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A03312 Summary:

BILL NOA03312
 
SAME ASNo Same As
 
SPONSORBrindisi
 
COSPNSRAbinanti, Curran, McDonald, Mosley, Raia
 
MLTSPNSRRa
 
Amd 4406-c & 2801-a, Pub Health L; amd 3224-a, Ins L; amd 1676 & 1680, Pub Auth L
 
Requires contracts with home care service providers to provide sufficient resources to ensure compensation to a qualified workforce providing high quality care; authorizes the commissioner of health to establish a program to provide loans, through the dormitory authority, to home care facilities to finance health care reform efforts.
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A03312 Actions:

BILL NOA03312
 
01/27/2017referred to health
01/03/2018referred to health
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A03312 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3312
 
SPONSOR: Brindisi (MS)
  TITLE OF BILL: An act to amend the public health law, the insurance law and the public authorities law, in relation to payments to home care services providers 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   PURPOSE: This bill will address payment challenges for home care during the tran- sition from fee for service to managed care by ensuring managed care contracts support wage parity, providing for prompt payments, authoriz- ing the Department of Health and the Dormitory Authority to establish a program offering credit enhancement to allow access to capital for home care providers that are unable to borrow money from conventional lenders to invest in necessary health reform initiatives.   SUMMARY OF PROVISIONS: Section one adds a new § 4406-c.(9) to the PHL to ensure that funds made available to licensed home care service programs, certified home health agencies, long term home health care programs and consumer directed personal assistance services through contracts with health care plans shall. provide compensation sufficient to support compensation for persons providing such home care aide services and consumer directed personal assistance services to ensure the retention of a qualified workforce. Section two amends § 3224-a of the insurance law to provide for 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 rendered during the transition from fee for service to Medicaid managed long term. This section also requires payment to such providers of disputed claims and provides for access to arbitration pursuant article seventy five of the civil practice law and rules by insurers or organizations or corporations licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law. Section three adds a new subdivision (17) to Public Health Law (PHL)) § 2801-a. This subdivision authorizes the commissioner of Health to create the program and specifies that it applies to health care providers licensed or certified pursuant to article thirty-six of the public health law 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 Medi- caid Redesign team. Applicants to the program must submit a comprehen- sive program and business plan, and such plan must promote agreed objec- tives of transition. The credit enhancement program shall be administered by the Dormitory Authority, or a not-for-profit designated by the Dormitory Authority. This section also authorizes an optional debt service reserve fund to pre-fund potential obligations in the event of a default. In the event of a default by a borrower, funds would be drawn from health reform funding made available to New York by the federal government under the proposed Section 1115 waiver funds, other ACA health reform funds provided to N.Y, or other allocated funds. This paragraph clarifies that under no circumstances are the potential State payments to be considered a general obligation of the State. Sections four and five amend Public Authorities Law 1676(b) (2) and 1680(1), respectively, to health care providers licensed or certified by article thirty-six as are approved for the credit enhancement program pursuant to PHL § 2801-a(17). Section six provides that this act shall take effect immediately.   JUSTIFICATION: This legislation aims to ensure that the home care system in New York, which has been hit with hundreds of millions of dollars in cuts, unfunded wage mandates, the transition to managed long term care, a devastating storm and rate recoupments in 2012 of $250 million, has the necessary system supports to ensure a stable and successful transition from fee for service medicaid to managed long term care. Providers, workers and patients are shifting into a new system of managed long term care with fewer resources while working hard to maintain the high quali- ty of home care which New York State is regarded for across the country. Currently, agencies seeking to pay home care wage parity rates or other wages and benefits as required by law are not guaranteed the proper payment amounts by managed long term care entities. In addition, agen- cies are reporting exploding accounts receivables from lags in the payment of claims under managed care and the frequent rejection of the payment of claims. The transition from fee for service to managed care has created myriad complications with billing and payment for services rendered and the providers of services are often left unpaid because of transition issues. This has led many agencies into financial and cash flow crises impacting workers and more importantly the patients they serve. This legislation will provide for more timely cash flow and payments while disputes are arbitrated by insurers if deemed appropri- ate. This proposal also facilitates access to capital to support reform initiatives as it relates to transitions from fee for service to Medi- caid managed long term care. It includes capital financing to providers have chronic financial challenges and are consequently unsuccessful in accessing capital to undertake reform initiatives. It would allow home care providers to finance capital investments at a lower cost, therefore providing added savings for the New York health care system. Funding under the program would be for the full spectrum of transition needs including operational/business changes to adapt to the new care management system, health information technology, "soft" costs, working capital, and care management infrastructure development. The provisions of this legislation combined attempts to assist patients, workers and providers in keeping the promise to people facing illness or disability - maintaining their independence in the comfort, security and privacy of their homes - by providing system supports during this time of transition and financial uncertainty.   LEGISLATIVE HISTORY: New bill. 2016: 2332   FISCAL IMPLICATIONS: No net fiscal impact. The State obligation to pay any funds is contin- gent upon a borrower's default in repayment to a lender, which may never occur. In the event a default did occur, payments by the State would be made to the lender solely from allocated funds from the 1115 waiver or other federal health reform funds, or other allocated funds.   EFFECTIVE DATE: Immediately
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A03312 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3312
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 27, 2017
                                       ___________
 
