Bill Text: NY A00293 | 2021-2022 | General Assembly | Introduced


Bill Title: Provides increases in the rates of payment for certified home health agencies, directs the commissioner of health to establish minimum standards and a minimum benchmark for home care service payments by any Medicaid payor.

Spectrum: Moderate Partisan Bill (Democrat 29-4)

Status: (Introduced) 2021-01-20 - reported referred to ways and means [A00293 Detail]

Download: New_York-2021-A00293-Introduced.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                           293

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                       (Prefiled)

                                     January 6, 2021
                                       ___________

        Introduced  by  M.  of  A. GOTTFRIED, REYES, PERRY, CRUZ, DICKENS, NIOU,
          BENEDETTO, SIMON, ABINANTI,  LUPARDO,  STIRPE,  L. ROSENTHAL,  COLTON,
          BARRON,  CYMBROWITZ,  ZEBROWSKI,  SEAWRIGHT,  BUTTENSCHON,  McDONOUGH,
          MONTESANO,  FRONTUS,  HEVESI,  JACOBSON,  THIELE,  DINOWITZ,  BRONSON,
          RODRIGUEZ, GRIFFIN, TAGUE, SAYEGH, WEPRIN -- read once and referred 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-one,  the  commissioner shall provide for a ten percent
    20  increase in the base episodic payment, and in the individual  rates  for

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00388-01-1

        A. 293                              2

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