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

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

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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-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4583

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 17, 2023
                                       ___________

        Introduced by M. of A. PAULIN, KIM, SIMON, L. ROSENTHAL -- read once and
          referred 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 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,
    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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05278-01-3
        A. 4583                             2

     1  services  agencies[,  to]  and  workforce;  the  recruitment,  training,
     2  compensation and retention of a capable  and  committed  workforce;  the
     3  integration  of home care provider roles in the state's strategic prima-
     4  ry,  preventive,  public  health  and  health care delivery planning and
     5  programming; the central collection and public accessibility of informa-
     6  tion concerning all  organized  home  care  services[,];  and  [to]  the
     7  adequate regulation and coordination of existing home care services.
     8    §  3. The public health law is amended by adding a new section 3603 to
     9  read as follows:
    10    § 3603. Home care policy; implementation.  1. The  commissioner  shall
    11  make  regulations, issue guidance and take actions reasonably necessary,
    12  including coordinating with other state agencies, to promote the  policy
    13  under this article including, but not be limited to:
    14    (a)  information  and referral guidance to be made available to hospi-
    15  tals and nursing home discharge  planners,  health  care  professionals,
    16  ambulatory  surgical  centers,  mental  health  providers, county public
    17  health departments and other applicable health care settings, to  assist
    18  in  the consideration and referral of patients for home care services as
    19  a primary or adjunctive service option.  The  information  and  guidance
    20  shall also be made available for the purpose of assisting providers' and
    21  practitioners'  responsibilities  under  subdivision  eleven  of section
    22  three hundred  sixty-five-a  (relating  to  eligibility  for  home  care
    23  services) of the social services law;
    24    (b)  the development of a comprehensive public education program about
    25  home care services, including  but  not  limited  to:  (i)  a  dedicated
    26  portion  of  the  department's  website that describes and distinguishes
    27  home care provider types offered or authorized by any state agency; (ii)
    28  the types of services typically available by provider and  program  type
    29  including home and community based waiver programs and consumer directed
    30  personal  assistance  programs;  (iii)  home  care  third party benefits
    31  provided under the insurance law for individual, small group  and  large
    32  group    non-public  coverages, Medicaid, Medicare, and other state-sup-
    33  ported public programs; (iv) the contact information by which  consumers
    34  may  access  home  care  services; and (v) the name and location of home
    35  care service agencies throughout the state;
    36    (c) the integration of home care provider roles in the state's strate-
    37  gic primary, preventive, public health and health care delivery planning
    38  and programming; and
    39    (d) the  inclusion  of  home  care  service  providers  in  department
    40  programs  that  provide  support  and  funding  for health care capital,
    41  infrastructure, including electronic medical records  and  interoperabi-
    42  lity,  as well as direct point of service clinical technology, and work-
    43  force development.
    44    2. In implementing this section, the commissioner shall seek the input
    45  of representatives of home care providers, hospitals and nursing  homes,
    46  health  care  professionals,  health  plans  and insurers, consumers and
    47  their family members and caregivers, and home  care  workers  (including
    48  labor organizations).
    49    §  4.  Section 365-a of the social services law is amended by adding a
    50  new subdivision 11 to read as follows:
    51    11. Home care services. If an individual eligible for  services  under
    52  this  title  is  determined under this article, by a health care profes-
    53  sional, to be medically eligible for admission to a general hospital for
    54  services other than acute or emergency services, or to a  nursing  home,
    55  or  the  individual  is being cared for in a general hospital or nursing
    56  home and desires to receive care at home, and home care  services  would
        A. 4583                             3

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

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

     1    § 6. Subdivision 8 of section 4403-f of  the  public  health  law,  as
     2  amended  by  section  21 of part B of chapter 59 of the laws of 2016, is
     3  amended to read as follows:
     4    8.  Payment  rates  for managed long term care plan enrollees eligible
     5  for medical assistance. The commissioner shall establish  payment  rates
     6  for  services  provided  to  enrollees  eligible  under title XIX of the
     7  federal social security act. Such payment  rates  shall  be  subject  to
     8  approval by the director of the division of the budget and shall reflect
     9  savings to both state and local governments when compared to costs which
    10  would  be incurred by such program if enrollees were to receive compara-
    11  ble health and long term care services on a fee-for-service basis in the
    12  geographic region in which such services are proposed  to  be  provided.
    13  Payment rates shall be risk-adjusted to take into account the character-
    14  istics  of  enrollees, or proposed enrollees, including, but not limited
    15  to:   frailty, disability level,  health  and  functional  status,  age,
    16  gender,  the  nature  of  services provided to such enrollees, and other
    17  factors as determined by the commissioner. The  risk  adjusted  premiums
    18  may  also  be  combined  with  disincentives or requirements designed to
    19  mitigate any incentives to obtain higher payment categories. In  setting
    20  such  payment  rates, the commissioner shall consider costs borne by the
    21  managed care program to ensure actuarially sound and adequate  rates  of
    22  payment  to ensure quality of care shall comply with all applicable laws
    23  and regulations, state and federal, including [regulations as  to],  but
    24  not  limited  to, those relating to wages, labor and actuarial soundness
    25  [for medicaid managed care]. For premiums effective on and  after  April
    26  first, two thousand twenty-three, the commissioner shall further consid-
    27  er  increases  to premiums to address cost and reimbursement adjustments
    28  required by the department's implementation of the amendments to article
    29  thirty-six of this chapter and section three hundred sixty-five-a of the
    30  social services law made by the chapter of  the  laws  of  two  thousand
    31  twenty-three that amended this subdivision.
    32    §  7.  The  superintendent of financial services, in consultation with
    33  the commissioner of health, and representatives of state-licensed health
    34  insurers, home care service agencies  and  consumers  (including  family
    35  members  of  consumers),  labor  organizations  representing  home  care
    36  service workers, and respective statewide associations or organizations,
    37  shall examine the terms of coverage for home care services as  specified
    38  in articles 32 and 43 of the insurance law and, on or before December 1,
    39  2023, report to the legislature and governor on the following:
    40    a. The extent to which these coverage terms, including coverage exclu-
    41  sions  as  well as riders that permit the purchase of expanded coverage,
    42  are aligned with state of the art medical and health system practice for
    43  providing in-home care;
    44    b. The extent to which state incentives  for  purchase  of  home  care
    45  service coverage, including expanded coverage, may be cost-beneficial to
    46  recipients,  to  the  health  care  system, and state medical assistance
    47  program specifically; and
    48    c. Recommendations for modifications of articles  32  and  43  of  the
    49  insurance  law,  and  such  other laws, including the public health law,
    50  workers' compensation law, social services law, mental hygiene  law  and
    51  elder  law, as would align the terms of home care coverage with state of
    52  the art medical and health system practices.
    53    § 8. This act shall take effect immediately; provided,  however,  that
    54  the  amendments  to subdivision 8 of section 4403-f of the public health
    55  law made by section six of this act shall be subject to  the  repeal  of
    56  such section and shall be deemed repealed therewith.