Bill Text: NY A09148 | 2021-2022 | General Assembly | Introduced

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Bill Title: Amends provisions to improve accessibility of home care services, develop and maintain a qualified workforce, develop a comprehensive public education program and approve rates of reimbursement under medicaid for home care services that support the provision of those services.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced - Dead) 2022-05-10 - reported referred to ways and means [A09148 Detail]

Download: New_York-2021-A09148-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          9148

                   IN ASSEMBLY

                                    January 31, 2022
                                       ___________

        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health

        AN ACT to amend the public health law and the social  services  law,  in
          relation to enacting the New York home care first act

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. This act shall be known and may be cited as the  "New  York
     2  home care first act".
     3    § 2. Section 3600 of the public health law, as added by chapter 895 of
     4  the laws of 1977, is amended to read as follows:
     5    §  3600.  Declaration of legislative findings and intent. The legisla-
     6  ture hereby finds and declares that the provision of high  quality  home
     7  care  services  to  residents  of  New York state is a priority concern.
     8  [Expanding] Ensuring the availability of these services  [to  make  them
     9  available]  throughout  the  state as a [viable] core part of the health
    10  care system [and as an] for individuals' needs, including as an alterna-
    11  tive to institutional care should be a  primary  focus  of  the  state's
    12  actions.
    13    Home  health  care  has [only recently] long been recognized [legisla-
    14  tively] as an integral part of the health care delivery system  and  has
    15  proven  to  have  an  important  and  valuable role in patient care. The
    16  certified home health and  licensed  home  care  services  agencies  and
    17  programs  render  a  coordinated  array of services to patients in their
    18  homes[,] and communities. These home care services agencies partner with
    19  health care professionals, hospitals, health plans, county public health
    20  departments and mental health providers in  the  provision  of  primary,
    21  preventive,  public  health,  pre-acute,  post-acute and long-term care,
    22  thereby avoiding prolonged institutionalization, concomitant high  costs
    23  and associated adverse social and medical implications.
    24    The  legislature  intends  that  there  be  a public commitment to the
    25  appropriate provision and [expansion] accessibility of services rendered
    26  to the residents of the state by [certified] home [health] care services
    27  agencies, [to] including financial and  programmatic  support  for:  the
    28  maintenance  of  a  consistently high level of services by all home care
    29  services  agencies[,  to]  and  workforce;  the  recruitment,  training,
    30  compensation  and  retention  of  a capable and committed workforce; the
    31  integration of home care provider roles in the state's strategic  prima-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14002-01-1
        A. 9148                             2

