED  CARE  PLANS  OR  ORGANIZATIONS
LICENSED  OR  OPERATED  PURSUANT  TO THE PROVISIONS OF THIS CHAPTER, THE
SOCIAL SERVICES LAW OR THE INSURANCE LAW AND FOR ALL BILLS FOR  PERSONAL
CARE,  HOME  HEALTH CARE SERVICES, CONSUMER DIRECTED PERSONAL ASSISTANCE
SERVICES OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE
SOCIAL SERVICES LAW  OR  OTHER  LONG  TERM  CARE  SERVICES  RENDERED  BY
LICENSED  HOME  CARE  SERVICES PROGRAMS, CERTIFIED HOME HEALTH AGENCIES,
LONG TERM HOME HEALTH CARE PROGRAMS OR A FISCAL  INTERMEDIARY  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME  HEALTH
CARE  AGENCY,  LONG TERM HOME HEALTH CARE PROGRAM, INSURER, MANAGED LONG

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

                                                           LBD04830-01-5

A. 379                              2

TERM CARE PLAN, MANAGED CARE PLAN OR ORGANIZATION LICENSED  OR  OPERATED
PURSUANT TO THE PROVISIONS OF THIS CHAPTER, THE SOCIAL SERVICES LAW, THE
EXECUTIVE LAW OR THE INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STAND-
ARDS:
  (A) SHALL PAY A CLEAN CLAIM SUBMITTED BY A LICENSED HOME CARE SERVICES
PROGRAM,  CERTIFIED  HOME  HEALTH  AGENCY,  LONG  TERM  HOME HEALTH CARE
PROGRAM OR A FISCAL INTERMEDIARY OPERATING  PURSUANT  TO  SECTION  THREE
HUNDRED  SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW WITHIN THIRTY DAYS OF
RECEIPT OF THE CLEAN CLAIM FOR SERVICES RENDERED THAT IS TRANSMITTED VIA
THE INTERNET OR ELECTRONIC MAIL, OR FORTY-FIVE DAYS OF  RECEIPT  OF  THE
CLEAN CLAIM FOR SERVICES RENDERED THAT IS SUBMITTED BY OTHER MEANS, SUCH
AS PAPER OR FACSIMILE;
  (B)  SHALL  PAY  ANY UNDISPUTED PORTION OF A CLAIM AS A CLEAN CLAIM AS
SET FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION SUBMITTED BY  A  LICENSED
HOME CARE SERVICES PROGRAM, CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY OPERATING PURSUANT TO SECTION
THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW;
  (C)  NOTIFY ANY SUCH AGENCY, PROGRAM OR FISCAL INTERMEDIARY IN WRITING
WITHIN FIFTEEN CALENDAR DAYS OF THE RECEIPT OF AN INITIAL CLAIM  OF  ALL
SPECIFIC  DEFECTS  OR DISPUTES OF SUCH CLAIM AND SPECIFICALLY REQUEST IN
WRITING THE ADDITIONAL INFORMATION  OR  REMEDY  NEEDED  TO  PROCESS  ANY
DISPUTED PORTIONS OF THE CLAIM; AND
  (D)  ANY DISPUTED CLAIM REMEDIED SHALL BE PAID AS A CLEAN CLAIM AS SET
FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION.
  2. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" SHALL:
  (A) IDENTIFY THE LICENSED HOME CARE SERVICES PROGRAM,  CERTIFIED  HOME
HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL
SERVICES LAW;
  (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON;
  (C) LIST THE DATE AND PLACE OF SERVICE;
  (D) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
  (E) STATE IF PRIOR AUTHORIZATION IS REQUIRED FOR SUCH ELIGIBLE COVERED
PERSON AND SERVICE; AND
  (F) STATE ANY DOCUMENTATION  AS  REASONABLY  REQUIRED  BY  ANY  ENTITY
REFERENCED IN THIS SECTION.
  3.  EACH CLEAN 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 CERTIFIED  HOME  HEALTH  AGENCIES,  LONG  TERM  HOME
HEALTH  CARE  PROGRAMS,  LICENSED  HOME  HEALTH  CARE PROGRAMS OR FISCAL
INTERMEDIARIES OPERATING PURSUANT TO SECTION THREE HUNDRED  SIXTY-FIVE-F
OF  THE  SOCIAL  SERVICES  LAW  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  3622. MEDICAL ASSISTANCE RECOUPMENTS AND REDUCTIONS.  NOTWITHSTAND-
ING ANY OTHER PROVISION OF LAW TO  THE  CONTRARY,  ON  AND  AFTER  APRIL
FIRST,  TWO  THOUSAND  NINE,  ANY  RECOUPMENTS  OR REDUCTIONS IN MEDICAL
ASSISTANCE PAYMENTS FOR LICENSED HOME CARE SERVICES AGENCIES AND  CERTI-
FIED  HOME  HEALTH  AGENCIES LICENSED PURSUANT TO THIS ARTICLE OR FISCAL
INTERMEDIARIES OPERATING PURSUANT TO SECTION THREE HUNDRED  SIXTY-FIVE-F

A. 379                              3

OF  THE SOCIAL SERVICES LAW SHALL NOT BE SUBJECT TO INTEREST OR INTEREST
PENALTIES.
  S  3.  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 ASSIST-
ANCE   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 4. This act shall take effect  immediately,  provided  that  section
3622  of  the  public  health  law, as added by section two of this act,
shall expire and be deemed repealed March 31, 2017.

