Assembly Bill A7013C

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7013
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 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 and a new paragraph (d) is added 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 TO THE CONTRARY, THE COMMISSIONER IS AUTHORIZED  TO
 INCREASE,  AS  NECESSARY,  THE  EPISODIC  PAYMENT  LEVEL  FOR  COSTS NOT
 REFLECTED IN THE STATEWIDE BASE, SUBJECT TO THE APPROVAL OF THE DIRECTOR
 OF THE STATE DIVISION OF BUDGET, 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, PARTIC-
 ULARLY IN SHORTAGE AREAS AND DISCIPLINES; FACILITATING PROVIDER CAPABIL-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10053-01-5
              

 A. 7013                             2
 
 ITY TO FURTHER ALIGN WITH STATE HEALTH REFORM MODELS AND  POLICY  GOALS;
 HEALTH  CARE  CLINICAL  AND  INFORMATION TECHNOLOGY INVESTMENTS; AND ANY
 OTHER MATTERS THE COMMISSIONER DETERMINES APPROPRIATE.
   (D)  NOTWITHSTANDING  ANY  INCONSISTENT  LAW OR REGULATION, BY OCTOBER
 FIRST, TWO THOUSAND TWENTY-FIVE AND ANNUALLY   THEREAFTER,  THE  COMMIS-
 SIONER SHALL MAKE THE SYSTEM OF EPISODIC PAYMENTS, INCLUDING ALL PRICING
 MECHANISMS,  AVAILABLE  TO  ALL  MEDICAID  MANAGED  CARE PLANS INCLUDING
 MANAGED LONG TERM CARE PLANS LICENSED TO OPERATE IN NEW YORK STATE,  ALL
 CHILD  HEALTH  INSURANCE PLANS LICENSED TO OPERATE UNDER SECTION TWENTY-
 FIVE HUNDRED ELEVEN OF THIS CHAPTER, AND ALL ESSENTIAL PLANS  AUTHORIZED
 BY  SECTION  THREE  HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW. BY
 OCTOBER FIRST, TWO THOUSAND TWENTY-FIVE  AND  ANNUALLY  THEREAFTER,  THE
 COMMISSIONER SHALL NOTIFY ALL SUCH MANAGED CARE PLANS OF THEIR RESPONSI-
 BILITIES  FOR ENSURING THAT THEIR ENROLLED MEMBERS HAVE ACCESS TO CERTI-
 FIED HOME HEALTH AGENCY SERVICES; THAT SUCH  SERVICES  ARE  CRITICAL  TO
 IMPROVING  PATIENT  CARE  AND REDUCING OVERALL COSTS, PARTICULARLY COSTS
 RELATED TO  AVOIDABLE  HOSPITAL  USE;  AND  THAT  EPISODIC  PAYMENTS  AS
 DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION ARE CONSIDERED THE STAND-
 ARD  METHOD  OF  CERTIFIED  HOME HEALTH AGENCY PAYMENT BY NEW YORK STATE
 GOVERNMENT AGENCIES. NOTHING IN THIS PARAGRAPH SHALL PRECLUDE A  MANAGED
 CARE  PLAN AND CERTIFIED HOME HEALTH AGENCY FROM AGREEING UPON AN ALTER-
 NATIVE RATE METHODOLOGY AND PAYMENT RATE, INCLUDING VALUE-BASED PAYMENTS
 RELATED TO HEALTH OUTCOME MEASUREMENTS.
   § 2. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7013--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- 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 and a new paragraph (d) is  added  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 TO THE CONTRARY, THE COMMISSIONER IS AUTHORIZED TO
 INCREASE, AS  NECESSARY,  THE  EPISODIC  PAYMENT  LEVEL  FOR  COSTS  NOT
 REFLECTED IN THE STATEWIDE BASE, SUBJECT TO THE APPROVAL OF THE DIRECTOR
 OF  THE  STATE  DIVISION OF BUDGET, 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,  PARTIC-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10053-02-5
              

