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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7460A
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law, in relation to rates of payment
for certified home health agencies
PURPOSE:
Increases rates of payment for certified home health agencies
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends paragraph (b) of subdivision 13 of section 3614 of the
public health law as it relates to payments for certified home health
agencies. This section authorizes the commissioner to provide a 10%
increase in the base episodic payment from the available funds for the
Medical Assistant program. The commissioner may also authorize an
increase in the episodic payment level based on matters that are deemed
appropriate by the commissioner, including but not limited to inflation-
ary increases in the healthcare market, new program regulatory require-
ments, and staff recruitment and retention needs.
Section 2 adds a new section 3614-g to the public health law by adding
the legislative intent and establishing standards for home care services
payments.
Section 3 provides the effective date.
JUSTIFICATION:
Certified home health agencies (CHHAs) provide acute and post-acute
nursing and home health aide services other than long term care. In the
Medicaid program, episodic payments relate to a 60 day plan of care.
Other non-episodic service rates are subject to ceiling limitations that
were set in 2009. CHHAs have not received a payment rate trend adjust-
ment to either rate in over 12 years. During this time, unfunded
mandates, labor obligations, and operation costs have escalated.
Hospitals are under pressure to discharge patients sooner and in more
acute condition than in the past. The need for reliable CHHA services
has increased without a commensurate reimbursement. The vast majority of
New York's CHHAs have incurred ongoing, steep financial losses. for
purposes of system stability. This bill directs the Commissioner of
Health to establish a minimum benchmark for Medicaid payers. This bench-
mark rate would help ensure that home health agencies are able to oper-
ate at sustainable rates in order to provide services to the state's
frail and vulnerable populations.
LEGISLATIVE HISTORY:
2019-2020: S5915A/A7798A Gottfried
2021-2022: S2117A/A293A Gottfried
FISCAL IMPLICATIONS:
No fiscal implications in SFY 2023-2024
EFFECTIVE DATE:
This act shall be effective immediately
STATE OF NEW YORK
________________________________________________________________________
7460--A
2023-2024 Regular Sessions
IN ASSEMBLY
May 23, 2023
___________
Introduced by M. of A. PAULIN, REYES, CRUZ, DICKENS, BENEDETTO, SIMON,
LUPARDO, STIRPE, L. ROSENTHAL, COLTON, ZEBROWSKI, SEAWRIGHT, BUTTENS-
CHON, HEVESI, JACOBSON, THIELE, DINOWITZ, BRONSON, TAGUE, SAYEGH,
WEPRIN, TAYLOR, LEMONDES -- read once and referred to the Committee on
Health -- recommitted to the Committee on Health in accordance with
Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
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-four, the commissioner shall provide for a ten percent
20 increase in the base episodic payment, and in the individual rates for
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08058-04-4
A. 7460--A 2
1 services exempt from episodic payments under paragraph (a) of this
2 subdivision, from funds available for the Medical Assistance program.
3 Provided, further, that for rate years beginning April first, two thou-
4 sand twenty-four and after, the commissioner is authorized to increase
5 the episodic payment level for costs not reflected in the statewide
6 base, subject to the approval of the state budget director, including
7 the cost of: inflationary increases in the health care market basket
8 and/or consumer price index impacting providers; new state or federally
9 mandated program regulatory requirements; home care staff recruitment
10 and retention needs, particularly in shortage areas and disciplines;
11 facilitating provider capability to further align with state health
12 reform models and policy goals; health care clinical and information
13 technology investments approved by the commissioner; and other matters
14 the commissioner determines appropriate.
15 § 2. The public health law is amended by adding a new section 3614-g
16 to read as follows:
17 § 3614-g. Standards for home care services payments. 1. Legislative
18 intent. Adequate reimbursement for home care services is essential to
19 the policies set forth in section thirty-six hundred of this article as
20 well as state policies contingent on access, availability and quality of
21 these services. The degree of variability across state regulated home
22 care rates, episodic payments, fees for individual home care services,
23 and negotiated payments, leaves the home care system without a standard
24 basis of payment and stable revenue necessary to budget, plan and ensure
25 sustainability. To help ensure the home care system's viability to
26 deliver the needed services, the commissioner shall establish minimum
27 standards and a minimum benchmark within the Medicaid program for
28 payment of home health agency services, including the services of
29 subcontracting licensed home care services agencies, that can also serve
30 as the benchmark to be considered in rates paid by non-Medicaid third-
31 party payors.
32 2. Establishment of standards. Effective for rates issued April first,
33 two thousand twenty-four and for each rate year thereafter, the commis-
34 sioner shall establish minimum standards and a minimum benchmark for
35 home care service payment by any Medicaid payor. The commissioner shall
36 also post such standards and benchmark in an administrative directive to
37 the attention of all other third-party payors of home care services in
38 the state for considered use in payment of home care services. In estab-
39 lishing the benchmark, the commissioner shall utilize the rates estab-
40 lished under the episodic payment system under subdivision thirteen of
41 section thirty-six hundred fourteen of this article, and the individual
42 services rates established under such section.
43 § 3. This act shall take effect immediately.
