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.
STATE OF NEW YORK
________________________________________________________________________
2931--B
2023-2024 Regular Sessions
IN SENATE
January 25, 2023
___________
Introduced by Sens. RIVERA, ADDABBO, ASHBY, GALLIVAN, HOYLMAN-SIGAL --
read twice and ordered printed, and when printed to be committed to
the Committee on Health -- reported favorably from said committee and
committed to the Committee on Finance -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee -- recommitted to the Committee on Health in accordance with
Senate Rule 6, sec. 8 -- 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05278-04-4
S. 2931--B 2
1 departments and mental health providers in the provision of primary,
2 preventive, public health, pre-acute, post-acute and long-term care,
3 thereby avoiding prolonged institutionalization, concomitant high costs
4 and associated adverse social and medical implications.
5 The legislature intends that there be a public commitment to the
6 appropriate provision and [expansion] accessibility of services rendered
7 to the residents of the state by [certified] home [health] care services
8 agencies, [to] including financial and programmatic support for: the
9 maintenance of a consistently high level of services by all home care
10 services agencies[, to] and workforce; the recruitment, training,
11 compensation and retention of a capable and committed workforce; the
12 integration of home care provider roles in the state's strategic prima-
13 ry, preventive, public health and health care delivery planning and
14 programming; the central collection and public accessibility of informa-
15 tion concerning all organized home care services[,]; and [to] the
16 adequate regulation and coordination of existing home care services.
17 § 3. The public health law is amended by adding a new section 3603 to
18 read as follows:
19 § 3603. Home care policy; implementation. 1. The commissioner shall
20 make regulations, issue guidance and take actions reasonably necessary,
21 including coordinating with other state agencies, to promote the policy
22 under this article including, but not be limited to:
23 (a) information and referral guidance to be made available to hospi-
24 tals and nursing home discharge planners, health care professionals,
25 ambulatory surgical centers, mental health providers, county public
26 health departments and other applicable health care settings, to assist
27 in the consideration and referral of patients for home care services as
28 a primary or adjunctive service option. The information and guidance
29 shall also be made available for the purpose of assisting providers' and
30 practitioners' responsibilities under subdivision eleven of section
31 three hundred sixty-five-a (relating to eligibility for home care
32 services) of the social services law;
33 (b) the development of a comprehensive public education program about
34 home care services, including but not limited to: (i) a dedicated
35 portion of the department's website that describes and distinguishes
36 home care provider types offered or authorized by any state agency; (ii)
37 the types of services typically available by provider and program type
38 including home and community based waiver programs and consumer directed
39 personal assistance programs; (iii) home care third party benefits
40 provided under the insurance law for individual, small group and large
41 group non-public coverages, Medicaid, Medicare, and other state-sup-
42 ported public programs; (iv) the contact information by which consumers
43 may access home care services; and (v) the name and location of home
44 care service agencies throughout the state;
45 (c) the integration of home care provider roles in the state's strate-
46 gic primary, preventive, public health and health care delivery planning
47 and programming; and
48 (d) the inclusion of home care service providers in department
49 programs that provide support and funding for health care capital,
50 infrastructure, including electronic medical records and interoperabi-
51 lity, as well as direct point of service clinical technology, and work-
52 force development.
53 2. In implementing this section, the commissioner shall seek the input
54 of representatives of home care providers, hospitals and nursing homes,
55 health care professionals, health plans and insurers, consumers and
S. 2931--B 3
1 their family members and caregivers, and home care workers (including
2 labor organizations).
3 § 4. Section 365-a of the social services law is amended by adding a
4 new subdivision 11 to read as follows:
5 11. Home care services. If an individual eligible for services under
6 this title is determined under this article, by a health care profes-
7 sional, to be medically eligible for admission to a general hospital for
8 services other than acute or emergency services, or to a nursing home,
9 or the individual is being cared for in a general hospital or nursing
10 home and desires to receive care at home, and home care services would
11 be reasonably appropriate for the individual, the individual shall be
12 informed orally and in writing of the availability of home care services
13 available in the person's county of residence. If the individual
14 consents, an appropriate health care professional may refer the person
15 for a comprehensive assessment for home care services under this title.
16 Where the individual lacks capacity to make health care decisions, the
17 notice shall be made to, and consent may be made by, a person authorized
18 to make health care decisions for the individual.