 A. 7013--A                          2
 
 ULARLY IN SHORTAGE AREAS AND DISCIPLINES; FACILITATING PROVIDER CAPABIL-
 ITY  TO  FURTHER ALIGN WITH STATE HEALTH REFORM MODELS AND POLICY GOALS;
 HEALTH CARE CLINICAL AND INFORMATION  TECHNOLOGY  INVESTMENTS;  AND  ANY
 OTHER MATTERS THE COMMISSIONER DETERMINES APPROPRIATE.
   (D)  NOTWITHSTANDING  ANY  INCONSISTENT  LAW OR REGULATION, BY OCTOBER
 FIRST, TWO THOUSAND TWENTY-FIVE AND ANNUALLY   THEREAFTER,  THE  COMMIS-
 SIONER SHALL MAKE THE SYSTEM OF EPISODIC PAYMENTS, INCLUDING ALL PRICING
 MECHANISMS,  AVAILABLE  TO  ALL  MEDICAID MANAGED CARE PLANS LICENSED TO
 OPERATE IN NEW YORK STATE, ALL CHILD HEALTH INSURANCE PLANS LICENSED  TO
 OPERATE  UNDER  SECTION  TWENTY-FIVE HUNDRED ELEVEN OF THIS CHAPTER, AND
 ALL ESSENTIAL PLANS AUTHORIZED BY SECTION THREE HUNDRED SIXTY-NINE-GG OF
 THE SOCIAL SERVICES LAW. BY OCTOBER FIRST, TWO THOUSAND TWENTY-FIVE  AND
 ANNUALLY THEREAFTER, THE COMMISSIONER SHALL NOTIFY ALL SUCH MANAGED CARE
 PLANS OF THEIR RESPONSIBILITIES FOR ENSURING THAT THEIR ENROLLED MEMBERS
 HAVE ACCESS TO CERTIFIED HOME HEALTH AGENCY SERVICES; THAT SUCH SERVICES
 ARE  CRITICAL  TO  IMPROVING  PATIENT  CARE  AND REDUCING OVERALL COSTS,
 PARTICULARLY COSTS RELATED TO AVOIDABLE HOSPITAL USE; AND THAT  EPISODIC
 PAYMENTS  AS  DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION ARE CONSID-
 ERED THE STANDARD METHOD OF CERTIFIED HOME HEALTH AGENCY PAYMENT BY  NEW
 YORK STATE GOVERNMENT AGENCIES. NOTHING IN THIS PARAGRAPH SHALL PRECLUDE
 A  MANAGED CARE PLAN AND CERTIFIED HOME HEALTH AGENCY FROM AGREEING UPON
 AN ALTERNATIVE RATE METHODOLOGY AND PAYMENT RATE, INCLUDING  VALUE-BASED
 PAYMENTS RELATED TO HEALTH OUTCOME MEASUREMENTS.
   § 2. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7013--B
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced   by  M.  of  A.  PAULIN,  WEPRIN,  REYES,  LUNSFORD,  TAPIA,
   SEAWRIGHT, GONZALEZ-ROJAS, McDONALD -- read once and referred  to  the
   Committee  on  Health  --  committee discharged, bill amended, ordered
   reprinted as amended  and  recommitted  to  said  committee  --  again
   reported  from  said  committee  with amendments, 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. Subdivision 13 of section 3614 of the public health law  is
 amended by adding a new paragraph (d) to read as follows:
   (D)  NOTWITHSTANDING  ANY  INCONSISTENT  LAW OR REGULATION, BY OCTOBER
 FIRST, TWO THOUSAND TWENTY-FIVE AND ANNUALLY   THEREAFTER,  THE  COMMIS-
 SIONER SHALL MAKE THE SYSTEM OF EPISODIC PAYMENTS, INCLUDING ALL PRICING
 MECHANISMS,  AVAILABLE  TO  ALL  MEDICAID MANAGED CARE PLANS LICENSED TO
 OPERATE IN NEW YORK STATE, ALL CHILD HEALTH INSURANCE PLANS LICENSED  TO
 OPERATE  UNDER  SECTION  TWENTY-FIVE HUNDRED ELEVEN OF THIS CHAPTER, AND
 ALL ESSENTIAL PLANS AUTHORIZED BY SECTION THREE HUNDRED SIXTY-NINE-GG OF
 THE SOCIAL SERVICES LAW. BY OCTOBER FIRST, TWO THOUSAND TWENTY-FIVE  AND
 ANNUALLY THEREAFTER, THE COMMISSIONER SHALL NOTIFY ALL SUCH MANAGED CARE
 PLANS OF THEIR RESPONSIBILITIES FOR ENSURING THAT THEIR ENROLLED MEMBERS
 HAVE ACCESS TO CERTIFIED HOME HEALTH AGENCY SERVICES; THAT SUCH SERVICES
 ARE  CRITICAL  TO  IMPROVING  PATIENT  CARE  AND REDUCING OVERALL COSTS,
 PARTICULARLY COSTS RELATED TO AVOIDABLE HOSPITAL USE; AND THAT  EPISODIC
 PAYMENTS  AS  DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION ARE CONSID-
 ERED THE STANDARD METHOD OF CERTIFIED HOME HEALTH AGENCY PAYMENT BY  NEW
 YORK STATE GOVERNMENT AGENCIES. NOTHING IN THIS PARAGRAPH SHALL PRECLUDE
 A  MANAGED CARE PLAN AND CERTIFIED HOME HEALTH AGENCY FROM AGREEING UPON
 AN ALTERNATIVE RATE METHODOLOGY AND PAYMENT RATE, INCLUDING  VALUE-BASED
 PAYMENTS RELATED TO HEALTH OUTCOME MEASUREMENTS.
   § 2. This act shall take effect immediately.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10053-04-5