     1  ry,  preventive,  public  health  and  health care delivery planning and
     2  programming; the central collection and public accessibility of informa-
     3  tion concerning all  organized  home  care  services[,];  and  [to]  the
     4  adequate regulation and coordination of existing home care services.
     5    §  3. The public health law is amended by adding a new section 3603 to
     6  read as follows:
     7    § 3603. Home care policy; implementation.  1. The  commissioner  shall
     8  make  regulations, issue guidance and take actions reasonably necessary,
     9  including coordinating with other state agencies, to promote the  policy
    10  under this article including, but not be limited to:
    11    (a)  information  and referral guidance to be made available to hospi-
    12  tals and nursing home discharge  planners,  health  care  professionals,
    13  ambulatory  surgical  centers,  mental  health  providers, county public
    14  health departments and other applicable health care settings, to  assist
    15  in  the consideration and referral of patients for home care services as
    16  a primary or adjunctive service option.  The  information  and  guidance
    17  shall also be made available for the purpose of assisting providers' and
    18  practitioners'  responsibilities  under  subdivision  eleven  of section
    19  three hundred  sixty-five-a  (relating  to  eligibility  for  home  care
    20  services) of the social services law;
    21    (b)  the development of a comprehensive public education program about
    22  home care services, including  but  not  limited  to:  (i)  a  dedicated
    23  portion  of  the  department's  website that describes and distinguishes
    24  home care provider types offered or authorized by any state agency; (ii)
    25  the types of services typically available by provider and  program  type
    26  including home and community based waiver programs and consumer directed
    27  personal  assistance  programs;  (iii)  home  care  third party benefits
    28  provided under the insurance law for individual, small group  and  large
    29  group    non-public  coverages, Medicaid, Medicare, and other state-sup-
    30  ported public programs; (iv) the contact information by which  consumers
    31  may  access  home  care  services; and (v) the name and location of home
    32  care service agencies throughout the state;
    33    (c) the integration of home care provider roles in the state's strate-
    34  gic primary, preventive, public health and health care delivery planning
    35  and programming; and
    36    (d) the  inclusion  of  home  care  service  providers  in  department
    37  programs  that  provide  support  and  funding  for health care capital,
    38  infrastructure, including electronic medical records  and  interoperabi-
    39  lity,  as well as direct point of service clinical technology, and work-
    40  force development.
    41    2. In implementing this section, the commissioner shall seek the input
    42  of representatives of home care providers, hospitals and nursing  homes,
    43  health  care  professionals,  health  plans  and insurers, consumers and
    44  their family members and caregivers, and home  care  workers  (including
    45  labor organizations).
    46    §  4.  Section 365-a of the social services law is amended by adding a
    47  new subdivision 11 to read as follows:
    48    11. Home care services. If an individual eligible for  services  under
    49  this  title  is  determined under this article, by a health care profes-
    50  sional, to be medically eligible for admission to a general hospital for
    51  services other than acute or emergency services, or to a  nursing  home,
    52  or  the  individual  is being cared for in a general hospital or nursing
    53  home and desires to receive care at home, and home care  services  would
    54  be  reasonably  appropriate  for the individual, the individual shall be
    55  informed orally and in writing of the availability of home care services
    56  available in  the  person's  county  of  residence.  If  the  individual
        A. 9148                             3

     1  consents,  an  appropriate health care professional may refer the person
     2  for a comprehensive assessment for home care services under this  title.
     3  Where  the  individual lacks capacity to make health care decisions, the
     4  notice shall be made to, and consent may be made by, a person authorized
     5  to make health care decisions for the individual.
     6    §  5.  Subdivision  3 and paragraphs (a) and (b) of subdivision 3-c of
     7  section 3614 of the public health law, subdivision 3 as amended by chap-
     8  ter 622 of the laws of 1988, paragraphs (a) and (b) of  subdivision  3-c
     9  as  added  by  section 63-b of part C of chapter 58 of the laws of 2007,
    10  are amended  and three new subdivisions 1-a, 9-a and  15  are  added  to
    11  read as follows:
    12    1-a.    Rates  for  home care services agencies and home care services
    13  under this section shall be reasonable and  reasonably  related  to  the
    14  cost  of efficiently providing the services and assuring an adequate and
    15  accessible supply of  the  services  (including  workforce  recruitment,
    16  training,  compensation, retention and sufficiency); taking into consid-
    17  eration the elements of cost, geographical differentials in the elements
    18  of cost considered, economic factors in the area in which  the  services
    19  are to be delivered.
    20    3.  Prior  to the approval of [such] the rates, the commissioner shall
    21  determine and certify to the state  director  of  the  budget  that  the
    22  proposed  rate  schedules  for payments for certified home health agency
    23  services or services provided by long term home health care programs  or
    24  AIDS  home  care  programs  [are  reasonably related to the costs of the
    25  efficient production of such services. In making such certification, the
    26  commissioner  shall  take  into  consideration  the  elements  of  cost,
    27  geographical  differentials in the elements of cost considered, economic
    28  factors in the area in which the certified home health agency,  provider
    29  of a long term home health care program or provider of an AIDS home care
    30  program  is  located, costs of certified home health agencies, providers
    31  of long term home health care programs or providers of  AIDS  home  care
    32  programs  of  comparable  size,  and  the need for incentives to improve
    33  services and institute economies] meet the requirements of this section.
    34    (a) [Demonstration rates] Rates of payment or  fees  shall  be  estab-
    35  lished  in compliance with this section for telehealth services provided
    36  by a certified home health agency, a long term home health care  program
    37  or AIDS home care program, or for telehealth services by a licensed home
    38  care  services  agency under contract with such an agency or program, in
    39  order to ensure the availability of technology-based patient monitoring,
    40  communication  and  health  management.  Reimbursement  for   telehealth
    41  services  provided  [pursuant  to]  under this section shall be provided
    42  [only in connection with Federal Food and  Drug  Administration-approved
    43  and  interoperable  devices,  and  incorporated as part of the patient's
    44  plan of care] for telehealth services described in this section, as well
    45  as telehealth as defined in article twenty-nine-G of this  chapter.  The
    46  commissioner  shall  seek federal financial participation with regard to
    47  this [demonstration] initiative. Such reimbursement shall be provided as
    48  either a separate rate from, or as a specified payment under, the  meth-
    49  odology under subdivision thirteen of this section.
    50    (b)  The  purposes  of  [such]  the services shall be to assist in the
    51  effective monitoring and management of  patients  whose  medical,  func-
    52  tional  and/or  environmental needs can be appropriately and cost-effec-
    53  tively met at home through the application of  telehealth  intervention.
    54  Reimbursement provided [pursuant to] under this subdivision shall be for
    55  services  to  patients with conditions or clinical circumstances associ-
    56  ated with the need  for  frequent  monitoring,  [and/or]  the  need  for
        A. 9148                             4

