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S05915 Summary:

Amd 3614, add 3614-f, Pub Health L
Relates to rates of payment for certified home health agencies.
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S05915 Actions:

01/14/2020PRINT NUMBER 5915A
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S05915 Text:

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                    IN SENATE
                                      May 16, 2019
        Introduced  by  Sens. RIVERA, HOYLMAN, SEPULVEDA, STAVISKY -- read twice
          and ordered printed, and when printed to be committed to the Committee
          on Health -- recommitted to the Committee on Health in accordance with
          Senate Rule 6, sec. 8 -- 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
    19  thousand  twenty,  the  commissioner  shall  provide  for  a ten percent
    20  increase in the base episodic payment, and in the individual  rates  for
    21  services  exempt  from  episodic  payments  under  paragraph (a) of this
    22  subdivision, from funds available for the  Medical  Assistance  program.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        S. 5915--A                          2
     1  Provided,  further, that for rate years beginning April first, two thou-
     2  sand twenty and after, the commissioner is authorized  to  increase  the
     3  episodic  payment  level  for costs not reflected in the statewide base,
     4  subject to the approval of the state budget director, including the cost
     5  of:  inflationary  increases  in  the  health  care market basket and/or
     6  consumer  price  index  impacting  providers;  new  state  or  federally
     7  mandated  program  regulatory  requirements; home care staff recruitment
     8  and retention needs, particularly in  shortage  areas  and  disciplines;
     9  facilitating  provider  capability  to  further  align with state health
    10  reform models and policy goals; health  care  clinical  and  information
    11  technology  investments  approved by the commissioner; and other matters
    12  the commissioner determines appropriate.
    13    § 2. The public health law is amended by adding a new  section  3614-f
    14  to read as follows:
    15    §  3614-f.  Standards  for home care services payments. 1. Legislative
    16  intent. Adequate reimbursement for home care services  is  essential  to
    17  the  policies set forth in section thirty-six hundred of this article as
    18  well as state policies contingent on access, availability and quality of
    19  these services. The degree of variability across  state  regulated  home
    20  care  rates,  episodic payments, fees for individual home care services,
    21  and negotiated payments, leaves the home care system without a  standard
    22  basis of payment and stable revenue necessary to budget, plan and ensure
    23  sustainability.  To  help  ensure  the  home  care system's viability to
    24  deliver the needed services, the commissioner  shall  establish  minimum
    25  standards  and  a  minimum  benchmark  within  the  Medicaid program for
    26  payment of home  health  agency  services,  including  the  services  of
    27  subcontracting licensed home care services agencies, that can also serve
    28  as  the  benchmark to be considered in rates paid by non-Medicaid third-
    29  party payors.
    30    2. Establishment of standards. Effective for rates issued April first,
    31  two thousand twenty and for each rate year thereafter, the  commissioner
    32  shall  establish minimum standards and a minimum benchmark for home care
    33  service payment by any Medicaid payor. The commissioner shall also  post
    34  such  standards  and  benchmark  in  an  administrative directive to the
    35  attention of all other third-party payors of home care services  in  the
    36  state for considered use in payment of home care services. In establish-
    37  ing  the benchmark, the commissioner shall utilize the rates established
    38  under the episodic payment system under subdivision thirteen of  section
    39  thirty-six hundred fourteen of this article, and the individual services
    40  rates established under such section.
    41    § 3. This act shall take effect immediately.
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