Kim, Simon, Rosenthal L, Ardila, Kelles, Gonzalez-Rojas, Raga
MLTSPNSR
Amd §§3600, 3614 & 4403-f, add §3603, Pub Health L; amd §365-a, Soc Serv L
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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4583A
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law and the social services law, in
relation to enacting the New York home care first act
PURPOSE OR GENERAL IDEA OF BILL:
To improve the integration of home care in primary care, public health,
and health care delivery planning.
SUMMARY OF SPECIFIC PROVISIONS:
The bill amends Public Health Law Article 36, ensure that home care
first (HCF) is a core health service option and principal alternative to
institutional care. The Declaration of legislative findings and intent
is updated and modernized. A new PHL § 3603 will require regulations to
assist referral for home care by hospitals, nursing homes, and practi-
tioners; comprehensive online public education tools; integration of
home care into the state's strategic health and public health plans; and
inclusion of home care in Departmental programs that provide capital,
infrastructure and workforce development funding.
The bill adds a new subdivision 11 to Social Services Law § 365-a to
include HCF requirements that individuals be presented the option to be
assessed and considered for care at home when medically appropriate and
before referral for institutional care from a hospital or community
setting.
The bill amends PHL § 3614 to ensure Medicaid reimbursement for home
telehealth under the home health episodic rate methodology, consistent
with the way telehealth is reimbursed for other sectors; and adds the
authority to disburse new workforce funding for recruitment, training,
retention, and occupational supports, with provisions to target shortage
areas and disciplines through rate-based and direct-to-agency payment
methods. And the bill amends PHL 4403-f to provide an upward adjustment
to managed long term care plan premiums for related costs.
Lastly, the bill directs the superintendent of financial services, in
consultation with the commissioner of health and representatives of
health plans, home care agencies and consumers, to report on whether
current health plan coverage for home care aligns with best-practices,
and to provide a cost-benefit analysis for any recommended modifications
JUSTIFICATION:
Decades ago, NY enacted the nation's first program for home care. Chap-
ter 895 of 1977 established the policy that home care be "a priority of
the state's actions". It required that home care be available to indi-
viduals according to their needs, particularly as an option to nursing
home care. In the last decade however, that focus has been lost. Home
care has been increasingly overlooked or relegated to peripheral status
in too many major programs such as the Delivery. System Reform Incentive
Payment program (DSRIP), the "State Health Improvement Plan," the exist-
ing and proposed Medicaid 1115 waivers.
The New York Home Care First Act offers coordination across state
programs, including managed care, system finance, the various Medicaid
waivers, capital and technology funds, indigent care, and preventive and
public health strategies to address the gaps that are paralyzing the
broader system, contributing to staffing shortages and wait lists for
persons who will fail without services.
Hundreds of thousands of NY's most vulnerable people - children, adults
and elderly - depend on these services, including thousands who are
designated "priority level one" patients requiring uninterrupted care.
Home care agencies and workers must be adequately supported to meet the
care goals of hundreds of thousands of patients. At the community level,
hospital discharges, rehabilitation regimens, local public health
departments, all key parts of the health delivery system depend on home
care services to collaboratively meet the community's needs.
PRIOR LEGISLATIVE HISTORY:
2021-2022: A 9148 reported to Ways & Means
FISCAL IMPLICATIONS:
Dependent on subsequent state budget actions.
EFFECTIVE DATE:
Immediately
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.