     1  frequent  physician, skilled nursing or acute care services, [and] where
     2  the provision of telehealth services can appropriately reduce  the  need
     3  for  on-site  or  in-office  visits  or acute or long term care facility
     4  admissions,  or  where the telehealth services appropriately allow for a
     5  home care service by  means  of  telehealth  technology  instead  of  an
     6  in-person  visit by the home care services agency. [Such] The conditions
     7  and clinical circumstances shall include, but not be limited to, conges-
     8  tive heart failure, diabetes,  chronic  pulmonary  obstructive  disease,
     9  wound  care,  polypharmacy, mental or behavioral problems limiting self-
    10  management, and technology-dependent care  such  as  continuous  oxygen,
    11  ventilator care, total parenteral nutrition or enteral feeding.
    12    9-a.  (a)  Notwithstanding any inconsistent provision of this section,
    13  effective for annual periods beginning April first, two  thousand  twen-
    14  ty-two,  the  commissioner shall, subject to the availability of federal
    15  financial participation and upon approval of the state director  of  the
    16  budget, further adjust medical assistance rates of payment for home care
    17  services  agencies  and home care services, including home care services
    18  provided by entities qualifying under subdivision nine of this  section,
    19  targeted  for  increased  salary  and  benefits  for  home health aides,
    20  personal care aides and consumer directed personal assistants,  as  well
    21  as  for  recruitment,  training and retention of direct care workers for
    22  services in shortage areas and by shortage disciplines which may include
    23  nurses, therapists, social workers, home health aides and personal  care
    24  aides.  The  commissioner  shall be further authorized, upon approval of
    25  the state director of the budget, to utilize state funds, as  available,
    26  including  federal  COVID-19  relief  funds  allocated  to  New York, to
    27  distribute as direct funding to home care service provider entities  for
    28  these  purposes and personnel for services to Medical assistance recipi-
    29  ents.
    30    (b) Rate adjustments and direct payments made under  this  subdivision
    31  may  also  be  provided  to  pilot  test  the  impact on recruitment and
    32  retention of allowing funds to be used for critical supports and  incen-
    33  tives  for  direct  care personnel, including transportation, education,
    34  training, child  day  care,  career  ladder,  peer  support,  and  other
    35  supports which the commissioner may determine.
    36    (c) On or before October first, two thousand twenty-three, the commis-
    37  sioner shall report to the governor and legislature on the effectiveness
    38  of  this  section  in recruitment and retention of direct care home care
    39  personnel, and in addressing community need, and shall make  recommenda-
    40  tions  for  the continuation or modification of the program. The commis-
    41  sioner shall seek the input of representatives of the providers,  plans,
    42  consumers and workers in examining and reporting on the program.
    43    15. Subject to the availability of federal financial participation and
    44  approval  of  the  state  director of the budget, for home care services
    45  provided on and after April first, two thousand twenty-two, the  commis-
    46  sioner  shall  adjust  Medicaid  rates  of payment for home care service
    47  agencies to address increases in reimbursement as  may  be  required  by
    48  implementation  of  amendments to this article and subdivision eleven of
    49  section three hundred sixty-five-a of the social services  law  made  by
    50  the  chapter  of  the  laws  of  two thousand twenty-two that added this
    51  subdivision.
    52    § 6. Subdivision 8 of section 4403-f of  the  public  health  law,  as
    53  amended  by  section  21 of part B of chapter 59 of the laws of 2016, is
    54  amended to read as follows:
    55    8. Payment rates for managed long term care  plan  enrollees  eligible
    56  for  medical  assistance. The commissioner shall establish payment rates
        A. 9148                             5