        Introduced  by  M.  of  A. BRINDISI, ABINANTI, CURRAN, McDONALD, MOSLEY,
          RAIA -- Multi-Sponsored by -- M. of A. McLAUGHLIN, RA -- 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:
 
     1    Section 1. Section 4406-c of the  public  health  law  is  amended  by
     2  adding a new subdivision 9 to read as follows:
     3    9.  Notwithstanding  any inconsistent provision of law, contracts with
     4  certified home health agencies, long term  home  health  care  programs,
     5  licensed  home care services programs or fiscal intermediaries operating
     6  pursuant to section three hundred sixty-five-f of  the  social  services
     7  law  to provide home care aide services as defined in section thirty-six
     8  hundred fourteen-c  of  this  chapter,  or  consumer  directed  personal
     9  assistance  services  as  authorized  pursuant  to section three hundred
    10  sixty-five-f of the social services law shall at a minimum  ensure  that
    11  the  resources  made  available  by such contracts shall support compen-
    12  sation for persons providing such home care aide services  and  consumer
    13  directed personal assistance services to ensure the retention of a qual-
    14  ified  workforce capable of providing high quality care to recipients of
    15  such services consistent with the provisions of such section.
    16    § 2. Subsection (a) of section 3224-a of the insurance law, as amended
    17  by chapter 237 of the laws of 2009, is amended to read as follows:
    18    (a) Except in a case where the obligation of an insurer or  an  organ-
    19  ization  or corporation licensed or certified pursuant to article forty-
    20  three or forty-seven of this chapter or article forty-four of the public
    21  health law to pay a claim submitted by a policyholder or person  covered
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02064-01-7

        A. 3312                             2
 
     1  under  such policy ("covered person") or make a payment to a health care
     2  provider is not reasonably clear, or when there is  a  reasonable  basis
     3  supported  by  specific  information  available for review by the super-
     4  intendent  that such claim or bill for health care services rendered was
     5  submitted fraudulently, such  insurer  or  organization  or  corporation
     6  shall  pay  the  claim  to  a  policyholder  or covered person or make a
     7  payment to a health care provider within thirty days  of  receipt  of  a
     8  claim or bill for services rendered that is transmitted via the internet
     9  or electronic mail, or forty-five days of receipt of a claim or bill for
    10  services  rendered  that  is  submitted by other means, such as paper or
    11  facsimile. Provided, however, any payment for services  to  health  care
    12  providers  licensed under article thirty-six of the public health law or
    13  fiscal  intermediaries  operating  pursuant  to  section  three  hundred
    14  sixty-five-f  of  the  social  services law shall be paid within fifteen
    15  days of the receipt of a claim or a bill for  services  rendered  during
    16  the transition period from fee for service to Medicaid managed long term
    17  care  consistent  with  the  state  Medicaid  plan  for such health care
    18  providers and for the twelve month period beyond the final transition of
    19  Medicaid beneficiaries in that county. In  addition,  payments  for  any
    20  disputed  claim  or  bill for services shall be paid to such health care
    21  providers by an insurer or an organization or  corporation  licensed  or
    22  certified pursuant to article forty-three or forty-seven of this chapter
    23  or article forty-four of the public health law within twenty days of the
    24  receipt  of  a claim or a bill for services; provided that at the option
    25  of such insurer or organization or  corporation  licensed  or  certified
    26  pursuant  to article forty-three or forty-seven of this chapter or arti-
    27  cle forty-four of the public health law, such claim or bill for services
    28  shall subsequently be subject to arbitration pursuant to article  seven-
    29  ty-five of the civil practice law and rules.
    30    §  3.  Section  2801-a of the public health law is amended by adding a
    31  new subdivision 17 to read as follows:
    32    17. (a) The commissioner is  authorized  to  establish  a  program  to
    33  assist  in  restructuring long term home health care delivery systems by
    34  providing credit enhancement to health care providers licensed  pursuant
    35  to  article  thirty-six  of  this chapter that lack the credit resources
    36  necessary to transition from fee for service to managed long  term  care
    37  consistent  with  the  goals  of the state's Medicaid program multi-year
    38  action as adopted by the Medicaid redesign team. The program shall apply
    39  to health care providers who can demonstrate financial need and  advance
    40  the state's health reform agenda of better care, better health for popu-
    41  lations,  lower  costs,  and  transitioning  the  state's long term care
    42  system.
    43    (b) Applicants must commit that the uses of the credit-enhanced  loans
    44  will  promote  agreed  upon  goals  of  transitioning the long term home
    45  health care delivery systems. Applicants shall  submit  a  comprehensive
    46  program  and business plan, and such plan must promote agreed objectives
    47  of transition. Loan documents shall  contain  health  reform  covenants,
    48  milestone  dates and statistical targets to be attained by the borrower.
    49  The application must  address  how  the  applicant  will  undertake  the
    50  improvements  in  formal  or informal cooperation with other health care
    51  providers in the  region.  To  the  extent  required  to  provide  legal
    52  protection  for such cooperative endeavors, the commissioner shall exer-
    53  cise all necessary powers pursuant  to  article  twenty-nine-F  of  this
    54  chapter  and  any fees associated with such oversight may be included in
    55  the project financing costs.

