S T A T E O F N E W Y O R K
________________________________________________________________________
1208
2019-2020 Regular Sessions
I N A S S E M B L Y
January 14, 2019
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Introduced by M. of A. GOTTFRIED, RAIA, LUPARDO, D'URSO, WOERNER, STECK,
TAGUE -- Multi-Sponsored by -- M. of A. PALMESANO -- read once and
referred to the Committee on Health
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.
LBD03394-01-9
A. 1208 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. 1208 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.