Bill Text: NY S05853 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to long term home health care program enhancement; expands availability thereto; provides for prospective payment methodology.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2012-06-12 - PRINT NUMBER 5853A [S05853 Detail]
Download: New_York-2011-S05853-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5853
2011-2012 Regular Sessions
I N S E N A T E
June 23, 2011
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the public health law and the social services law, in
relation to long term home health care program enhancement
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Section 3614 of the public health law is amended by adding
2 a new subdivision 14 to read as follows:
3 14. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
4 LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
5 IPATION AND TO THE PROVISIONS OF PARAGRAPH (G) OF THIS SUBDIVISION,
6 EFFECTIVE APRIL FIRST, TWO THOUSAND TWELVE, PAYMENTS BY GOVERNMENT AGEN-
7 CIES FOR SERVICES PROVIDED BY LONG TERM HOME HEALTH CARE PROGRAMS SHALL
8 BE BASED ON EPISODIC PAYMENTS, EXCEPT FOR SUCH SERVICES PROVIDED TO
9 CHILDREN UNDER EIGHTEEN YEARS OF AGE. IN ESTABLISHING SUCH PAYMENTS, A
10 STATEWIDE BASE PRICE SHALL BE ESTABLISHED, BASED ON THE STATEWIDE AVER-
11 AGE OF MEDICAID CLAIMS PAID IN THE BASE PERIOD, FOR EACH SIXTY DAY
12 EPISODE OF CARE AND ADJUSTED BY A REGIONAL WAGE INDEX FACTOR BASED ON
13 THE DEPARTMENT OF LABOR'S TEN LABOR MARKET REGIONS AND AN INDIVIDUAL
14 PATIENT CASE MIX INDEX. SUCH EPISODIC PAYMENTS MAY BE FURTHER ADJUSTED
15 FOR AND SHALL EXCLUDE LOW UTILIZATION CASES WHICH SHALL BE REIMBURSED ON
16 A FEE FOR SERVICE BASIS AND TO REFLECT A PERCENTAGE LIMITATION OF THE
17 COST FOR HIGH-UTILIZATION CASES THAT EXCEED OUTLIER THRESHOLDS OF SUCH
18 PAYMENTS; PROVIDED HOWEVER THAT THE OUTLIER METHODOLOGY SHALL BE ALIGNED
19 TO PATIENT CASE MIX AND SHALL ALSO INCLUDE A MECHANISM FOR APPEAL OR
20 ADJUSTMENT WHERE COST AND UTILIZATION NOT RECOGNIZED BY THE OUTLIER
21 PAYMENT ARE NECESSARY FOR THE SAFE AND ADEQUATE CARE OF THE PATIENT; AND
22 PROVIDED FURTHER HOWEVER THAT, PRIOR TO FINALIZATION, THE OUTLIER METH-
23 ODOLOGY SHALL BE PROVIDED FOR REVIEW AND CONSIDERATION OF ITS EFFECTS ON
24 PATIENT ACCESS TO CARE AND PROVIDER FISCAL STABILITY BY THE LEGISLATURE,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13221-01-1
