Senate Bill S7052

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7052
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                              March 31, 2025
                                ___________
 
 Introduced  by  Sen.  WEBB  --  read twice and ordered printed, and when
   printed to be committed 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.
                                                            LBD10053-03-5
              

 S. 7052                             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 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.