Bill Text: NY S05915 | 2019-2020 | General Assembly | Introduced

Bill Title: Relates to rates of payment for certified home health agencies.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2019-05-16 - REFERRED TO HEALTH [S05915 Detail]

Download: New_York-2019-S05915-Introduced.html

                STATE OF NEW YORK


                               2019-2020 Regular Sessions

                    IN SENATE

                                      May 16, 2019

        Introduced  by  Sen.  RIVERA -- 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:

     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.
    23  Provided, further, that for rate years beginning April first, two  thou-
    24  sand  nineteen and after, the commissioner is authorized to increase the
    25  episodic payment level for costs not reflected in  the  statewide  base,

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        S. 5915                             2

     1  subject to the approval of the state budget director, including the cost
     2  of:  inflationary  increases  in  the  health  care market basket and/or
     3  consumer  price  index  impacting  providers;  new  state  or  federally
     4  mandated  program  regulatory  requirements; home care staff recruitment
     5  and retention needs, particularly in  shortage  areas  and  disciplines;
     6  facilitating  provider  capability  to  further  align with state health
     7  reform models and policy goals; health  care  clinical  and  information
     8  technology  investments  approved by the commissioner; and other matters
     9  the commissioner determines appropriate.
    10    § 2. The public health law is amended by adding a new  section  3614-f
    11  to read as follows:
    12    §  3614-f.  Standards  for home care services payments. 1. Legislative
    13  intent. Adequate reimbursement for home care services  is  essential  to
    14  the  policies set forth in section thirty-six hundred of this article as
    15  well as state policies contingent on access, availability and quality of
    16  these services. The degree of variability across  state  regulated  home
    17  care  rates,  episodic payments, fees for individual home care services,
    18  and negotiated payments, leaves the home care system without a  standard
    19  basis of payment and stable revenue necessary to budget, plan and ensure
    20  sustainability.  To  help  ensure  the  home  care system's viability to
    21  deliver the needed services, the commissioner  shall  establish  minimum
    22  standards  and  a  minimum  benchmark  within  the  Medicaid program for
    23  payment of home  health  agency  services,  including  the  services  of
    24  subcontracting licensed home care services agencies, that can also serve
    25  as  the  benchmark to be considered in rates paid by non-Medicaid third-
    26  party payors.
    27    2. Establishment of standards. Effective for rates issued April first,
    28  two thousand twenty and for each rate year thereafter, the  commissioner
    29  shall  establish minimum standards and a minimum benchmark for home care
    30  service payment by any Medicaid payor. The commissioner shall also  post
    31  such  standards  and  benchmark  in  an  administrative directive to the
    32  attention of all other third-party payors of home care services  in  the
    33  state for considered use in payment of home care services. In establish-
    34  ing  the benchmark, the commissioner shall utilize the rates established
    35  under the episodic payment system under subdivision thirteen of  section
    36  thirty-six hundred fourteen of this article, and the individual services
    37  rates established under such section.
    38    § 3. This act shall take effect immediately.