S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  293--A
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of  A. GOTTFRIED, REYES, PERRY, CRUZ, DICKENS, NIOU,
   BENEDETTO, SIMON, ABINANTI,  LUPARDO,  STIRPE,  L. ROSENTHAL,  COLTON,
   CYMBROWITZ,  ZEBROWSKI,  SEAWRIGHT, BUTTENSCHON, McDONOUGH, MONTESANO,
   FRONTUS, HEVESI, JACOBSON, THIELE, DINOWITZ, BRONSON, GRIFFIN,  TAGUE,
   SAYEGH,  WEPRIN,  TAYLOR,  LEMONDES  --  read once and referred to the
   Committee on Health -- reported and referred to the Committee on  Ways
   and Means -- recommitted to the Committee on Ways and Means in accord-
   ance  with  Assembly  Rule  3,  sec.  2  -- 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 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

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

                                                            LBD00388-02-2
 A. 293--A                           2
 
 OF  LAW  OR REGULATION, IN ADDITION TO THE BASE YEAR ADJUSTMENT PROVIDED
 FOR IN THIS PARAGRAPH, FOR THE RATE YEAR  COMMENCING  APRIL  FIRST,  TWO
 THOUSAND  TWENTY-TWO,  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-TWO  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-TWO AND FOR EACH RATE YEAR THEREAFTER, THE COMMIS-
 SIONER 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 ESTAB-
 LISHING  THE  BENCHMARK, THE COMMISSIONER SHALL UTILIZE THE RATES ESTAB-
 LISHED 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.