Senate Bill S4297A

2015-2016 Legislative Session

Directs the department of health to establish standards for universal coding of payment of claims for long term care and provide for the electronic payment of such claims

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2016	referred to health
Jun 25, 2015	committed to rules
Mar 19, 2015	advanced to third reading
Mar 18, 2015	2nd report cal. amended 4297a
Mar 17, 2015	1st report cal.256
Mar 11, 2015	referred to health

Votes

- Mar 17, 2015 - Health Committee Vote
  S4297A
  
  Aye
  
  17
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Health Committee Vote: Mar 17, 2015
      
      aye (17)
      
      Farley
      
      Felder
      
      Golden
      
      Hannon
      
      Hassell-Thompson
      
      Hoylman-Sigal
      
      Larkin
      
      Little
      
      Martins
      
      Montgomery
      
      Murphy
      
      Panepinto
      
      Rivera
      
      Seward
      
      Stavisky
      
      Valesky
      
      Young

Bill Amendments

Original

A (Active)

co-Sponsors

2015-S4297 - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §§3614-d & 3614-e, Pub Health L

2015-S4297 - Summary

Directs the department of health to establish standards for universal coding of payment of claims for long term care and provide for the electronic payment of such claims.

2015-S4297 - Sponsor Memo

                                BILL NUMBER:S4297

TITLE OF BILL:  An act to amend the public health law, in relation to
universal standards for coding of payment of claims for long term care
and electronic payment of claims

PURPOSE: Requires contracts or agreements for the payment of long term
care services to utilize universal standards of coding similar to
other health care providers and the payment of such claims to be via
electronic funds transfer.

SUMMARY OF PROVISIONS:

Section one of the bill by adding a new section 3614-d of the public
health law providing for contracts or agreements issued or entered
into or between certified 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, executive or
insurance law shall be based on universal billing codes approved by
the department or a nationally accredited organization.

Section two of the bill adds a new section 3614-e to provide that the
payment of claims for long term care services must be by electronic
funds transfer.

JUSTIFICATION:  The State's transition to managed long term care
(MLTC) has now been underway for over two years. During that time,
home care agencies have experienced ongoing - and mounting -
challenges related to an overall lack of standardization and
efficiency in procedures and billing processes when working with
various MLTC plans. These inefficiencies have created significant
obstacles for providers to secure prompt reimbursement for services
which threaten their ability to continue the high standard of long
term care to the elderly and disabled.

Surveys of providers were conducted in September 2013 and in 2015 to
document and analyze over time how the transition to managed care has
impacted home care providers across the State. Topping the list of
concerns of home care providers in both years is the inability to
secure adequate and timely reimbursement for services provided under
contract with Medicaid managed care and MLTC plans.

In 2015, 50% of the respondents indicated that they were contracting
with eight or more MLTCs, up from 32% in 2013. Each of these plans has
different billing codes for services and different procedures for
submitting claims. This has significantly added to the administrative
burden of home care providers, draining home care resources and
contributing to delays in payments.


When asked how agencies could use financial assistance to support the
MLTC transition and other large-scale health-related State policy
initiatives underway, 43% of survey respondents in 2015 said that they
would hire additional administrative staff and 36% responded they
would enhance their agency's IT capabilities. This reflects the
significant increase in administrative burdens that home care
providers have experienced with the transition to manager care. When
asked the same question in 2013, none of the respondents selected
these categories.

Inefficiencies and delays in the managed care system have led to
serious cash flow problems for home care agencies and threaten their
viability to continue to provide care to all parts of the State. More
than 60% of respondents in 2015 indicated that they are currently
experiencing cash flow issues or have faced cash flow issues in the
past.

This legislation will help relieve the administrative burden on
providers by requiring the Department of Health to establish universal
billing codes that will be used by all of the managed care plans and
providers with whom they have contracts or agreements. It will also
expedite the reimbursement process by requiring payments to be made
via electronic funds transfer, as is currently done in the Medicaid
system.

LEGISLATIVE HISTORY: New legislation.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately, provided it shall apply to any coding of
payment of claims for long term care on or after January 1, 2016.

2015-S4297 - Bill Text download pdf

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

                                  4297

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             March 11, 2015
                               ___________

Introduced  by  Sen.  HANNON -- 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  universal  stand-
  ards for coding of payment of claims for long term care and electronic
  payment of claims

