Bill Text: NY S04791 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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: Partisan Bill (Democrat 7-0)

Status: (Introduced) 2024-05-21 - REPORTED AND COMMITTED TO FINANCE [S04791 Detail]

Download: New_York-2023-S04791-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4791

                               2023-2024 Regular Sessions

                    IN SENATE

                                    February 14, 2023
                                       ___________

        Introduced  by  Sens.  RIVERA,  ADDABBO, COMRIE, HOYLMAN-SIGAL, JACKSON,
          SEPULVEDA, STAVISKY -- read twice and ordered printed, and when print-
          ed 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-three, 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  twenty-three and after, the commissioner is authorized to increase

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08058-01-3
        S. 4791                             2

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