STATE OF NEW YORK
________________________________________________________________________
1807--A
2009-2010 Regular Sessions
IN ASSEMBLY
January 12, 2009
___________
Introduced by M. of A. GOTTFRIED, DINOWITZ, SCHIMEL, N. RIVERA, ROSEN-
THAL -- Multi-Sponsored by -- M. of A. TOWNS -- read once and referred
to the Committee on Health -- recommitted to the Committee on Health
in accordance with Assembly Rule 3, sec. 2 -- 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, in relation to rate of payment
for home health care programs using statewide average calculation
excluding certain costs
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 7 of section 3614 of the public health law, as
2 added by chapter 41 of the laws of 1992, the opening paragraph as
3 amended by section 18 of part C of chapter 109 of the laws of 2006, the
4 second undesignated paragraph as added by chapter 170 of the laws of
5 1994 and the third undesignated paragraph as added and the closing para-
6 graph as amended by chapter 59 of the laws of 1993, is amended to read
7 as follows:
8 7. (a) Notwithstanding any inconsistent provision of law or regu-
9 lation, for purposes of establishing rates of payment by governmental
10 agencies for certified home health agencies for the period April first,
11 nineteen hundred ninety-five through December thirty-first, nineteen
12 hundred ninety-five and for rate periods beginning on or after January
13 first, nineteen hundred ninety-six, the reimbursable base year adminis-
14 trative and general costs of a provider of services shall not exceed the
15 statewide average of total reimbursable base year administrative and
16 general costs of such providers of services; provided, however, that for
17 purposes of establishing such rates of payment for periods on and after
18 April first, two thousand ten, such statewide average calculation shall
19 exclude any costs reported and allocable as administrative and general
20 but attributable to the provision and management of patient care includ-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00404-03-0
A. 1807--A 2
1 ing, but not limited to, costs attributable to: patient outreach;
2 assessment; coordination and management of services; telephone and other
3 telehealth monitoring and communication; medical supplies; staff trans-
4 portation and escort services; family and/or informal caregiver support
5 services; patient recordkeeping; and technology investments for patient
6 care. The amount of such reduction in certified home health agency
7 rates of payments made during the period April first, nineteen hundred
8 ninety-five through March thirty-first, nineteen hundred ninety-six
9 shall be adjusted in the nineteen hundred ninety-six rate period on a
10 pro-rata basis, if it is determined upon post-audit review by June
11 fifteenth, nineteen hundred ninety-six and reconciliation that the
12 savings for the state share, excluding the federal and local government
13 shares, of medical assistance payments pursuant to title eleven of arti-
14 cle five of the social services law based on the limitation of such
15 payment pursuant to this subdivision is in excess of one million five
16 hundred thousand dollars or is less than one million five hundred thou-
17 sand dollars for payments made on or before March thirty-first, nineteen
18 hundred ninety-six to reflect the amount by which such savings are in
19 excess of or lower than one million five hundred thousand dollars. For
20 rate periods on and after January first, two thousand five through
21 December thirty-first, two thousand six, there shall be no such recon-
22 ciliation of the amount of savings in excess of or lower than one
23 million five hundred thousand dollars.
24 (b) No such limit shall be applied to a provider of services reim-
25 bursed on an initial budget basis, or a new provider, excluding changes
26 in ownership or changes in name, who begins operations in the year prior
27 to the year which is used as a base year in determining rates of
28 payment.
29 (c) For the purposes of this subdivision, reimbursable base year oper-
30 ational costs shall mean those base year operational costs remaining
31 after application of all other efficiency standards, including, but not
32 limited to, peer group cost ceilings or guidelines.
33 (d) The limitation on reimbursement for provider administrative and
34 general expenses provided by this subdivision shall be expressed as a
35 percentage reduction for the rate promulgated by the commissioner to
36 each certified home health agency and long term home health care program
37 provider; provided, however, that such reduction percentage shall not be
38 increased for any provider as a consequence of the exclusions provided
39 for in paragraph (a) of this subdivision.
