Bill Text: NY A04583 | 2023-2024 | General Assembly | Amended

---

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 8-0)

Status: (Introduced - Dead) 2024-01-03 - referred to ways and means [A04583 Detail]

Download: New_York-2023-A04583-Amended.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                         4583--A

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 17, 2023
                                       ___________

        Introduced by M. of A. PAULIN, KIM, SIMON, L. ROSENTHAL, ARDILA, KELLES,
          GONZALEZ-ROJAS,  RAGA  --  read  once and referred to the Committee on
          Health -- reported and referred to the Committee on Ways and Means  --
          committee  discharged,  bill amended, ordered reprinted as amended and
          recommitted to said committee

        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,

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05278-02-3
        A. 4583--A                          2

     1  thereby avoiding prolonged institutionalization, concomitant high  costs
     2  and associated adverse social and medical implications.
     3    The  legislature  intends  that  there  be  a public commitment to the
     4  appropriate provision and [expansion] accessibility of services rendered
     5  to the residents of the state by [certified] home [health] care services
     6  agencies, [to] including financial and  programmatic  support  for:  the
     7  maintenance  of  a  consistently high level of services by all home care
     8  services  agencies[,  to]  and  workforce;  the  recruitment,  training,
     9  compensation  and  retention  of  a capable and committed workforce; the
    10  integration of home care provider roles in the state's strategic  prima-
    11  ry,  preventive,  public  health  and  health care delivery planning and
    12  programming; the central collection and public accessibility of informa-
    13  tion concerning all  organized  home  care  services[,];  and  [to]  the
    14  adequate regulation and coordination of existing home care services.
    15    §  3. The public health law is amended by adding a new section 3603 to
    16  read as follows:
    17    § 3603. Home care policy; implementation.  1. The  commissioner  shall
    18  make  regulations, issue guidance and take actions reasonably necessary,
    19  including coordinating with other state agencies, to promote the  policy
    20  under this article including, but not be limited to:
    21    (a)  information  and referral guidance to be made available to hospi-
    22  tals and nursing home discharge  planners,  health  care  professionals,
    23  ambulatory  surgical  centers,  mental  health  providers, county public
    24  health departments and other applicable health care settings, to  assist
    25  in  the consideration and referral of patients for home care services as
    26  a primary or adjunctive service option.  The  information  and  guidance
    27  shall also be made available for the purpose of assisting providers' and
    28  practitioners'  responsibilities  under  subdivision  eleven  of section
    29  three hundred  sixty-five-a  (relating  to  eligibility  for  home  care
    30  services) of the social services law;
    31    (b)  the development of a comprehensive public education program about
    32  home care services, including  but  not  limited  to:  (i)  a  dedicated
    33  portion  of  the  department's  website that describes and distinguishes
    34  home care provider types offered or authorized by any state agency; (ii)
    35  the types of services typically available by provider and  program  type
    36  including home and community based waiver programs and consumer directed
    37  personal  assistance  programs;  (iii)  home  care  third party benefits
    38  provided under the insurance law for individual, small group  and  large
    39  group    non-public  coverages, Medicaid, Medicare, and other state-sup-
    40  ported public programs; (iv) the contact information by which  consumers
    41  may  access  home  care  services; and (v) the name and location of home
    42  care service agencies throughout the state;
    43    (c) the integration of home care provider roles in the state's strate-
    44  gic primary, preventive, public health and health care delivery planning
    45  and programming; and
    46    (d) the  inclusion  of  home  care  service  providers  in  department
    47  programs  that  provide  support  and  funding  for health care capital,
    48  infrastructure, including electronic medical records  and  interoperabi-
    49  lity,  as well as direct point of service clinical technology, and work-
    50  force development.
    51    2. In implementing this section, the commissioner shall seek the input
    52  of representatives of home care providers, hospitals and nursing  homes,
    53  health  care  professionals,  health  plans  and insurers, consumers and
    54  their family members and caregivers, and home  care  workers  (including
    55  labor organizations).
        A. 4583--A                          3

