Assembly Bill A7798A

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7798--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 23, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, McDONALD, REYES, PERRY, CRUZ, DICKENS,
   NIOU,  BENEDETTO,  SIMON,  ABINANTI,  LUPARDO,  STIRPE,  L. ROSENTHAL,
   COLTON, BARRON, CYMBROWITZ, ZEBROWSKI, SEAWRIGHT,  BUTTENSCHON,  SIMO-
   TAS,  McDONOUGH, MONTESANO, FRONTUS, CRESPO, HEVESI, JACOBSON, THIELE,
   BURKE, DINOWITZ, MOSLEY, ORTIZ, BRONSON,  RODRIGUEZ,  GRIFFIN,  TAGUE,
   LENTOL  -- read once and referred to the Committee on Health -- recom-
   mitted to the Committee on Health in accordance with Assembly Rule  3,
   sec.  2  --  committee  discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee
 
 AN ACT to amend the public health law, in relation to rates  of  payment
   for certified home health agencies
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (b) of subdivision 13  of  section  3614  of  the
 public  health law, as added by section 4 of part H of chapter 59 of the
 laws of 2011, is amended to read as follows:
   (b) Initial base year episodic payments shall  be  based  on  Medicaid
 paid  claims,  as determined and adjusted by the commissioner to achieve
 savings comparable to the prior state fiscal year, for services provided
 by all certified home health agencies in  the  base  year  two  thousand
 nine.  Subsequent  base  year episodic payments may be based on Medicaid
 paid claims for services provided by all certified home health  agencies
 in  a  base  year  subsequent to two thousand nine, as determined by the
 commissioner, provided, however, that such base year adjustment shall be
 made not less frequently than every three  years.  In  determining  case
 mix,  each  patient shall be classified using a system based on measures
 which may include, but not limited to, clinical and functional measures,
 as reported on  the  federal  Outcome  and  Assessment  Information  Set
 (OASIS),  as  may be amended. NOTWITHSTANDING ANY INCONSISTENT PROVISION
 OF LAW OR REGULATION, IN ADDITION TO THE BASE YEAR  ADJUSTMENT  PROVIDED
 FOR  IN  THIS  PARAGRAPH,  FOR THE RATE YEAR COMMENCING APRIL FIRST, TWO
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11759-03-0

 A. 7798--A                          2
 
 THOUSAND TWENTY, THE  COMMISSIONER  SHALL  PROVIDE  FOR  A  TEN  PERCENT
 INCREASE  IN  THE BASE EPISODIC PAYMENT, AND IN THE INDIVIDUAL RATES FOR
 SERVICES EXEMPT FROM EPISODIC  PAYMENTS  UNDER  PARAGRAPH  (A)  OF  THIS
 SUBDIVISION,  FROM  FUNDS  AVAILABLE FOR THE MEDICAL ASSISTANCE PROGRAM.
 PROVIDED, FURTHER, THAT FOR RATE YEARS BEGINNING APRIL FIRST, TWO  THOU-
 SAND  TWENTY  AND  AFTER, THE COMMISSIONER IS AUTHORIZED TO INCREASE THE
 EPISODIC PAYMENT LEVEL FOR COSTS NOT REFLECTED IN  THE  STATEWIDE  BASE,
 SUBJECT TO THE APPROVAL OF THE STATE BUDGET DIRECTOR, INCLUDING THE COST
 OF:  INFLATIONARY  INCREASES  IN  THE  HEALTH  CARE MARKET BASKET AND/OR
 CONSUMER  PRICE  INDEX  IMPACTING  PROVIDERS;  NEW  STATE  OR  FEDERALLY
 MANDATED  PROGRAM  REGULATORY  REQUIREMENTS; HOME CARE STAFF RECRUITMENT
 AND RETENTION NEEDS, PARTICULARLY IN  SHORTAGE  AREAS  AND  DISCIPLINES;
 FACILITATING  PROVIDER  CAPABILITY  TO  FURTHER  ALIGN WITH STATE HEALTH
 REFORM MODELS AND POLICY GOALS; HEALTH  CARE  CLINICAL  AND  INFORMATION
 TECHNOLOGY  INVESTMENTS  APPROVED BY THE COMMISSIONER; AND OTHER MATTERS
 THE COMMISSIONER DETERMINES APPROPRIATE.
   § 2. The public health law is amended by adding a new  section  3614-f
 to read as follows:
   §  3614-F.  STANDARDS  FOR HOME CARE SERVICES PAYMENTS. 1. LEGISLATIVE
 INTENT. ADEQUATE REIMBURSEMENT FOR HOME CARE SERVICES  IS  ESSENTIAL  TO
 THE  POLICIES SET FORTH IN SECTION THIRTY-SIX HUNDRED OF THIS ARTICLE AS
 WELL AS STATE POLICIES CONTINGENT ON ACCESS, AVAILABILITY AND QUALITY OF
 THESE SERVICES. THE DEGREE OF VARIABILITY ACROSS  STATE  REGULATED  HOME
 CARE  RATES,  EPISODIC PAYMENTS, FEES FOR INDIVIDUAL HOME CARE SERVICES,
 AND NEGOTIATED PAYMENTS, LEAVES THE HOME CARE SYSTEM WITHOUT A  STANDARD
 BASIS OF PAYMENT AND STABLE REVENUE NECESSARY TO BUDGET, PLAN AND ENSURE
 SUSTAINABILITY.  TO  HELP  ENSURE  THE  HOME  CARE SYSTEM'S VIABILITY TO
 DELIVER THE NEEDED SERVICES, THE COMMISSIONER  SHALL  ESTABLISH  MINIMUM
 STANDARDS  AND  A  MINIMUM  BENCHMARK  WITHIN  THE  MEDICAID PROGRAM FOR
 PAYMENT OF HOME  HEALTH  AGENCY  SERVICES,  INCLUDING  THE  SERVICES  OF
 SUBCONTRACTING LICENSED HOME CARE SERVICES AGENCIES, THAT CAN ALSO SERVE
 AS  THE  BENCHMARK TO BE CONSIDERED IN RATES PAID BY NON-MEDICAID THIRD-
 PARTY PAYORS.
   2. ESTABLISHMENT OF STANDARDS. EFFECTIVE FOR RATES ISSUED APRIL FIRST,
 TWO THOUSAND TWENTY AND FOR EACH RATE YEAR THEREAFTER, THE  COMMISSIONER
 SHALL  ESTABLISH MINIMUM STANDARDS AND A MINIMUM BENCHMARK FOR HOME CARE
 SERVICE PAYMENT BY ANY MEDICAID PAYOR. THE COMMISSIONER SHALL ALSO  POST
 SUCH  STANDARDS  AND  BENCHMARK  IN  AN  ADMINISTRATIVE DIRECTIVE TO THE
 ATTENTION OF ALL OTHER THIRD-PARTY PAYORS OF HOME CARE SERVICES  IN  THE
 STATE FOR CONSIDERED USE IN PAYMENT OF HOME CARE SERVICES. IN ESTABLISH-
 ING  THE BENCHMARK, THE COMMISSIONER SHALL UTILIZE THE RATES ESTABLISHED
 UNDER THE EPISODIC PAYMENT SYSTEM UNDER SUBDIVISION THIRTEEN OF  SECTION
 THIRTY-SIX HUNDRED FOURTEEN OF THIS ARTICLE, AND THE INDIVIDUAL SERVICES
 RATES ESTABLISHED UNDER SUCH SECTION.
   § 3. This act shall take effect immediately.