40 § 2. The opening paragraph of subdivision 7 of section 3614 of the
41 public health law, as amended by chapter 170 of the laws of 1994, is
42 amended to read as follows:
43 (a) Notwithstanding any inconsistent provision of law or regulation to
44 the contrary, for purposes of establishing rates of payment by govern-
45 mental agencies for certified home health agencies and long term home
46 health care programs for rate period beginning on or after January
47 first, nineteen hundred ninety-five, the department of health may not by
48 rule or regulation limit the reimbursable base year administrative and
49 general costs of a provider of services to a percentage which is other
50 than thirty percent of total reimbursable base year operational costs of
51 such provider of services; provided, however, that for purposes of
52 establishing such rates of payment for periods on and after April first,
53 two thousand ten, such statewide average calculation shall exclude any
54 costs reported and allocable as administrative and general but attribut-
55 able to the provision and management of patient care including, but not
56 limited to, costs attributable to: patient outreach; assessment; coordi-
A. 1807--A 3
1 nation and management of services; telephone and other telehealth moni-
2 toring and communication; medical supplies; staff transportation and
3 escort services; family and/or informal caregiver support services;
4 patient recordkeeping; and technology investments for patient care.
5 § 3. Subdivision 7-a of section 3614 of the public health law, as
6 amended by section 89 of part C of chapter 58 of the laws of 2007 and
7 the opening paragraph as amended by section 46 of part B of chapter 58
8 of the laws of 2009, is amended to read as follows:
9 7-a. (a) Notwithstanding any inconsistent provision of law or regu-
10 lation, for the purposes of establishing rates of payment by govern-
11 mental agencies for long term home health care programs for the period
12 April first, two thousand five, through December thirty-first, two thou-
13 sand five, and for the period January first, two thousand six through
14 March thirty-first, two thousand seven, and on and after April first,
15 two thousand seven through March thirty-first, two thousand nine, and on
16 and after April first, two thousand nine through March thirty-first, two
17 thousand eleven, the reimbursable base year administrative and general
18 costs of a provider of services shall not exceed the statewide average
19 of total reimbursable base year administrative and general costs of such
20 providers of services; provided, however, that for the purposes of
21 establishing such rates of payment for periods on and after April first,
22 two thousand ten, such statewide average calculation shall exclude any
23 costs reported and allocable as administrative and general but attribut-
24 able to the provision and management of patient care including, but not
25 limited to, costs attributable to: patient outreach; assessment; coordi-
26 nation and management of services; telephone and other telehealth moni-
27 toring and communication; medical supplies; staff transportation and
28 escort services; family and/or informal caregiver support services;
29 patient recordkeeping; and technology investments for patient care.
30 (b) No such limit shall be applied to a provider of services reim-
31 bursed on an initial budget basis, or a new provider, excluding changes
32 in ownership or changes in name, who begins operations in the year prior
33 to the year which is used as a base year in determining rates of
34 payment.
35 (c) For the purposes of this subdivision, reimbursable base year oper-
36 ational costs shall mean those base year operational costs remaining
37 after application of all other efficiency standards, including, but not
38 limited to, cost guidelines.
39 (d) The limitation on reimbursement for provider administrative and
40 general expenses provided by this subdivision shall be expressed as a
41 percentage reduction for the rate promulgated by the commissioner to
42 each long term home health care program provider; provided, however,
43 that such reduction percentage shall not be increased for any provider
44 as a consequence of the exclusions provided for in paragraph (a) of this
45 subdivision.
46 § 4. This act shall take effect on the first of April next succeeding
47 the date on which it shall have become law; provided, however, that the
48 amendments to the opening paragraph of subdivision 7 of section 3614 of
49 the public health law made by section one of this act shall be subject
50 to the expiration and reversion of such opening paragraph pursuant to
51 section 64-b and subdivision 5-a of section 246 of chapter 81 of the
52 laws of 1995, as amended, when upon such date the provisions of section
53 two of this act shall take effect.
