S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1331
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2023
                                ___________
 
 Introduced  by M. of A. BUTTENSCHON, CRUZ, DARLING, JACKSON, WILLIAMS --
   read once and referred to the Committee on Health
 
 AN ACT to amend the public health law, the insurance law and the  public
   authorities law, in relation to payments to home care services provid-
   ers  and authorizing the commissioner of health to establish a program
   to provide loans, through the dormitory authority,  to  home  care  to
   finance health care reform efforts
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 4406-c of the  public  health  law  is  amended  by
 adding a new subdivision 13 to read as follows:
   13.  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, CONTRACTS WITH
 CERTIFIED HOME HEALTH AGENCIES, LONG TERM  HOME  HEALTH  CARE  PROGRAMS,
 LICENSED  HOME CARE SERVICES PROGRAMS OR FISCAL INTERMEDIARIES OPERATING
 PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL  SERVICES
 LAW  TO PROVIDE HOME CARE AIDE SERVICES AS DEFINED IN SECTION THIRTY-SIX
 HUNDRED FOURTEEN-C  OF  THIS  CHAPTER,  OR  CONSUMER  DIRECTED  PERSONAL
 ASSISTANCE  SERVICES  AS  AUTHORIZED  PURSUANT  TO SECTION THREE HUNDRED
 SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW SHALL AT A MINIMUM  ENSURE  THAT
 THE  RESOURCES  MADE  AVAILABLE  BY SUCH CONTRACTS SHALL SUPPORT COMPEN-
 SATION FOR PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES  AND  CONSUMER
 DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUAL-
 IFIED  WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS OF
 SUCH SERVICES CONSISTENT WITH THE PROVISIONS OF SUCH SECTION.
   § 2. Subsection (a) of section 3224-a of the insurance law, as amended
 by chapter 237 of the laws of 2009, is amended to read as follows:
   (a) Except in a case where the obligation of an insurer or  an  organ-
 ization  or corporation licensed or certified pursuant to article forty-
 three or forty-seven of this chapter or article forty-four of the public
 health law to pay a claim submitted by a policyholder or person  covered
 under  such policy ("covered person") or make a payment to a health care
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04856-01-3
              