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

  Section 1. The public health law is amended by adding two new sections
3614-d and 3614-e to read as follows:
  S 3614-D. UNIVERSAL STANDARDS FOR CODING OF PAYMENT OF CLAIMS FOR LONG
TERM CARE.  STANDARDS FOR THE CODES OF CLAIMS OF PAYMENTS  FOR  PERSONAL
CARE, HOME HEALTH CARE SERVICES OR OTHER LONG TERM CARE SERVICES. IN THE
PROCESSING  OF  CODES  OF CLAIMS SUBMITTED UNDER CONTRACTS OR AGREEMENTS
ISSUED OR ENTERED INTO OR BETWEEN CERTIFIED HOME HEALTH  AGENCIES,  LONG
TERM  HOME  HEALTH  CARE PROGRAMS, LICENSED HOME CARE SERVICES PROGRAMS,
INSURERS, MANAGED LONG TERM CARE PLANS, MANAGED CARE PLANS OR  ORGANIZA-
TIONS  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  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 THIS CHAPTER, THE SOCIAL SERVICES LAW,  THE  EXECU-
TIVE  LAW OR THE INSURANCE LAW SHALL BE BASED ON UNIVERSAL BILLING CODES
APPROVED BY THE DEPARTMENT OR A NATIONALLY  ACCREDITED  ORGANIZATION  AS
APPROVED  BY  THE  DEPARTMENT;  PROVIDED,  HOWEVER, SUCH CODING SHALL BE
CONSISTENT WITH ANY CODES DEVELOPED AS PART OF  THE  UNIFORM  ASSESSMENT
SYSTEM FOR LONG TERM CARE ESTABLISHED BY THE DEPARTMENT.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09910-01-5

S. 4297                             2

  S  3614-E.  ELECTRONIC  PAYMENT  OF  CLAIMS.  IN THE PAYMENT OF CLAIMS
SUBMITTED UNDER CONTRACTS  OR  AGREEMENTS  ISSUED  OR  ENTERED  INTO  OR
BETWEEN  CERTIFIED  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  PURSUANT  TO  THE  PROVISIONS  OF THIS CHAPTER, THE SOCIAL
SERVICES LAW, THE EXECUTIVE LAW OR THE INSURANCE LAW, SUCH CLAIMS  SHALL
BE PAID VIA ELECTRONIC FUNDS TRANSFER.
  S  2.  This  act  shall take effect immediately but shall apply to any
coding of payment of claims for long term care on or  after  January  1,
2016.

co-Sponsors

2015-S4297A (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §§3614-d & 3614-e, Pub Health L

2015-S4297A (ACTIVE) - Summary

Directs the department of health to establish standards for universal coding of payment of claims for long term care and provide for the electronic payment of such claims.

2015-S4297A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S4297A

TITLE OF BILL:  An act to amend the public health law, in relation to
universal standards for coding of payment of claims for long term care
and electronic payment of claims

PURPOSE: Requires contracts or agreements for the payment of long term
care services to utilize universal standards of coding similar to
other health care providers and the payment of such claims to be via
electronic funds transfer.

SUMMARY OF PROVISIONS:

Section one of the bill by adding a new section 3614-d of the public
health law providing for contracts or agreements issued or entered
into or between certified home health agencies, long term home health
care programs, licensed home care services programs, fiscal
intermediaries, 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, fiscal intermediary,
insurer, managed long term care plans, managed care plan, or

organizations licensed or operated pursuant to the provisions of the
public health, social services, executive or insurance law shall be
based on universal billing codes approved by the department or a
nationally accredited organization.

Section two of the bill adds a new section 3614-e to provide that the
payment of claims for long term care services must be by electronic
funds transfer.

JUSTIFICATION:  The State's transition to managed long term care
(MLTC) has now been underway for over two years. During that time,
home care agencies have experienced ongoing - and mounting -
challenges related to an overall lack of standardization and
efficiency in procedures and billing processes when working with
various MLTC plans. These inefficiencies have created significant
obstacles for providers to secure prompt reimbursement for services
which threaten their ability to continue the high standard of long
term care to the elderly and disabled.

Surveys of providers were conducted in September 2013 and in 2015 to
document and analyze over time how the transition to managed care has
impacted home care providers across the State. Topping the list of
concerns of home care providers in both years is the inability to
secure adequate and timely reimbursement for services provided under
contract with Medicaid managed care and MLTC plans.

In 2015, 50% of the respondents indicated that they were contracting
with eight or more MLTCs, up from 32% in 2013. Each of these plans has
different billing codes for services and different procedures for
submitting claims. This has significantly added to the administrative


burden of home care providers, draining home care resources and
contributing to delays in payments.

When asked how agencies could use financial assistance to support the
MLTC transition and other large-scale health-related State policy
initiatives underway, 43% of survey respondents in 2015 said that they
would hire additional administrative staff and 36% responded they
would enhance their agency's IT capabilities. This reflects the
significant increase in administrative burdens that home care
providers have experienced with the transition to manager care. When
asked the same question in 2013, none of the respondents selected
these categories.

Inefficiencies and delays in the managed care system have led to
serious cash flow problems for home care agencies and threaten their
viability to continue to provide care to all parts of the State. More
than 60% of respondents in 2015 indicated that they are currently
experiencing cash flow issues or have faced cash flow issues in the
past.

