The New York State Senate

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

                                 2733--A

                       2017-2018 Regular Sessions

                          I N  A S S E M B L Y

                            January 23, 2017
                               ___________

Introduced  by  M.  of  A. GOTTFRIED, SKOUFIS, RAIA, LUPINACCI, LUPARDO,
  D'URSO -- Multi-Sponsored by -- M.  of  A.  LOPEZ  --  read  once  and
  referred  to  the  Committee  on  Health -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee

AN ACT to amend the public health law, in relation to authorizing colla-
  borative programs for community paramedicine services

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

  Section 1. Section 2805-x of  the  public  health  law,  as  added  by
section  48  of  part B of chapter 57 of the laws of 2015, is amended to
read as follows:
  § 2805-x. Hospital-home care-physician collaboration program.  1.  The
purpose  of  this section shall be to facilitate innovation in hospital,
home care agency and physician collaboration in meeting the  community's
health  care  needs.  It  shall provide a framework to support voluntary
initiatives in collaboration to improve patient care access and  manage-
ment,  patient  health outcomes, cost-effectiveness in the use of health
care services and community population health. Such collaborative HOSPI-
TAL-HOME CARE-PHYSICIAN initiatives may  also  include  payors,  skilled
nursing  facilities, EMERGENCY MEDICAL SERVICES and other interdiscipli-
nary providers, practitioners and  service  entities  AS  PART  OF  SUCH
HOSPITAL-HOME  CARE-PHYSICIAN  COLLABORATIVE  PROVIDED, HOWEVER, THAT IN
THE CASE OF COLLABORATIVE COMMUNITY PARAMEDICINE AS SET  FORTH  IN  THIS
SECTION  AND  ARTICLE  THIRTY  OF  THIS CHAPTER, THE COLLABORATIVE SHALL
MINIMALLY COMPRISE HOSPITAL, HOME CARE, PHYSICIAN, AND EMERGENCY MEDICAL
SERVICES PARTNERS.
  2. For purposes of this section:
  (a) "Hospital" shall include a general hospital  as  defined  in  this
article or other inpatient facility for rehabilitation or specialty care
within the definition of hospital in this article.

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

                                                           LBD02470-02-7

A. 2733--A                          2

  (b) "Home care agency" shall mean a certified home health agency, long
term  home  health care program or licensed home care services agency as
defined in article thirty-six of this chapter.
  (c)  "Payor"  shall  mean  a  health plan approved pursuant to article
forty-four of this chapter, or article thirty-two or forty-three of  the
insurance law.
  (d)  "Practitioner"  shall  mean  any  of the health, mental health or
health related professions licensed  pursuant  to  title  eight  of  the
education law.
  (E)  "EMERGENCY  MEDICAL SERVICES" (EMS) SHALL MEAN THE SERVICES OF AN
AMBULANCE SERVICE OR AN ADVANCED LIFE  SUPPORT  FIRST  RESPONSE  SERVICE
CERTIFIED  UNDER  ARTICLE  THIRTY  OF  THIS CHAPTER STAFFED BY EMERGENCY
MEDICAL TECHNICIANS OR ADVANCED EMERGENCY MEDICAL TECHNICIANS TO PROVIDE
BASIC OR ADVANCED LIFE SUPPORT AND, FOR THE PURPOSES  OF  THE  COMMUNITY
PARAMEDICINE  COLLABORATION  MODEL SET FORTH IN SUBDIVISION FOUR OF THIS
SECTION, ALSO TO PROVIDE  SUCH  SERVICES  PURSUANT  TO  SUCH  MODELS  IN
CIRCUMSTANCES  OTHER  THAN THE INITIAL EMERGENCY MEDICAL CARE AND TRANS-
PORTATION OF SICK AND INJURED PERSONS.
  3. The commissioner is authorized to provide financing including,  but
not  limited  to,  grants  or positive adjustments in medical assistance
rates or premium payments, to the extent of funds  available  and  allo-
cated  or  appropriated  therefor, including funds provided to the state
through federal waivers, funds made available  through  state  appropri-
ations  and/or  funding  through section twenty-eight hundred seven-v of
this article, as well as waivers of regulations under title ten  of  the
New  York  codes, rules and regulations, to support the voluntary initi-
atives and objectives of this section.  NOTHING IN THIS SECTION SHALL BE
CONSTRUED TO LIMIT, OR TO IMPLY THE NEED FOR STATE APPROVAL OF, COLLABO-
RATIVE INITIATIVES  ENUMERATED  IN  THIS  SECTION  WHICH  ARE  OTHERWISE
PERMISSIBLE  UNDER LAW OR REGULATION, PROVIDED HOWEVER THAT THE APPROVAL
OF THE COMMISSIONER SHALL BE REQUIRED FOR EITHER STATE FUNDING OR  REGU-
LATORY WAIVERS AS PROVIDED FOR UNDER THIS SECTION.
  4.  Hospital-home  care-physician collaborative initiatives under this
section may include, but shall not be limited to:
  (a) Hospital-home care-physician  integration  initiatives,  including
but not limited to:
  (i)  transitions  in  care  initiatives to help effectively transition
patients to post-acute care  at  home,  coordinate  follow-up  care  and
address issues critical to care plan success and readmission avoidance;
  (ii)  clinical  pathways  for  specified conditions, guiding patients'
progress and outcome goals, as well as effective health services use;
  (iii) application of telehealth/telemedicine  services  in  monitoring
and  managing  patient  conditions,  and promoting self-care/management,
improved outcomes and effective services use;
  (iv) facilitation of  physician  house  calls  to  homebound  patients
and/or  to  patients  for whom such home visits are determined necessary
and effective for patient care management;
  (v) additional models for prevention of  avoidable  hospital  readmis-
sions and emergency room visits;
  (vi) health home development;
  (vii)  development  and  demonstration  of new models of integrated or
collaborative care and care management not otherwise achievable  through
existing models; [and]
  (viii)  bundled payment demonstrations for hospital-to-post-acute-care
for specified conditions or categories  of  conditions,  in  particular,
conditions  predisposed  to  high  prevalence  of readmission, including