S. 5853 2
1 REPRESENTATIVES OF CONSUMERS AND STATEWIDE ASSOCIATIONS REPRESENTATIVE
2 OF LONG TERM HOME HEALTH CARE PROGRAMS.
3 (B) INITIAL BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID
4 PAID CLAIMS FOR SERVICES PROVIDED BY ALL LONG TERM HOME HEALTH CARE
5 PROGRAMS IN THE BASE YEAR TWO THOUSAND TEN, ADJUSTED BY ANNUAL TREND
6 FACTORS USING THE METHODOLOGY DESCRIBED IN PARAGRAPH (C) OF SUBDIVISION
7 TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS CHAPTER. SUBSEQUENT
8 BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID PAID CLAIMS FOR
9 SERVICES PROVIDED BY ALL LONG TERM HOME HEALTH CARE PROGRAMS IN A BASE
10 YEAR SUBSEQUENT TO TWO THOUSAND TEN, AS DETERMINED BY THE COMMISSIONER,
11 PROVIDED, HOWEVER, THAT SUCH BASE YEAR ADJUSTMENT SHALL BE MADE NOT LESS
12 FREQUENTLY THAN EVERY THREE YEARS. IN DETERMINING CASE MIX, EACH PATIENT
13 SHALL BE CLASSIFIED USING A SYSTEM BASED ON MEASURES WHICH MAY INCLUDE,
14 BUT NOT LIMITED TO, CLINICAL AND FUNCTIONAL MEASURES, AS REPORTED ON THE
15 FEDERAL OUTCOME AND ASSESSMENT INFORMATION SET (OASIS), AS MAY BE
16 AMENDED, BUT WHICH SHALL ADEQUATELY CAPTURE THE SERVICE REQUIREMENTS OF
17 POST-ACUTE, REHABILITATIVE, CHRONICALLY ILL AND DISABLED PERSONS IN THE
18 LONG TERM HOME HEALTH CARE PROGRAM.
19 (C) THE COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND SUBMIT DATA
20 REQUIRED TO IMPLEMENT THIS SUBDIVISION. THE COMMISSIONER MAY PROMULGATE
21 REGULATIONS TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
22 (D) THE COMMISSIONER IS AUTHORIZED AND DIRECTED TO FURTHER ADJUST THE
23 STATEWIDE BASE YEAR AMOUNT, AS MAY BE NECESSARY, TO REFLECT ACTUAL OR
24 PROJECTED INCREASES IN THE COST OF DELIVERING SERVICES IN THE RATE YEAR
25 WHICH ARE NOT REFLECTED IN THE BASE YEAR, INCLUDING COSTS ASSOCIATED
26 WITH: (I) PATIENT POPULATIONS OR SERVICES NOT INCLUDED IN THE BASE YEAR
27 EXPENDITURES; (II) NEW GOVERNMENTAL MANDATES AND REGULATIONS; (III)
28 LABOR; (IV) DISEASE OUTBREAK; (V) SEVERE SPIKES IN FUEL AND TRANSPORTA-
29 TION COSTS FOR DIRECT CARE STAFF; OR (VI) SUCH OTHER VARIABLES AS THE
30 COMMISSIONER DETERMINES APPROPRIATE.
31 (E) IN ADDITION, TO ADJUSTMENTS PROVIDED PURSUANT TO PARAGRAPH (D) OF
32 THIS SUBDIVISION, THE COMMISSIONER IS AUTHORIZED TO PROVIDE A MECHANISM
33 FOR AGENCY SPECIFIC ADJUSTMENTS TO THE BASE RATE AS ARE NECESSARY FOR
34 THE DELIVERY OF SERVICES OR THE QUALITY, COST-EFFECTIVENESS OR OPERATION
35 OF THE SYSTEM, INCLUDING ADJUSTMENTS FOR: (I) LABOR COSTS FOR DIRECT
36 CARE STAFF IN THE PARTICULAR MARKET AREA SERVED BY THE AGENCY; (II)
37 CAPITAL COSTS NECESSARY FOR THE AGENCY'S TECHNOLOGY INFRASTRUCTURE,
38 INCLUDING BUT NOT LIMITED TO ELECTRONIC HEALTH RECORDS, POINT OF CARE
39 TECHNOLOGY AND TELEHEALTH CARE; (III) HEALTH SYSTEMS IMPROVEMENT INITI-