        A. 3312                             3
 
     1    (c) The credit enhancement program shall be administered by the dormi-
     2  tory authority, or a not-for-profit corporation designated by the dormi-
     3  tory authority.   The commissioner shall chair  the  credit  enhancement
     4  application  and  approval  committee.  The commissioner shall designate
     5  three  or  more  members  of  the  Medicaid  redesign team as additional
     6  members of the credit enhancement application  and  approval  committee.
     7  The chair of the dormitory authority shall also serve as a member of the
     8  committee,  and  shall  determine  all rules for reviewing and approving
     9  applications, and administering approved credit enhancements.   Notwith-
    10  standing  any  other  law,  no  person serving as a member of the credit
    11  enhancement application and approval committee shall have  any  personal
    12  liability,  or  incur  liability  for their employer, by virtue of their
    13  role or vote in the credit enhancement application and approval process.
    14    (d) A debt service reserve fund may be created to facilitate the cred-
    15  it enhancement.
    16    (e)(i) In the event of a default by a borrower to a lender, the amount
    17  of the defaulted payment shall be paid by the commissioner to the  lend-
    18  er.   To  finance  the  commissioner's  remittance  of  those  defaulted
    19  payments, the commissioner shall first draw  upon  funds  allocated  for
    20  such  potential defaults, including but not limited to funds made avail-
    21  able for that purpose pursuant to the state's August sixth, two thousand
    22  twelve section 1115 partnership plan waiver application  and  additional
    23  federal  funds  made  available  through  implementation  of the federal
    24  Affordable Care Act (health reform).
    25    (ii) All payments of defaulted amounts shall be made solely  from  the
    26  allocated  funds  and  as  such  amounts are actually collected and made
    27  available to the commissioner for  remittance  to  lenders  pursuant  to
    28  subparagraph (i) of this paragraph. Neither the state, the commissioner,
    29  the  department,  the dormitory authority, nor any other instrumentality
    30  of the state, shall be legally responsible for payment of the  defaulted
    31  amounts,  other  than  pursuant  to  the process and financial resources
    32  described in subparagraph (i) of this paragraph.  No assets or resources
    33  of the state shall be pledged, or considered to be pledged or  obligated
    34  in  any  form,  to  payment  of the defaults, other than pursuant to the
    35  process and financial resources described in subparagraph  (i)  of  this
    36  paragraph,  as actually collected and made available to the commissioner
    37  for the purposes of paying defaulted amounts  pursuant  to  subparagraph
    38  (i) of this paragraph.
    39    §  4.  Paragraph  (b)  of  subdivision 2 of section 1676 of the public
    40  authorities law is amended by adding a  new  undesignated  paragraph  to
    41  read as follows:
    42    Such  health care providers licensed pursuant to article thirty-six of
    43  the public health law as are approved for the credit enhancement program
    44  pursuant to subdivision seventeen of section twenty-eight hundred  one-a
    45  of the public health law.
    46    §  5.  Subdivision  1 of section 1680 of the public authorities law is
    47  amended by adding a new undesignated paragraph to read as follows:
    48    Such health care providers licensed pursuant to article thirty-six  of
    49  the public health law as are approved for the credit enhancement program
    50  pursuant  to subdivision seventeen of section twenty-eight hundred one-a
    51  of the public health law.
    52    § 6. This act shall take effect immediately.
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