NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8171
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law, in relation to
rebasing of the episodic reimbursement methodology for certified home
health agencies
PURPOSE OR GENERAL IDEA OF BILL: To ensure that the state's planned
rebasing of the episodic pricing system (EPS) does not result in
reimbursement cuts for home health patient services that would exceed
cut levels projected in the 2015-16 state fiscal plan.
SUMMARY OF SPECIFIC PROVISIONS: Section one amends the public health
law provisions for state rebasing of EPS to ensure that any aggregate
cut in reimbursement for home health services for Medicaid patients that
stem from rebasing does not exceed amounts projected in the 2015-16
state fiscal plan (or $30 million).
Section 2 establishes an April 1, 2015 effective date for the bill,
consistent with the state budget and the planned start date of the
rebased EPS.
JUSTIFICATION: The 2011 state budget established an episodic pricing
system for reimbursement of home health care for Medicaid patients, with
this new system taking effect May 2012. As part of EPS, the statute
required DOH to update the base year used to set the EPS prices at least
every 3 years, thus triggering the first rebasing for 2015.
DOH's calculations for the fiscal impact of this 2015 EPS rebasing were
incorporated into the 201516 state budget. Those calculations reflected
a cut in EPS Medicaid reimbursement for home health of $30 million.
However, no actual language was included in the state budget to set
forth or limit the actual amount of the home health cut to comport to
the fiscal plan.
As DOH now prepares for implementation of the rebased EPS during the
course of this fiscal year, this bill will ensure that any reductions
from this rebasing (which will cut home health retroactive to April 1)
not exceed levels exacted under the state fiscal plan. This is especial-
ly critical in light of the state's major new health care models and
policies also being implemented which directly depend upon home care
services, and which require home care investment.
PRIOR LEGISLATIVE HISTORY: New bill
FISCAL IMPLICATIONS: None; comports with fiscal plan adopted with the
2015-16 state budget
EFFECTIVE DATE:. The bill would become effective April 1, 2015
consistent with the effective date of the state budget and the EPS
rebasing.
STATE OF NEW YORK
________________________________________________________________________
8171
2015-2016 Regular Sessions
IN ASSEMBLY
June 10, 2015
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, in relation to rebasing of the
episodic reimbursement methodology 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; and provided further
13 that, for the period April first, two thousand fifteen through March
14 thirty-first, two thousand sixteen, the statewide negative impact on
15 total episodic payments resulting from the base year adjustment required
16 under this paragraph shall in no event exceed thirty million dollars. In
17 determining case mix, each patient shall be classified using a system
18 based on measures which may include, but not limited to, clinical and
19 functional measures, as reported on the federal Outcome and Assessment
20 Information Set (OASIS), as may be amended.
21 § 2. This act shall take effect immediately and shall be deemed to
22 have been in full force and effect on and after April 1, 2015.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11587-01-5