40 ATIVES, INCLUDING CARE TRANSITIONS, PROVIDER COLLABORATION FOR IMPROVED
41 PATIENT OUTCOMES AND REDUCED AVOIDABLE HOSPITALIZATIONS, READMISSIONS,
42 EMERGENCY ROOM USE AND OTHER HIGH COST HEALTH CARE SERVICES USE; (IV)
43 ENHANCEMENTS TO THE AGENCY'S CARE MANAGEMENT CAPACITY, INCLUDING THE
44 INTEGRATION OF BEHAVIORAL HEALTH SERVICES, SPECIALTY NURSING CARE,
45 PRIMARY CARE OR OTHER CARE MANAGEMENT ENHANCEMENTS AS MAY BE APPROVED BY
46 THE COMMISSIONER; AND (V) SUCH OTHER PURPOSES AS THE COMMISSIONER MAY
47 DETERMINE TO BE NECESSARY.
48 (F) THE EPISODIC SYSTEM SHALL PROVIDE FOR A REQUEST FOR ANTICIPATED
49 PAYMENT (RAP), CONSISTENT WITH THE RAP PROVISIONS UNDER THE EPISODIC
50 PAYMENT SYSTEM APPLICABLE TO LONG TERM HOME HEALTH CARE PROGRAMS UNDER
51 THE FEDERAL MEDICARE PROGRAM.
52 (G) PRIOR TO STATEWIDE IMPLEMENTATION OF THE EPISODIC SYSTEM, THE
53 COMMISSIONER SHALL CONDUCT A PILOT TEST OF THE SYSTEM BY SELECTED
54 PROVIDERS PARTICIPATING ON A VOLUNTARY BASIS. THE PILOT SHALL ASSESS THE
55 EFFECTS OF THE SYSTEM ON PATIENT CARE AND ACCESS AND ON PROVIDER OPER-
56 ATIONS AND FISCAL STATUS. THE COMMISSIONER, IN CONJUNCTION WITH REPRE-
S. 5853 3
1 SENTATIVES OF PILOT PROVIDERS AND STATEWIDE ASSOCIATIONS REPRESENTATIVE
2 OF HOME CARE, SHALL ASSESS THE RESULTS OF THE PILOT AND REPORT TO THE
3 LEGISLATURE, INCLUDING THE IDENTIFICATION OF ANY ADJUSTMENTS NECESSARY
4 FOR THE OPERATION OF THE EPISODIC SYSTEM FOR STATEWIDE IMPLEMENTATION.
5 UPON THE IMPLEMENTATION OF SUCH ADJUSTMENTS, THE COMMISSIONER SHALL
6 PROCEED TO FURTHER IMPLEMENT THE EPISODIC SYSTEM.
7 (H) THE COMMISSIONER, IN CONSULTATION WITH REPRESENTATIVES OF LONG
8 TERM HOME HEALTH CARE PROGRAMS AND STATEWIDE ASSOCIATIONS REPRESENTATIVE
9 OF LONG TERM HOME HEALTH CARE PROGRAMS, SHALL EVALUATE THE EPISODIC
10 SYSTEM AFTER THE FIRST FULL YEAR OF IMPLEMENTATION, AND, WITHIN NINETY
11 DAYS FOLLOWING THE COMPLETION OF SUCH PERIOD, SHALL REPORT TO THE LEGIS-
12 LATURE, INCLUDING THE IDENTIFICATION OF AND PLAN FOR EXECUTING ADJUST-
13 MENTS AS MAY BE NECESSARY FOR THE OPERATION OF THE EPISODIC SYSTEM.
14 S 2. The opening paragraph of subdivision 8 of section 3602 of the
15 public health law, as amended by chapter 622 of the laws of 1988, is
16 amended to read as follows:
17 "Long term home health care program" means a coordinated plan of care
18 and services provided at home TO PERSONS REQUIRING HOME AND
19 COMMUNITY-BASED SERVICES, INCLUDING to invalid, infirm, or disabled
20 persons who are medically eligible for placement in a hospital or resi-
21 dential health care facility for an extended period of time if such
22 program were unavailable.
23 S 3. Section 367-c of the social services law is amended by adding a
24 new subdivision 6-a to read as follows:
25 6-A. NOTWITHSTANDING THE PROVISIONS OF SUBDIVISIONS ONE THROUGH FIVE
26 OF THIS SECTION, ON AND AFTER APRIL FIRST, TWO THOUSAND TWELVE, AUTHORI-
27 ZATION UNDER THIS TITLE FOR RECIPIENT PARTICIPATION IN A LONG TERM HOME
28 HEALTH CARE PROGRAM SHALL BE IN ACCORDANCE WITH THIS SUBDIVISION.
29 IF A PERSON WHO REQUIRES HOME AND COMMUNITY BASED SERVICES, INCLUDING
30 A PERSON WHO REQUIRES CARE IN A NURSING FACILITY, DESIRES TO REMAIN AT
31 HOME AND IS DEEMED BY HIS OR HER PHYSICIAN ABLE TO RECEIVE CARE AT HOME,
32 SUCH PERSON OR SUCH PERSON'S REPRESENTATIVE SHALL SO INFORM A PROVIDER
33 OF A LONG TERM HOME HEALTH CARE PROGRAM. THE LONG TERM HOME HEALTH CARE
34 PROGRAM PROVIDER SHALL INFORM THE LOCAL SOCIAL SERVICES OFFICIAL OR
35 OTHER PERSON OR ENTITY DESIGNATED BY THE DEPARTMENT AND SHALL CONDUCT A
36 COMPREHENSIVE ASSESSMENT OF THE PATIENT'S NEEDS IN ACCORDANCE WITH
37 SECTION THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW. IF THE
38 RESULTS OF THE ASSESSMENT INDICATE THAT THE PERSON CAN RECEIVE THE
39 APPROPRIATE LEVEL OF CARE AT HOME, A REPRESENTATIVE OF THE LONG TERM
40 HOME HEALTH CARE PROGRAM SHALL PREPARE FOR SUCH PERSON A PLAN OF CARE
41 SUBJECT TO THE APPROVAL OF SUCH PERSON'S PHYSICIAN. IF THE PLAN OF CARE
42 INDICATES THAT THE PERSON CAN BE CARED FOR APPROPRIATELY AT HOME BY THE
43 LONG TERM HOME HEALTH CARE PROGRAM, THE PERSON MAY BE ADMITTED TO THE
44 PROGRAM. THE LONG TERM HOME HEALTH CARE PROGRAM SHALL NOTIFY THE LOCAL
45 SOCIAL SERVICES OFFICIAL OR ALTERNATE ENTITY DESIGNATED BY THE DEPART-
46 MENT OF THE PERSON'S ADMISSION TO THE LONG TERM HOME HEALTH CARE
47 PROGRAM. THE PERSON'S ELIGIBILITY FOR THE LONG TERM HOME HEALTH CARE
48 PROGRAM ALONG WITH THE PLAN OF CARE THAT HAS BEEN PREPARED FOR SUCH
49 PERSON SHALL BE SUBJECT TO AUDIT BY THE LOCAL SOCIAL SERVICES OFFICIAL
50 OR ALTERNATE ENTITY IDENTIFIED BY THE DEPARTMENT. SUCH PERSON SHALL
51 RECEIVE A COMPREHENSIVE REASSESSMENT AT LEAST EVERY ONE HUNDRED EIGHTY
52 DAYS, PURSUANT TO SECTION THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC
53 HEALTH LAW, WHICH SHALL BE THE BASIS FOR DETERMINING THE PERSON'S
54 CONTINUED ELIGIBILITY AND CARE UNDER THE LONG TERM HOME HEALTH CARE
55 PROGRAM.
S. 5853 4
1 S 4. Subdivisions 1 and 2 of section 3616 of the public health law,
2 subdivision 1 as amended by chapter 622 of the laws of 1988 and subdivi-
3 sion 2 as amended by section 33 of part B of chapter 109 of the laws of
4 2010, are amended to read as follows:
5 1. A long term home health care program shall be provided [only] to
6 those patients who REQUIRE HOME AND COMMUNITY BASED SERVICES, INCLUDING
7 PERSONS WHO are medically eligible for placement in a hospital or resi-
8 dential health care facility. An AIDS home care program shall be
9 provided [only] to persons who REQUIRE HOME AND COMMUNITY BASED
10 SERVICES, INCLUDING PERSONS WHO are medically eligible for placement in
11 a hospital or residential health care facility and who (a) are diagnosed
12 by a physician as having acquired immune deficiency syndrome, or (b) are
13 deemed by a physician, within his judgment, to be infected with the
14 etiologic agent of acquired immune deficiency syndrome, and whose
15 illness, infirmity or disability can be reasonably ascertained to be
16 associated with such infection. Provision of certified home health agen-
17 cy services, a long term home health care program or an AIDS home care
18 program paid for by government funds shall be based upon, but not limit-
19 ed to, a comprehensive assessment that shall include, but not be limited
20 to, an evaluation of the medical, social and environmental needs of each
21 applicant for such services or program. This assessment shall also serve
22 as the basis for the development and provision of an appropriate plan of
23 care for the applicant. In cases in which the applicant is a patient in
24 a hospital or residential health care facility, the assessment shall be
25 completed by persons designated by the commissioner, including, but not
26 limited to, the applicant's physician, the discharge coordinator of the
27 hospital or residential health care facility referring the applicant, [a
28 representative of the local department of social services,] and a repre-
29 sentative of the provider of a long term home health care program, AIDS
30 home care program, or the certified home health agency that will provide
31 services for the patient. In cases in which the applicant is not a
32 patient in a hospital or residential health care facility, the assess-
33 ment shall be completed by persons designated by the commissioner
34 including, but not limited to, the applicant's physician[, a represen-
35 tative of the local department of social services] and a representative
36 of the provider of a long term home health care program, AIDS home care
37 program or the certified home health agency that will provide services
38 for the patient. [The assessment shall be completed prior to or within
39 thirty days after the provision of services begins. Payment for services
40 provided prior to the completion of the assessment shall be made only if
41 it is determined, based upon such assessment, that the recipient quali-
42 fies for such services.] The commissioner shall prescribe the forms on
43 which the assessment will be made.
