Bill Text: NY S08295 | 2021-2022 | General Assembly | Introduced
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: Slight Partisan Bill (Democrat 3-1)
Status: (Introduced - Dead) 2022-05-03 - REPORTED AND COMMITTED TO FINANCE [S08295 Detail]
Download: New_York-2021-S08295-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8295 IN SENATE February 10, 2022 ___________ 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 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 them9available] 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-14tively] 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. LBD14002-01-1S. 8295 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 individualS. 8295 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 the25efficient production of such services. In making such certification, the26commissioner shall take into consideration the elements of cost,27geographical differentials in the elements of cost considered, economic28factors in the area in which the certified home health agency, provider29of a long term home health care program or provider of an AIDS home care30program is located, costs of certified home health agencies, providers31of long term home health care programs or providers of AIDS home care32programs of comparable size, and the need for incentives to improve33services 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-approved43and interoperable devices, and incorporated as part of the patient's44plan 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 forS. 8295 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 ratesS. 8295 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.