Bill Text: NY A00054 | 2017-2018 | General Assembly | Introduced

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Bill Title: Includes certain out of home services such as transition from a hospital, nursing facility or other institutional setting to the home within home care insurance coverage.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2018-01-03 - referred to insurance [A00054 Detail]

Download: New_York-2017-A00054-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                           54
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                       (Prefiled)
                                     January 4, 2017
                                       ___________
        Introduced by M. of A. CAHILL -- read once and referred to the Committee
          on Insurance
        AN  ACT to amend the insurance law, in relation to including certain out
          of home services such as transition from a hospital, nursing  facility
          or  other institutional setting to the home within home care insurance
          coverage
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section 1. Subparagraphs (C), (D) and (E) of paragraph 1 of subsection
     2  (k)  of  section 3221 of the insurance law, subparagraphs (C) and (D) as
     3  amended by chapter 557 of the laws of  2000,  are  amended  to  read  as
     4  follows:
     5    (C)  Home care means the care and treatment of a covered person who is
     6  under the care of a  physician  [but  only  if]  and  who  requires  the
     7  services  of  an  agency described in subparagraph (D) of this paragraph
     8  for: transition of the covered person from hospital, nursing facility or
     9  other institutional setting to home; rehabilitation, recovery or medical
    10  management of the covered person at home  following  hospitalization  or
    11  following  care in a nursing facility or other institutional setting; or
    12  medical management of a condition predisposing the covered individual to
    13  hospitalization [or], confinement in a nursing facility [as  defined  in
    14  subchapter  XVIII  of the federal Social Security Act, 42 U.S.C. §§ 1395
    15  et seq, would otherwise have been required] or the need for  other  out-
    16  of-home services otherwise covered under the contract if home care [was]
    17  is not provided, and the plan covering the home health service is estab-
    18  lished and approved in writing by such physician.
    19    (D)  Home  care  shall  be  provided  by  an agency possessing a valid
    20  certificate of approval or license issued pursuant to article thirty-six
    21  of the public health law and shall consist of one or more of the follow-
    22  ing:
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01655-01-7
        A. 54                               2
     1    (i) Part-time or intermittent home nursing care by or under the super-
     2  vision of a registered professional nurse (R.N.).
     3    (ii) Part-time or intermittent home health aide services which consist
     4  primarily of caring for the patient.
     5    (iii)  Physical,  occupational or speech therapy, social work, respir-
     6  atory therapy and nutritional counseling, if provided by the home health
     7  service or agency.
     8    (iv) Medical supplies, drugs and medications prescribed  by  a  physi-
     9  cian, and laboratory services by or on behalf of a certified home health
    10  agency  or  licensed  home care services agency to the extent such items
    11  would have been covered under the contract if  the  covered  person  had
    12  been  hospitalized  or confined in a skilled nursing facility as defined
    13  in subchapter XVIII of the federal Social Security  Act,  42  U.S.C.  §§
    14  1395 et seq.
    15    (E)  For  the purpose of determining the benefits for home care avail-
    16  able to a covered person, [each visit by a member of a  home  care  team
    17  shall  be  considered as one home care visit; the contract may contain a
    18  limitation on the number of home care visits, but not  less  than  forty
    19  such  visits  in any calendar year or in any continuous period of twelve
    20  months, for each person covered under the contract; four hours  of  home
    21  health  aide service shall be considered as one home care visit] nothing
    22  in this paragraph shall be construed to prevent the management or utili-
    23  zation review of home care benefits, including the  use  of  preauthori-
    24  zation  and  appropriateness  criteria  as to the level and intensity of
    25  treatment applicable to home care, provided however that any such deter-
    26  minations may be subject to appeal  under  article  forty-nine  of  this
    27  chapter.
    28    §  2.  Paragraph  3 of subsection (a) of section 4303 of the insurance
    29  law, subparagraphs (A), (B) and (C) as amended by  chapter  557  of  the
    30  laws  of  2000 and subparagraph (D) as amended by chapter 21 of the laws
    31  of 1990, is amended to read as follows:
    32    (3) For home care to residents in this state. Such home care  coverage
    33  shall  be  included  at  the  inception  of  all new contracts and, with
    34  respect to all other contracts, added at any  anniversary  date  of  the
    35  contract  subject  to  evidence  of  insurability.  Such coverage may be
    36  subject to an annual deductible of not more than fifty dollars for  each
    37  covered  person  and  may  be  subject  to a coinsurance provision which
    38  provides for coverage of not  less  than  seventy-five  percent  of  the
    39  reasonable  cost  of  services  for  which  payment may be made. No such
    40  corporation need provide such coverage to persons eligible for medicare.
