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A07798 Summary:

BILL NOA07798A
 
SAME ASSAME AS S05915-A
 
SPONSORGottfried
 
COSPNSRMcDonald, Reyes, Perry, Cruz, Dickens, Niou, Benedetto, Simon, Abinanti, Lupardo, Stirpe, Rosenthal L, Colton, Barron, Cymbrowitz, Zebrowski, Seawright, Buttenschon, Simotas, McDonough, Montesano, Raia, Frontus, Crespo, Hevesi, Jacobson, Thiele, Burke, Dinowitz, Mosley, Ortiz, Bronson, Rodriguez, Griffin, Tague, Lentol, Sayegh, Jaffee, Weprin
 
MLTSPNSR
 
Amd 3614, add 3614-f, Pub Health L
 
Relates to rates of payment for certified home health agencies.
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A07798 Actions:

BILL NOA07798A
 
05/23/2019referred to health
01/08/2020referred to health
01/14/2020amend and recommit to health
01/14/2020print number 7798a
01/22/2020reported referred to ways and means
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A07798 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7798A
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to rates of payment for certified home health agencies   PURPOSE OR GENERAL IDEA OF BILL: Provide a 10% increase in the base episodic rates and the individual rates for Medicaid payments to certified home health agencies (CHHA), and establish suggested rate standards for other third-party payers.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends Public Health Law section 3614 to authorize a ten percent increase in the base episodic payment and in the individual rates for other services that are exempt from episodic payments, subject to inflationary increase in the health care market basket and/or consum- er price index, and the approval of the State Budget Director. Section 2 amends Public Health Law section 3614 to establish and make public for the use of other third-party payers, suggested standards and benchmark for payments for CHHA services.   JUSTIFICATION: Certified home health agencies (CHHAs) provide acute and post-acute nursing and home health aide services other than long term care. In the Medicaid program, episodic payments relate to a 60 day plan of care. Other non-episodic service rates are subject to ceiling limitations that were set in 2009. Unlike other Medicaid service providers, CHHAs have not received a payment rate trend adjustment to either rate in over ten years. During this time, unfunded mandates, labor obligations, and oper- ation costs have escalated. Beyond Medicaid, other insurers pay rates that vary widely and unpre- dictably. Hospitals are under pressure to discharge patients sooner and in more acute condition than in the past. The need to for reliable CHHA services has increased without a commensurate reimbursement. The vast majority of New York's CHHAs have incurred ongoing, steep financial losses Benchmarking is a method of equalizing payment rates within the Medicaid service system for purposes of system stability. This bill directs the Commissioner of Health to establish a minimum benchmark for Medicaid payers and to post the benchmarks for other third-party payers' use. This benchmark would ensure that home health agencies are able to oper- ate at sustainable rates in order to provide services to the state's frail and vulnerable populations.   PRIOR LEGISLATIVE HISTORY: New.   FISCAL IMPLICATIONS: To be determined   EFFECTIVE DATE: Immediately.
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A07798 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7798--A
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 23, 2019
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, McDONALD, REYES, PERRY, CRUZ, DICKENS,
          NIOU,  BENEDETTO,  SIMON,  ABINANTI,  LUPARDO,  STIRPE,  L. ROSENTHAL,
          COLTON, BARRON, CYMBROWITZ, ZEBROWSKI, SEAWRIGHT,  BUTTENSCHON,  SIMO-
          TAS,  McDONOUGH, MONTESANO, FRONTUS, CRESPO, HEVESI, JACOBSON, THIELE,
          BURKE, DINOWITZ, MOSLEY, ORTIZ, BRONSON,  RODRIGUEZ,  GRIFFIN,  TAGUE,
          LENTOL  -- read once and referred to the Committee on Health -- recom-
          mitted to the Committee on Health in accordance with Assembly Rule  3,
          sec.  2  --  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:
 