44 2. Continued provision of a long term home health care program, AIDS
45 home care program or certified home health agency services paid for by
46 government funds shall be based upon a comprehensive assessment of the
47 medical, social and environmental needs of the recipient of the
48 services. Such assessment shall be performed at least every one hundred
49 eighty days by the provider of a long term home health care program,
50 AIDS home care program or the certified home health agency providing
51 services for the patient [and the local department of social services],
52 and shall be reviewed by a physician charged with the responsibility by
53 the commissioner. The commissioner shall prescribe the forms on which
54 the assessment will be made.
S. 5853 5
1 S 5. The closing paragraph of subdivision 2 of section 3610 of the
2 public health law, as amended by section 65 of part A of chapter 58 of
3 the laws of 2010, is amended to read as follows:
4 If the application is approved, the applicant shall be so notified in
5 writing. The commissioner's written approval of the application shall
6 constitute authorization to provide a long term home health care
7 program. [In making his or her authorization, the commissioner shall
8 stipulate the maximum number of persons which a provider of a long term
9 home health care program may serve.] If the commissioner proposes to
10 disapprove the application, he or she shall notify the applicant in
11 writing, stating his or her reasons for disapproval, and afford the
12 applicant an opportunity for a public hearing.
13 S 6. Subdivision 5 of section 3610 of the public health law, as
14 amended by chapter 636 of the laws of 1980, is amended to read as
15 follows:
16 5. (a) Notwithstanding the provisions of subdivision four of this
17 section, the commissioner shall suspend, limit or revoke the authori-
18 zation of a provider of a long term home health care program after
19 taking into consideration the public need for the program and the avail-
20 ability of other services which may serve as alternatives or substi-
21 tutes, and after finding that suspending, limiting, or revoking the
22 authorization of such provider would be within the public interest in
23 order to conserve health resources by restricting the level of services
24 to those which are actually needed.
25 (b) [Notwithstanding the provisions of subdivision four of this
26 section, the commissioner may reduce the maximum number of persons which
27 a provider of a long term home health care program is authorized to
28 serve after finding that the number stipulated in such provider's
29 authorization is not being effectively utilized. In addition, the
30 commissioner may increase the number of persons which a provider of a
31 long term home health care program is authorized to serve after finding
32 that the number stipulated in such provider's authorization is insuffi-
33 cient to serve persons eligible to receive long term home health care
34 who reside in the area served by such provider.
35 (c)] Whenever any finding as described in paragraph (a) of this subdi-
36 vision is under consideration with respect to any particular provider of
37 a long term home health care program, the commissioner shall cause to be
38 published, in a newspaper of general circulation in the geographic area
39 of such provider, at least thirty days prior to making such a finding an
40 [annnouncement] ANNOUNCEMENT that such a finding is under consideration
41 and an address to which interested persons can write to make their views
42 known. The commissioner shall take all public comments into consider-
43 ation in making such a finding.
44 [(d)] (C) The commissioner shall, upon making any finding described in
45 paragraph (a) of this subdivision with respect to any provider of a long
46 term home health care program, cause such provider and the appropriate
47 health systems agency to be notified of the finding at least thirty days
48 in advance of taking the proposed action. Upon receipt of any such
49 notification and before the expiration of the thirty days or such longer
50 period as may be specified in the notice, the provider or the appropri-
51 ate health systems agency may request a public hearing to be held in the
52 county in which the provider is located. In no event shall the revoca-
53 tion, suspension or limitation take effect prior to the thirtieth day
54 after the date of the notice, or prior to the effective date specified
55 in the notice or prior to the date of the hearing decision, whichever is
56 later.
S. 5853 6
1 [(e)] (D) Except as otherwise provided by law, all appeals from a
2 finding of the commissioner made pursuant to paragraph (a) of this
3 subdivision shall be directly to the appellate division of the supreme
4 court in the third department. Except as otherwise expressly provided by
5 law, such appeals shall have preference over all issues in all courts.
6 S 7. This act shall take effect immediately; provided that sections
7 two and four of this act shall take effect April 1, 2012.