 A. 1331                             2
 
 provider is not reasonably clear, or when there is  a  reasonable  basis
 supported  by  specific  information  available for review by the super-
 intendent that such claim or bill for health care services rendered  was
 submitted  fraudulently,  such  insurer  or  organization or corporation
 shall pay the claim to a  policyholder  or  covered  person  or  make  a
 payment  to  a  health  care provider within thirty days of receipt of a
 claim or bill for services rendered that is transmitted via the internet
 or electronic mail, or forty-five days of receipt of a claim or bill for
 services rendered that is submitted by other means,  such  as  paper  or
 facsimile.  PROVIDED,  HOWEVER,  ANY PAYMENT FOR SERVICES TO HEALTH CARE
 PROVIDERS LICENSED UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW  OR
 FISCAL  INTERMEDIARIES  OPERATING  PURSUANT  TO  SECTION  THREE  HUNDRED
 SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW SHALL  BE  PAID  WITHIN  FIFTEEN
 DAYS  OF  THE  RECEIPT OF A CLAIM OR A BILL FOR SERVICES RENDERED DURING
 THE TRANSITION PERIOD FROM FEE FOR SERVICE TO MEDICAID MANAGED LONG TERM
 CARE CONSISTENT WITH THE  STATE  MEDICAID  PLAN  FOR  SUCH  HEALTH  CARE
 PROVIDERS AND FOR THE TWELVE MONTH PERIOD BEYOND THE FINAL TRANSITION OF
 MEDICAID  BENEFICIARIES  IN  THAT  COUNTY. IN ADDITION, PAYMENTS FOR ANY
 DISPUTED CLAIM OR BILL FOR SERVICES SHALL BE PAID TO  SUCH  HEALTH  CARE
 PROVIDERS  BY  AN  INSURER OR AN ORGANIZATION OR CORPORATION LICENSED OR
 CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER
 OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW WITHIN TWENTY DAYS OF THE
 RECEIPT OF A CLAIM OR A BILL FOR SERVICES; PROVIDED THAT AT  THE  OPTION
 OF  SUCH  INSURER  OR  ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED
 PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW, SUCH CLAIM OR BILL FOR SERVICES
 SHALL  SUBSEQUENTLY BE SUBJECT TO ARBITRATION PURSUANT TO ARTICLE SEVEN-
 TY-FIVE OF THE CIVIL PRACTICE LAW AND RULES.
   § 3. Section 2801-a of the public health law is amended  by  adding  a
 new subdivision 17 to read as follows:
   17.  (A)  THE  COMMISSIONER  IS  AUTHORIZED  TO ESTABLISH A PROGRAM TO
 ASSIST IN RESTRUCTURING LONG TERM HOME HEALTH CARE DELIVERY  SYSTEMS  BY
 PROVIDING  CREDIT ENHANCEMENT TO HEALTH CARE PROVIDERS LICENSED PURSUANT
 TO ARTICLE THIRTY-SIX OF THIS CHAPTER THAT  LACK  THE  CREDIT  RESOURCES
 NECESSARY  TO  TRANSITION FROM FEE FOR SERVICE TO MANAGED LONG TERM CARE
 CONSISTENT WITH THE GOALS OF THE  STATE'S  MEDICAID  PROGRAM  MULTI-YEAR
 ACTION AS ADOPTED BY THE MEDICAID REDESIGN TEAM. THE PROGRAM SHALL APPLY
 TO  HEALTH CARE PROVIDERS WHO CAN DEMONSTRATE FINANCIAL NEED AND ADVANCE
 THE STATE'S HEALTH REFORM AGENDA OF BETTER CARE, BETTER HEALTH FOR POPU-
 LATIONS, LOWER COSTS, AND  TRANSITIONING  THE  STATE'S  LONG  TERM  CARE
 SYSTEM.
   (B)  APPLICANTS MUST COMMIT THAT THE USES OF THE CREDIT-ENHANCED LOANS
 WILL PROMOTE AGREED UPON GOALS  OF  TRANSITIONING  THE  LONG  TERM  HOME
 HEALTH  CARE  DELIVERY  SYSTEMS. APPLICANTS SHALL SUBMIT A COMPREHENSIVE
 PROGRAM AND BUSINESS PLAN, AND SUCH PLAN MUST PROMOTE AGREED  OBJECTIVES
 OF  TRANSITION.  LOAN  DOCUMENTS  SHALL CONTAIN HEALTH REFORM COVENANTS,
 MILESTONE DATES AND STATISTICAL TARGETS TO BE ATTAINED BY THE  BORROWER.
 THE  APPLICATION  MUST  ADDRESS  HOW  THE  APPLICANT  WILL UNDERTAKE THE
 IMPROVEMENTS IN FORMAL OR INFORMAL COOPERATION WITH  OTHER  HEALTH  CARE
 PROVIDERS  IN  THE  REGION.  TO  THE  EXTENT  REQUIRED  TO PROVIDE LEGAL
 PROTECTION FOR SUCH COOPERATIVE ENDEAVORS, THE COMMISSIONER SHALL  EXER-
 CISE  ALL  NECESSARY  POWERS  PURSUANT  TO ARTICLE TWENTY-NINE-F OF THIS
 CHAPTER AND ANY FEES ASSOCIATED WITH SUCH OVERSIGHT MAY BE  INCLUDED  IN
 THE PROJECT FINANCING COSTS.
   (C) THE CREDIT ENHANCEMENT PROGRAM SHALL BE ADMINISTERED BY THE DORMI-
 TORY AUTHORITY, OR A NOT-FOR-PROFIT CORPORATION DESIGNATED BY THE DORMI-
 A. 1331                             3
 