    41    (A) Home care shall mean the care and treatment of  a  covered  person
    42  who is under the care of a physician [but only if:
    43    (i)]  and who requires the services of an agency described in subpara-
    44  graph (B) of this paragraph for: transition of the covered  person  from
    45  hospital,  nursing  facility or other institutional setting to home; for
    46  rehabilitation, recovery or medical management of the covered person  at
    47  home  following  hospitalization or following care in a nursing facility
    48  or other institutional setting; or medical  management  of  a  condition
    49  predisposing the covered individual to hospitalization [or], confinement
    50  in  a  nursing  facility  [as  defined in subchapter XVIII of the Social
    51  Security Act, 42 U.S.C.  §  1395  et  seq,  would  otherwise  have  been
    52  required]  or  the need for other out-of-home services otherwise covered
    53  under the policy, if home care [was] is not provided, and
    54    [(ii)] the plan covering the home health service  is  established  and
    55  approved in writing by such physician.
        A. 54                               3
     1    (B)  Home  care  shall  be  provided  by  an agency possessing a valid
     2  certificate of approval or license issued pursuant to article thirty-six
     3  of the public health law.
     4    (C) Home care shall consist of one or more of the following:
     5    (i) part-time or intermittent home nursing care by or under the super-
     6  vision of a registered professional nurse (R.N.),
     7    (ii) part-time or intermittent home health aide services which consist
     8  primarily of caring for the patient,
     9    (iii)  physical,  occupational or speech therapy, social work, respir-
    10  atory therapy and nutritional counseling, if provided by the home health
    11  service or agency, and
    12    (iv) medical supplies, drugs and medications prescribed  by  a  physi-
    13  cian, and laboratory services by or on behalf of a certified home health
    14  agency  or  licensed  home care services agency to the extent such items
    15  would have been covered or provided under the contract  if  the  covered
    16  person  had  been hospitalized or confined in a skilled nursing facility
    17  as defined in subchapter XVIII of the Social Security Act, 42  U.S.C.  §
    18  1395 et seq.
    19    (D)  For  the purpose of determining the benefits for home care avail-
    20  able to a covered person, [each visit by a member of a  home  care  team
    21  shall  be  considered as one home care visit. The contract may contain a
    22  limitation on the number of home care visits, but not  less  than  forty
    23  such  visits  in any calendar year or in any continuous period of twelve
    24  months, for each covered person. Four hours of home health aide  service
    25  shall  be  considered as one home care visit. Every contract issued by a
    26  hospital  service  corporation  or  health  service  corporation   which
    27  provides coverage supplementing part A and part B of subchapter XVIII of
    28  the  Social  Security  Act, 42 U.S.C. § 1395 et seq, must make available
    29  and, if requested by a subscriber holding a direct payment  contract  or
    30  by all subscribers in a group remittance group or by the contract holder
    31  in  the case of group contracts issued pursuant to section four thousand
    32  three hundred five of this article,  provide  coverage  of  supplemental
    33  home  care visits beyond those provided by part A and part B, sufficient
    34  to produce an aggregate coverage of three hundred sixty-five  home  care
    35  visits  per  contract  year. Such coverage shall be provided pursuant to
    36  regulations prescribed by the  superintendent.  Written  notice  of  the
    37  availability  of such coverage shall be delivered to the group remitting
    38  agent or group contract holder prior to inception of such  contract  and
    39  annually thereafter, except that this notice shall not be required where
    40  a  policy  covers  two  hundred  or  more employees or where the benefit
    41  structure was the subject of collective bargaining affecting persons who
    42  are employed in more than one state] nothing in this paragraph shall  be
    43  construed  to  prevent the management or utilization review of home care
    44  benefits, including the  use  of  preauthorization  and  appropriateness
    45  criteria  as  to the level and intensity of treatment applicable to home
    46  care, provided however that any such determinations may  be  subject  to
    47  appeal under article forty-nine of this chapter.
    48    § 3. This act shall take effect January 1, 2018 and shall apply to all
    49  policies  and contracts issued, renewed, modified, altered or amended on
    50  or after such date.