A. 2733--A                          3

those currently subject to federal/state penalty, and  other  discharges
with extensive post-acute needs; AND
  (IX) MODELS OF COMMUNITY PARAMEDICINE, UNDER WHICH HOSPITALS, EMERGEN-
CY  MEDICAL SERVICES WHO UTILIZE EMPLOYED OR VOLUNTEER EMERGENCY MEDICAL
TECHNICIANS OR ADVANCED EMERGENCY MEDICAL  TECHNICIANS,  PHYSICIANS  AND
HOME  CARE  AGENCIES,  IN JOINT PARTNERSHIP, MAY DEVELOP AND IMPLEMENT A
PLAN FOR THE COLLABORATIVE PROVISION OF SERVICES IN COMMUNITY  SETTINGS.
IN  ADDITION TO EMERGENCY SERVICES PROVIDED UNDER ARTICLE THIRTY OF THIS
CHAPTER, MODELS OF  COMMUNITY  PARAMEDICINE  MAY  INCLUDE  COLLABORATIVE
SERVICES TO AT-RISK INDIVIDUALS LIVING IN THE COMMUNITY TO PREVENT EMER-
GENCIES,  AVOIDABLE  EMERGENCY ROOM NEED, AVOIDABLE TRANSPORT AND POTEN-
TIALLY AVOIDABLE HOSPITAL ADMISSIONS AND READMISSIONS; COMMUNITY  PARAM-
EDICINE  SERVICES  TO  INDIVIDUALS WITH BEHAVIORAL HEALTH CONDITIONS, OR
DEVELOPMENTAL OR INTELLECTUAL DISABILITIES, SHALL  FURTHER  INCLUDE  THE
COLLABORATION  OF  APPROPRIATE  PROVIDERS  OF BEHAVIORAL HEALTH SERVICES
LICENSED OR CERTIFIED UNDER THE MENTAL HYGIENE LAW;
  (b) Recruitment, training and retention of hospital/home  care  direct
care  staff  and  physicians,  in geographic or clinical areas of demon-
strated need. Such initiatives may include, but are not limited to,  the
following activities:
  (i)  outreach and public education about the need and value of service
in health occupations;
  (ii) training/continuing education  and  regulatory  facilitation  for
cross-training  to  maximize  flexibility  in  the utilization of staff,
including:
  (A) training of hospital nurses in home care;
  (B) dual certified nurse aide/home health aide certification; [and]
  (C) dual personal care aide/HHA certification; AND
  (D) ORIENTATION AND/OR COLLABORATIVE TRAINING OF EMS,  HOSPITAL,  HOME
CARE, PHYSICIAN AND, AS NECESSARY, OTHER PARTICIPATING PROVIDER STAFF IN
COMMUNITY PARAMEDICINE;
  (iii) salary/benefit enhancement;
  (iv) career ladder development; and
  (v) other incentives to practice in shortage areas; and
  (c)  Hospital  - home care - physician collaboratives for the care and
management of special needs, high-risk and high-cost patients, including
but not limited to best practices, and training and education of  direct
care practitioners and service employees.
  5.  Hospitals  and  home care agencies which are provided financing or
waivers pursuant to this section shall report to the commissioner on the
patient, service and cost experiences pursuant to this section,  includ-
ing the extent to which the project goals are achieved. The commissioner
shall  compile  and  make  such  reports  available  on the department's
website.
  § 2. The public health law is amended by adding a new  section  3001-a
to read as follows:
  §  3001-A. COMMUNITY PARAMEDICINE SERVICES. NOTWITHSTANDING ANY INCON-
SISTENT PROVISION OF THIS ARTICLE, AN EMERGENCY  MEDICAL  TECHNICIAN  OR
ADVANCED EMERGENCY MEDICAL TECHNICIAN IN COURSE OF HIS OR HER WORK AS AN
EMPLOYEE  OR  VOLUNTEER  OF  AN  AMBULANCE  SERVICE  OR AN ADVANCED LIFE
SUPPORT FIRST RESPONSE SERVICE CERTIFIED UNDER THIS ARTICLE  TO  PROVIDE
EMERGENCY  MEDICAL  SERVICES MAY ALSO PARTICIPATE IN MODELS OF COMMUNITY
PARAMEDICINE PURSUANT TO SECTION TWENTY-EIGHT  HUNDRED  FIVE-X  OF  THIS
CHAPTER.
  § 3. This act shall take effect immediately.