 TORY  AUTHORITY.    THE  COMMISSIONER SHALL CHAIR THE CREDIT ENHANCEMENT
 APPLICATION AND APPROVAL COMMITTEE.  THE  COMMISSIONER  SHALL  DESIGNATE
 THREE  OR  MORE  MEMBERS  OF  THE  MEDICAID  REDESIGN TEAM AS ADDITIONAL
 MEMBERS  OF  THE  CREDIT ENHANCEMENT APPLICATION AND APPROVAL COMMITTEE.
 THE CHAIR OF THE DORMITORY AUTHORITY SHALL ALSO SERVE AS A MEMBER OF THE
 COMMITTEE, AND SHALL DETERMINE ALL RULES  FOR  REVIEWING  AND  APPROVING
 APPLICATIONS,  AND ADMINISTERING APPROVED CREDIT ENHANCEMENTS.  NOTWITH-
 STANDING ANY OTHER LAW, NO PERSON SERVING AS  A  MEMBER  OF  THE  CREDIT
 ENHANCEMENT  APPLICATION  AND APPROVAL COMMITTEE SHALL HAVE ANY PERSONAL
 LIABILITY, OR INCUR LIABILITY FOR THEIR EMPLOYER,  BY  VIRTUE  OF  THEIR
 ROLE OR VOTE IN THE CREDIT ENHANCEMENT APPLICATION AND APPROVAL PROCESS.
   (D) A DEBT SERVICE RESERVE FUND MAY BE CREATED TO FACILITATE THE CRED-
 IT ENHANCEMENT.
   (E)(I) IN THE EVENT OF A DEFAULT BY A BORROWER TO A LENDER, THE AMOUNT
 OF  THE DEFAULTED PAYMENT SHALL BE PAID BY THE COMMISSIONER TO THE LEND-
 ER.  TO  FINANCE  THE  COMMISSIONER'S  REMITTANCE  OF  THOSE   DEFAULTED
 PAYMENTS,  THE  COMMISSIONER  SHALL  FIRST DRAW UPON FUNDS ALLOCATED FOR
 SUCH POTENTIAL DEFAULTS, INCLUDING BUT NOT LIMITED TO FUNDS MADE  AVAIL-
 ABLE FOR THAT PURPOSE PURSUANT TO THE STATE'S AUGUST SIXTH, TWO THOUSAND
 TWELVE  SECTION  1115 PARTNERSHIP PLAN WAIVER APPLICATION AND ADDITIONAL
 FEDERAL FUNDS MADE  AVAILABLE  THROUGH  IMPLEMENTATION  OF  THE  FEDERAL
 AFFORDABLE CARE ACT (HEALTH REFORM).
   (II)  ALL  PAYMENTS OF DEFAULTED AMOUNTS SHALL BE MADE SOLELY FROM THE
 ALLOCATED FUNDS AND AS SUCH AMOUNTS  ARE  ACTUALLY  COLLECTED  AND  MADE
 AVAILABLE  TO  THE  COMMISSIONER  FOR  REMITTANCE TO LENDERS PURSUANT TO
 SUBPARAGRAPH (I) OF THIS PARAGRAPH. NEITHER THE STATE, THE COMMISSIONER,
 THE DEPARTMENT, THE DORMITORY AUTHORITY, NOR ANY  OTHER  INSTRUMENTALITY
 OF  THE STATE, SHALL BE LEGALLY RESPONSIBLE FOR PAYMENT OF THE DEFAULTED
 AMOUNTS, OTHER THAN PURSUANT TO  THE  PROCESS  AND  FINANCIAL  RESOURCES
 DESCRIBED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH.  NO ASSETS OR RESOURCES
 OF  THE STATE SHALL BE PLEDGED, OR CONSIDERED TO BE PLEDGED OR OBLIGATED
 IN ANY FORM, TO PAYMENT OF THE DEFAULTS,  OTHER  THAN  PURSUANT  TO  THE
 PROCESS  AND  FINANCIAL  RESOURCES DESCRIBED IN SUBPARAGRAPH (I) OF THIS
 PARAGRAPH, AS ACTUALLY COLLECTED AND MADE AVAILABLE TO THE  COMMISSIONER
 FOR  THE  PURPOSES  OF PAYING DEFAULTED AMOUNTS PURSUANT TO SUBPARAGRAPH
 (I) OF THIS PARAGRAPH.
   § 4. Paragraph (b) of subdivision 2 of  section  1676  of  the  public
 authorities  law  is  amended  by adding a new undesignated paragraph to
 read as follows:
   SUCH HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX  OF
 THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
 PURSUANT  TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A
 OF THE PUBLIC HEALTH LAW.
   § 5. Subdivision 1 of section 1680 of the public  authorities  law  is
 amended by adding a new undesignated paragraph to read as follows:
   SUCH  HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX OF
 THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
 PURSUANT TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED  ONE-A
 OF THE PUBLIC HEALTH LAW.
   § 6. This act shall take effect immediately.