     1    §  4.  Section 365-a of the social services law is amended by adding a
     2  new subdivision 11 to read as follows:
     3    11.  Home  care services. If an individual eligible for services under
     4  this title is determined under this article, by a  health  care  profes-
     5  sional, to be medically eligible for admission to a general hospital for
     6  services  other  than acute or emergency services, or to a nursing home,
     7  or the individual is being cared for in a general  hospital  or  nursing
     8  home  and  desires to receive care at home, and home care services would
     9  be reasonably appropriate for the individual, the  individual  shall  be
    10  informed orally and in writing of the availability of home care services
    11  available  in  the  person's  county  of  residence.  If  the individual
    12  consents, an appropriate health care professional may refer  the  person
    13  for  a comprehensive assessment for home care services under this title.
    14  Where the individual lacks capacity to make health care  decisions,  the
    15  notice shall be made to, and consent may be made by, a person authorized
    16  to make health care decisions for the individual.
    17    §  5.  Subdivision  3 and paragraphs (a) and (b) of subdivision 3-c of
    18  section 3614 of the public health law, subdivision 3 as amended by chap-
    19  ter 622 of the laws of 1988, paragraphs (a) and (b) of  subdivision  3-c
    20  as  added  by  section 63-b of part C of chapter 58 of the laws of 2007,
    21  are amended  and three new subdivisions 1-a, 9-a and  15  are  added  to
    22  read as follows:
    23    1-a.    Rates  for  home care services agencies and home care services
    24  under this section shall be reasonable and  reasonably  related  to  the
    25  cost  of efficiently providing the services and assuring an adequate and
    26  accessible supply of  the  services  (including  workforce  recruitment,
    27  training,  compensation, retention and sufficiency); taking into consid-
    28  eration the elements of cost, geographical differentials in the elements
    29  of cost considered, economic factors in the area in which  the  services
    30  are to be delivered.
    31    3.  Prior  to the approval of [such] the rates, the commissioner shall
    32  determine and certify to the state  director  of  the  budget  that  the
    33  proposed  rate  schedules  for payments for certified home health agency
    34  services or services provided by long term home health care programs  or
    35  AIDS  home  care  programs  [are  reasonably related to the costs of the
    36  efficient production of such services. In making such certification, the
    37  commissioner  shall  take  into  consideration  the  elements  of  cost,
    38  geographical  differentials in the elements of cost considered, economic
    39  factors in the area in which the certified home health agency,  provider
    40  of a long term home health care program or provider of an AIDS home care
    41  program  is  located, costs of certified home health agencies, providers
    42  of long term home health care programs or providers of  AIDS  home  care
    43  programs  of  comparable  size,  and  the need for incentives to improve
    44  services and institute economies] meet the requirements of this section.
    45    (a) [Demonstration rates] Rates of payment or  fees  shall  be  estab-
    46  lished  in compliance with this section for telehealth services provided
    47  by a certified home health agency, a long term home health care  program
    48  or AIDS home care program, or for telehealth services by a licensed home
    49  care  services  agency under contract with such an agency or program, in
    50  order to ensure the availability of technology-based patient monitoring,
    51  communication  and  health  management.  Reimbursement  for   telehealth
    52  services  provided  [pursuant  to]  under this section shall be provided
    53  [only in connection with Federal Food and  Drug  Administration-approved
    54  and  interoperable  devices,  and  incorporated as part of the patient's
    55  plan of care] for telehealth services described in this section, as well
    56  as telehealth as defined in article twenty-nine-G of this  chapter.  The
        A. 4583--A                          4

     1  commissioner  shall  seek federal financial participation with regard to
     2  this [demonstration] initiative. Such reimbursement shall be provided as
     3  either a separate rate from, or as a specified payment under, the  meth-
     4  odology under subdivision thirteen of this section.
     5    (b)  The  purposes  of  [such]  the services shall be to assist in the
     6  effective monitoring and management of  patients  whose  medical,  func-
     7  tional  and/or  environmental needs can be appropriately and cost-effec-
     8  tively met at home through the application of  telehealth  intervention.
     9  Reimbursement provided [pursuant to] under this subdivision shall be for
    10  services  to  patients with conditions or clinical circumstances associ-
    11  ated with the need  for  frequent  monitoring,  [and/or]  the  need  for
    12  frequent  physician, skilled nursing or acute care services, [and] where
    13  the provision of telehealth services can appropriately reduce  the  need
    14  for  on-site  or  in-office  visits  or acute or long term care facility
    15  admissions, or where the telehealth services appropriately allow  for  a
    16  home  care  service  by  means  of  telehealth  technology instead of an
    17  in-person visit by the home care services agency. [Such] The  conditions
    18  and clinical circumstances shall include, but not be limited to, conges-
    19  tive  heart  failure,  diabetes,  chronic pulmonary obstructive disease,
    20  wound care, polypharmacy, mental or behavioral problems  limiting  self-
    21  management,  and  technology-dependent  care  such as continuous oxygen,
    22  ventilator care, total parenteral nutrition or enteral feeding.
    23    9-a. (a) Notwithstanding any inconsistent provision of  this  section,
    24  effective  for annual periods beginning July first, two thousand twenty-
    25  four, the commissioner shall, subject to  the  availability  of  federal
    26  financial  participation  and upon approval of the state director of the
    27  budget, further adjust medical assistance rates of payment for home care
    28  services agencies and home care services, including home  care  services
    29  provided  by entities qualifying under subdivision nine of this section,
    30  targeted for increased  salary  and  benefits  for  home  health  aides,
    31  personal  care  aides and consumer directed personal assistants, as well
    32  as for recruitment, training and retention of direct  care  workers  for
    33  services in shortage areas and by shortage disciplines which may include
    34  nurses,  therapists, social workers, home health aides and personal care
    35  aides. The commissioner shall be further authorized,  upon  approval  of
    36  the  state director of the budget, to utilize state funds, as available,
    37  including federal COVID-19  relief  funds  allocated  to  New  York,  to
    38  distribute  as direct funding to home care service provider entities for
    39  these purposes and personnel for services to medical assistance  recipi-
    40  ents.
    41    (b)  Rate  adjustments and direct payments made under this subdivision
    42  may also be provided  to  pilot  test  the  impact  on  recruitment  and
    43  retention  of allowing funds to be used for critical supports and incen-
    44  tives for direct care personnel,  including  transportation,  education,
    45  training,  child  day  care,  career  ladder,  peer  support,  and other
    46  supports which the commissioner may determine.
    47    (c) On or before October first, two thousand twenty-five, the  commis-
    48  sioner shall report to the governor and legislature on the effectiveness
    49  of  this  section  in recruitment and retention of direct care home care
    50  personnel, and in addressing community need, and shall make  recommenda-
    51  tions  for  the continuation or modification of the program. The commis-
    52  sioner shall seek the input of representatives of the providers,  plans,
    53  consumers and workers in examining and reporting on the program.
    54    15. Subject to the availability of federal financial participation and
    55  approval  of  the  state  director of the budget, for home care services
    56  provided on and after July first, two thousand twenty-four, the  commis-
        A. 4583--A                          5