     1    Section 1. Paragraph (b) of subdivision 13  of  section  3614  of  the
     2  public  health law, as added by section 4 of part H of chapter 59 of the
     3  laws of 2011, is amended to read as follows:
     4    (b) Initial base year episodic payments shall  be  based  on  Medicaid
     5  paid  claims,  as determined and adjusted by the commissioner to achieve
     6  savings comparable to the prior state fiscal year, for services provided
     7  by all certified home health agencies in  the  base  year  two  thousand
     8  nine.  Subsequent  base  year episodic payments may be based on Medicaid
     9  paid claims for services provided by all certified home health  agencies
    10  in  a  base  year  subsequent to two thousand nine, as determined by the
    11  commissioner, provided, however, that such base year adjustment shall be
    12  made not less frequently than every three  years.  In  determining  case
    13  mix,  each  patient shall be classified using a system based on measures
    14  which may include, but not limited to, clinical and functional measures,
    15  as reported on  the  federal  Outcome  and  Assessment  Information  Set
    16  (OASIS),  as  may be amended. Notwithstanding any inconsistent provision
    17  of law or regulation, in addition to the base year  adjustment  provided
    18  for  in  this  paragraph,  for the rate year commencing April first, two
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11759-03-0

        A. 7798--A                          2
 
     1  thousand twenty, the  commissioner  shall  provide  for  a  ten  percent
     2  increase  in  the base episodic payment, and in the individual rates for
     3  services exempt from episodic  payments  under  paragraph  (a)  of  this
     4  subdivision,  from  funds  available for the Medical Assistance program.
     5  Provided, further, that for rate years beginning April first, two  thou-
     6  sand  twenty  and  after, the commissioner is authorized to increase the
     7  episodic payment level for costs not reflected in  the  statewide  base,
     8  subject to the approval of the state budget director, including the cost
     9  of:  inflationary  increases  in  the  health  care market basket and/or
    10  consumer  price  index  impacting  providers;  new  state  or  federally
    11  mandated  program  regulatory  requirements; home care staff recruitment
    12  and retention needs, particularly in  shortage  areas  and  disciplines;
    13  facilitating  provider  capability  to  further  align with state health
    14  reform models and policy goals; health  care  clinical  and  information
    15  technology  investments  approved by the commissioner; and other matters
    16  the commissioner determines appropriate.
    17    § 2. The public health law is amended by adding a new  section  3614-f
    18  to read as follows:
    19    §  3614-f.  Standards  for home care services payments. 1. Legislative
    20  intent. Adequate reimbursement for home care services  is  essential  to
    21  the  policies set forth in section thirty-six hundred of this article as
    22  well as state policies contingent on access, availability and quality of
    23  these services. The degree of variability across  state  regulated  home
    24  care  rates,  episodic payments, fees for individual home care services,
    25  and negotiated payments, leaves the home care system without a  standard
    26  basis of payment and stable revenue necessary to budget, plan and ensure
    27  sustainability.  To  help  ensure  the  home  care system's viability to
    28  deliver the needed services, the commissioner  shall  establish  minimum
    29  standards  and  a  minimum  benchmark  within  the  Medicaid program for
    30  payment of home  health  agency  services,  including  the  services  of
    31  subcontracting licensed home care services agencies, that can also serve
    32  as  the  benchmark to be considered in rates paid by non-Medicaid third-
    33  party payors.
    34    2. Establishment of standards. Effective for rates issued April first,
    35  two thousand twenty and for each rate year thereafter, the  commissioner
    36  shall  establish minimum standards and a minimum benchmark for home care
    37  service payment by any Medicaid payor. The commissioner shall also  post
    38  such  standards  and  benchmark  in  an  administrative directive to the
    39  attention of all other third-party payors of home care services  in  the
    40  state for considered use in payment of home care services. In establish-
    41  ing  the benchmark, the commissioner shall utilize the rates established
    42  under the episodic payment system under subdivision thirteen of  section
    43  thirty-six hundred fourteen of this article, and the individual services
    44  rates established under such section.
    45    § 3. This act shall take effect immediately.
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