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

                                 379--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
  tee on Health -- committee discharged, bill amended, ordered reprinted
  as amended and recommitted to said committee

AN ACT to amend the public health law, in relation to enacting the "home
  care stabilization act"

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

  Section 1. Short title. This act shall be known and may  be  cited  as
the "home care stabilization act".
  S  2.  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. 1. 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, FISCAL INTERMEDIARIES OPERATING PURSUANT TO
SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW, INSURERS,
MANAGED LONG TERM  CARE  PLANS,  MANAGED  CARE  PLANS  OR  ORGANIZATIONS
LICENSED  OR  OPERATED  PURSUANT  TO THE PROVISIONS OF THIS CHAPTER, THE
SOCIAL SERVICES LAW OR THE INSURANCE LAW AND FOR ALL BILLS FOR  PERSONAL
CARE,  HOME  HEALTH CARE SERVICES, CONSUMER DIRECTED PERSONAL ASSISTANCE
SERVICES OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE
SOCIAL SERVICES LAW  OR  OTHER  LONG  TERM  CARE  SERVICES  RENDERED  BY
LICENSED  HOME  CARE  SERVICES PROGRAMS, CERTIFIED HOME HEALTH AGENCIES,
LONG TERM HOME HEALTH CARE PROGRAMS OR A FISCAL  INTERMEDIARY  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME  HEALTH
CARE  AGENCY,  LONG TERM HOME HEALTH CARE PROGRAM, INSURER, MANAGED LONG
TERM CARE PLAN, MANAGED CARE PLAN OR ORGANIZATION LICENSED  OR  OPERATED

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

                                                           LBD04830-03-5

A. 379--A                           2

PURSUANT TO THE PROVISIONS OF THIS CHAPTER, THE SOCIAL SERVICES LAW, THE
EXECUTIVE LAW OR THE INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STAND-
ARDS:
  (A) SHALL PAY A CLEAN CLAIM SUBMITTED BY A LICENSED HOME CARE SERVICES
PROGRAM,  CERTIFIED  HOME  HEALTH  AGENCY,  LONG  TERM  HOME HEALTH CARE
PROGRAM OR A FISCAL INTERMEDIARY OPERATING  PURSUANT  TO  SECTION  THREE
HUNDRED  SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW WITHIN THIRTY DAYS OF
RECEIPT OF THE CLEAN CLAIM FOR SERVICES RENDERED THAT IS TRANSMITTED VIA
THE INTERNET OR ELECTRONIC MAIL, OR FORTY-FIVE DAYS OF  RECEIPT  OF  THE
CLEAN CLAIM FOR SERVICES RENDERED THAT IS SUBMITTED BY OTHER MEANS, SUCH
AS PAPER OR FACSIMILE;
  (B)  SHALL  PAY  ANY UNDISPUTED PORTION OF A CLAIM AS A CLEAN CLAIM AS
SET FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION SUBMITTED BY  A  LICENSED
HOME CARE SERVICES PROGRAM, CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY OPERATING PURSUANT TO SECTION
THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW;
  (C)  NOTIFY ANY SUCH AGENCY, PROGRAM OR FISCAL INTERMEDIARY IN WRITING
WITHIN FIFTEEN CALENDAR DAYS OF THE RECEIPT OF AN INITIAL CLAIM  OF  ALL
SPECIFIC  DEFECTS  OR DISPUTES OF SUCH CLAIM AND SPECIFICALLY REQUEST IN
WRITING THE ADDITIONAL INFORMATION  OR  REMEDY  NEEDED  TO  PROCESS  ANY
DISPUTED PORTIONS OF THE CLAIM; AND
  (D)  ANY DISPUTED CLAIM REMEDIED SHALL BE PAID AS A CLEAN CLAIM AS SET
FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION.
  2. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" SHALL:
  (A) IDENTIFY THE LICENSED HOME CARE SERVICES PROGRAM,  CERTIFIED  HOME
HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL
SERVICES LAW;
  (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON;
  (C) LIST THE DATE AND PLACE OF SERVICE;
  (D) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
  (E) STATE IF PRIOR AUTHORIZATION IS REQUIRED FOR SUCH ELIGIBLE COVERED
PERSON AND SERVICE; AND
  (F) STATE ANY DOCUMENTATION  AS  REASONABLY  REQUIRED  BY  ANY  ENTITY
REFERENCED IN THIS SECTION.
  3.  EACH CLEAN 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 CERTIFIED  HOME  HEALTH  AGENCIES,  LONG  TERM  HOME
HEALTH  CARE  PROGRAMS,  LICENSED  HOME  HEALTH  CARE PROGRAMS OR FISCAL
INTERMEDIARIES OPERATING PURSUANT TO SECTION THREE HUNDRED  SIXTY-FIVE-F
OF  THE  SOCIAL  SERVICES  LAW  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  3.  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

A. 379--A                           3

HUNDRED FOURTEEN-C OF THIS CHAPTER OR CONSUMER DIRECTED PERSONAL ASSIST-
ANCE   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 4. This act shall take effect immediately.