     1  sioner  shall  adjust  Medicaid  rates  of payment for home care service
     2  agencies to address increases in reimbursement as  may  be  required  by
     3  implementation  of  amendments to this article and subdivision eleven of
     4  section  three  hundred  sixty-five-a of the social services law made by
     5  the chapter of the laws of two thousand  twenty-three  that  added  this
     6  subdivision.
     7    §  6.  Subdivision  8  of  section 4403-f of the public health law, as
     8  amended by section 21 of part B of chapter 59 of the laws  of  2016,  is
     9  amended to read as follows:
    10    8.  Payment  rates  for managed long term care plan enrollees eligible
    11  for medical assistance. The commissioner shall establish  payment  rates
    12  for  services  provided  to  enrollees  eligible  under title XIX of the
    13  federal social security act. Such payment  rates  shall  be  subject  to
    14  approval by the director of the division of the budget and shall reflect
    15  savings to both state and local governments when compared to costs which
    16  would  be incurred by such program if enrollees were to receive compara-
    17  ble health and long term care services on a fee-for-service basis in the
    18  geographic region in which such services are proposed  to  be  provided.
    19  Payment rates shall be risk-adjusted to take into account the character-
    20  istics  of  enrollees, or proposed enrollees, including, but not limited
    21  to:   frailty, disability level,  health  and  functional  status,  age,
    22  gender,  the  nature  of  services provided to such enrollees, and other
    23  factors as determined by the commissioner. The  risk  adjusted  premiums
    24  may  also  be  combined  with  disincentives or requirements designed to
    25  mitigate any incentives to obtain higher payment categories. In  setting
    26  such  payment  rates, the commissioner shall consider costs borne by the
    27  managed care program to ensure actuarially sound and adequate  rates  of
    28  payment  to ensure quality of care shall comply with all applicable laws
    29  and regulations, state and federal, including [regulations as  to],  but
    30  not  limited  to, those relating to wages, labor and actuarial soundness
    31  [for medicaid managed care]. For premiums effective on and  after  April
    32  first, two thousand twenty-four, the commissioner shall further consider
    33  increases  to  premiums  to  address  cost and reimbursement adjustments
    34  required by the department's implementation of the amendments to article
    35  thirty-six of this chapter and section three hundred sixty-five-a of the
    36  social services law made by the chapter of  the  laws  of  two  thousand
    37  twenty-three that amended this subdivision.
    38    §  7.  The  superintendent of financial services, in consultation with
    39  the commissioner of health, and representatives of state-licensed health
    40  insurers, home care service agencies  and  consumers  (including  family
    41  members  of  consumers),  labor  organizations  representing  home  care
    42  service workers, and respective statewide associations or organizations,
    43  shall examine the terms of coverage for home care services as  specified
    44  in articles 32 and 43 of the insurance law and, on or before December 1,
    45  2024, report to the legislature and governor on the following:
    46    a. The extent to which these coverage terms, including coverage exclu-
    47  sions  as  well as riders that permit the purchase of expanded coverage,
    48  are aligned with state of the art medical and health system practice for
    49  providing in-home care;
    50    b. The extent to which state incentives  for  purchase  of  home  care
    51  service coverage, including expanded coverage, may be cost-beneficial to
    52  recipients,  to  the  health  care  system, and state medical assistance
    53  program specifically; and
    54    c. Recommendations for modifications of articles  32  and  43  of  the
    55  insurance  law,  and  such  other laws, including the public health law,
    56  workers' compensation law, social services law, mental hygiene  law  and
        A. 4583--A                          6

     1  elder  law, as would align the terms of home care coverage with state of
     2  the art medical and health system practices.
     3    §  8.  This act shall take effect immediately; provided, however, that
     4  the amendments to subdivision 8 of section 4403-f of the  public  health
     5  law  made  by  section six of this act shall be subject to the repeal of
     6  such section and shall be deemed repealed therewith.