Bill Text: NY S05915 | 2019-2020 | General Assembly | Amended
Bill Title: Relates to rates of payment for certified home health agencies.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2020-01-14 - PRINT NUMBER 5915A [S05915 Detail]
Download: New_York-2019-S05915-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 5915--A 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. LBD11759-04-0S. 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.