     1  for services provided to enrollees  eligible  under  title  XIX  of  the
     2  federal  social  security  act.  Such  payment rates shall be subject to
     3  approval by the director of the division of the budget and shall reflect
     4  savings to both state and local governments when compared to costs which
     5  would  be incurred by such program if enrollees were to receive compara-
     6  ble health and long term care services on a fee-for-service basis in the
     7  geographic region in which such services are proposed  to  be  provided.
     8  Payment rates shall be risk-adjusted to take into account the character-
     9  istics  of  enrollees, or proposed enrollees, including, but not limited
    10  to:   frailty, disability level,  health  and  functional  status,  age,
    11  gender,  the  nature  of  services provided to such enrollees, and other
    12  factors as determined by the commissioner. The  risk  adjusted  premiums
    13  may  also  be  combined  with  disincentives or requirements designed to
    14  mitigate any incentives to obtain higher payment categories. In  setting
    15  such  payment  rates, the commissioner shall consider costs borne by the
    16  managed care program to ensure actuarially sound and adequate  rates  of
    17  payment  to ensure quality of care shall comply with all applicable laws
    18  and regulations, state and federal, including [regulations as  to],  but
    19  not  limited  to, those relating to wages, labor and actuarial soundness
    20  [for medicaid managed care]. For premiums effective on  an  after  April
    21  first,  two thousand twenty-two, the commissioner shall further consider
    22  increases to premiums to  address  cost  and  reimbursement  adjustments
    23  required by the department's implementation of the amendments to article
    24  thirty-six  of  this  chapter  and  subdivision  eleven of section three
    25  hundred sixty-five-a of the social services law made by the  chapter  of
    26  the laws of two thousand twenty-two that added this sentence.
    27    §  7.  The  superintendent of financial services, in consultation with
    28  the commissioner of health, and representatives of state-licensed health
    29  insurers, home care service agencies  and  consumers  (including  family
    30  members  of  consumers),  labor  organizations  representing  home  care
    31  service workers, and respective statewide associations or organizations,
    32  shall examine the terms of coverage for home care services as  specified
    33  in articles 32 and 43 of the insurance law and, on or before December 1,
    34  2022, report to the legislature and governor on the following:
    35    a. The extent to which these coverage terms, including coverage exclu-
    36  sions  as  well as riders that permit the purchase of expanded coverage,
    37  are aligned with state of art medical and health system practice for the
    38  providing in-home care;
    39    b. The extent to which state incentives  for  purchase  of  home  care
    40  service coverage, including expanded coverage, may be cost-beneficial to
    41  recipients,  to  the  health  care  system, and state medical assistance
    42  program specifically; and
    43    c. Recommendations for modifications of articles  32  and  43  of  the
    44  insurance  law,  and  such  other laws, including the public health law,
    45  workers' compensation law, social services law, mental hygiene  law  and
    46  elder  law, as would align the terms of home care coverage with state of
    47  art medical and health system practices.
    48    § 8. This act shall take effect immediately; provided,  however,  that
    49  the  amendments  to subdivision 8 of section 4403-f of the public health
    50  law made by section six of this act shall be subject to  the  expiration
    51  and repeal of such section and shall expire and be deemed repealed ther-
    52  ewith.