This legislation will help relieve the administrative burden on
providers by requiring the Department of Health to establish universal
billing codes that will be used by all of the managed care plans and
providers with whom they have contracts or agreements. It will also
expedite the reimbursement process by requiring payments to be made
via electronic funds transfer, as is currently done in the Medicaid
system.

LEGISLATIVE HISTORY: New legislation.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately, provided it shall apply to any coding of
payment of claims for long term care on or after January 1, 2016.

2015-S4297A (ACTIVE) - Bill Text download pdf

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

                                 4297--A
    Cal. No. 256

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             March 11, 2015
                               ___________

Introduced  by  Sens.  HANNON, LARKIN -- read twice and ordered printed,
  and when printed to  be  committed  to  the  Committee  on  Health  --
  reported  favorably  from  said  committee,  ordered  to first report,
  amended on first report,  ordered  to  a  second  report  and  ordered
  reprinted, retaining its place in the order of second report

AN  ACT  to amend the public health law, in relation to universal stand-
  ards for coding of payment of claims for long term care and electronic
  payment of claims

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

  Section 1. The public health law is amended by adding two new sections
3614-d and 3614-e to read as follows:
  S 3614-D. UNIVERSAL STANDARDS FOR CODING OF PAYMENT OF CLAIMS FOR LONG
TERM  CARE.   STANDARDS FOR THE CODES OF CLAIMS OF PAYMENTS FOR PERSONAL
CARE, HOME HEALTH CARE SERVICES OR OTHER LONG TERM CARE SERVICES. IN THE
PROCESSING OF CODES OF CLAIMS SUBMITTED UNDER  CONTRACTS  OR  AGREEMENTS
ISSUED  OR  ENTERED INTO OR BETWEEN CERTIFIED 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 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,
FISCAL   INTERMEDIARY   OPERATING  PURSUANT  TO  SECTION  THREE  HUNDRED
SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW, INSURER, MANAGED LONG TERM CARE
PLANS, MANAGED CARE PLAN, OR ORGANIZATIONS LICENSED OR OPERATED PURSUANT
TO THE PROVISIONS OF THIS CHAPTER, THE SOCIAL SERVICES LAW,  THE  EXECU-

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

                                                           LBD09910-02-5

S. 4297--A                          2

TIVE  LAW OR THE INSURANCE LAW SHALL BE BASED ON UNIVERSAL BILLING CODES
APPROVED BY THE DEPARTMENT OR A NATIONALLY  ACCREDITED  ORGANIZATION  AS
APPROVED  BY  THE  DEPARTMENT;  PROVIDED,  HOWEVER, SUCH CODING SHALL BE
CONSISTENT  WITH  ANY  CODES DEVELOPED AS PART OF THE UNIFORM ASSESSMENT
SYSTEM FOR LONG TERM CARE ESTABLISHED BY THE DEPARTMENT.
  S 3614-E. ELECTRONIC PAYMENT OF  CLAIMS.  IN  THE  PAYMENT  OF  CLAIMS
SUBMITTED  UNDER  CONTRACTS  OR  AGREEMENTS  ISSUED  OR  ENTERED INTO OR
BETWEEN CERTIFIED 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 PURSUANT TO THE  PROVISIONS  OF  THIS  CHAPTER,  THE  SOCIAL
SERVICES  LAW, THE EXECUTIVE LAW OR THE INSURANCE LAW, SUCH CLAIMS SHALL
BE PAID VIA ELECTRONIC FUNDS TRANSFER.
  S 2. This act shall take effect immediately but  shall  apply  to  any
coding  of  payment  of claims for long term care on or after January 1,
2016.

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Senate Bill S4297A

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Actions

Votes

Mar 17, 2015 - Health Committee Vote

Health Committee Vote: Mar 17, 2015

Bill Amendments

co-Sponsors

2015-S4297 - Details

2015-S4297 - Summary

2015-S4297 - Sponsor Memo

2015-S4297 - Bill Text download pdf

co-Sponsors

2015-S4297A (ACTIVE) - Details

2015-S4297A (ACTIVE) - Summary

2015-S4297A (ACTIVE) - Sponsor Memo

2015-S4297A (ACTIVE) - Bill Text download pdf

Comments

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Sponsored By

Kemp Hannon

Archive: Last Bill Status - In Senate Committee Health Committee

Actions

Votes

Bill Amendments

co-Sponsors

William Larkin

2015-S4297 - Details

2015-S4297 - Summary

2015-S4297 - Sponsor Memo

2015-S4297 - Bill Text download pdf

co-Sponsors

William Larkin

2015-S4297A (ACTIVE) - Details

2015-S4297A (ACTIVE) - Summary

2015-S4297A (ACTIVE) - Sponsor Memo

2015-S4297A (ACTIVE) - Bill Text download pdf

Comments