19 § 5. Subdivision 3 and paragraphs (a) and (b) of subdivision 3-c of
20 section 3614 of the public health law, subdivision 3 as amended by chap-
21 ter 622 of the laws of 1988, paragraphs (a) and (b) of subdivision 3-c
22 as added by section 63-b of part C of chapter 58 of the laws of 2007,
23 are amended and three new subdivisions 1-a, 9-a and 15 are added to
24 read as follows:
25 1-a. Rates for home care services agencies and home care services
26 under this section shall be reasonable and reasonably related to the
27 cost of efficiently providing the services and assuring an adequate and
28 accessible supply of the services (including workforce recruitment,
29 training, compensation, retention and sufficiency); taking into consid-
30 eration the elements of cost, geographical differentials in the elements
31 of cost considered, economic factors in the area in which the services
32 are to be delivered.
33 3. Prior to the approval of [such] the rates, the commissioner shall
34 determine and certify to the state director of the budget that the
35 proposed rate schedules for payments for certified home health agency
36 services or services provided by long term home health care programs or
37 AIDS home care programs [are reasonably related to the costs of the
38 efficient production of such services. In making such certification, the
39 commissioner shall take into consideration the elements of cost,
40 geographical differentials in the elements of cost considered, economic
41 factors in the area in which the certified home health agency, provider
42 of a long term home health care program or provider of an AIDS home care
43 program is located, costs of certified home health agencies, providers
44 of long term home health care programs or providers of AIDS home care
45 programs of comparable size, and the need for incentives to improve
46 services and institute economies] meet the requirements of this section.
47 (a) [Demonstration rates] Rates of payment or fees shall be estab-
48 lished in compliance with this section for telehealth services provided
49 by a certified home health agency, a long term home health care program
50 or AIDS home care program, or for telehealth services by a licensed home
51 care services agency under contract with such an agency or program, in
52 order to ensure the availability of technology-based patient monitoring,
53 communication and health management. Reimbursement for telehealth
54 services provided [pursuant to] under this section shall be provided
55 [only in connection with Federal Food and Drug Administration-approved
56 and interoperable devices, and incorporated as part of the patient's
S. 2931--B 4
1 plan of care] for telehealth services described in this section, as well
2 as telehealth as defined in article twenty-nine-G of this chapter. The
3 commissioner shall seek federal financial participation with regard to
4 this [demonstration] initiative. Such reimbursement shall be provided as
5 either a separate rate from, or as a specified payment under, the meth-
6 odology under subdivision thirteen of this section.
7 (b) The purposes of [such] the services shall be to assist in the
8 effective monitoring and management of patients whose medical, func-
9 tional and/or environmental needs can be appropriately and cost-effec-
10 tively met at home through the application of telehealth intervention.
11 Reimbursement provided [pursuant to] under this subdivision shall be for
12 services to patients with conditions or clinical circumstances associ-
13 ated with the need for frequent monitoring, [and/or] the need for
14 frequent physician, skilled nursing or acute care services, [and] where
15 the provision of telehealth services can appropriately reduce the need
16 for on-site or in-office visits or acute or long term care facility
17 admissions, or where the telehealth services appropriately allow for a
18 home care service by means of telehealth technology instead of an
19 in-person visit by the home care services agency. [Such] The conditions
20 and clinical circumstances shall include, but not be limited to, conges-
21 tive heart failure, diabetes, chronic pulmonary obstructive disease,
22 wound care, polypharmacy, mental or behavioral problems limiting self-
23 management, and technology-dependent care such as continuous oxygen,
24 ventilator care, total parenteral nutrition or enteral feeding.
25 9-a. (a) Notwithstanding any inconsistent provision of this section,
26 effective for annual periods beginning July first, two thousand twenty-
27 five, the commissioner shall, subject to the availability of federal
28 financial participation and upon approval of the state director of the
29 budget, further adjust medical assistance rates of payment for home care
30 services agencies and home care services, including home care services
31 provided by entities qualifying under subdivision nine of this section,
32 targeted for increased salary and benefits for home health aides,
33 personal care aides and consumer directed personal assistants, as well
34 as for recruitment, training and retention of direct care workers for
35 services in shortage areas and by shortage disciplines which may include
36 nurses, therapists, social workers, home health aides and personal care
37 aides. The commissioner shall be further authorized, upon approval of
38 the state director of the budget, to utilize state funds, as available,
39 including federal COVID-19 relief funds allocated to New York, to
40 distribute as direct funding to home care service provider entities for
41 these purposes and personnel for services to medical assistance recipi-
42 ents.
43 (b) Rate adjustments and direct payments made under this subdivision
44 may also be provided to pilot test the impact on recruitment and
45 retention of allowing funds to be used for critical supports and incen-
46 tives for direct care personnel, including transportation, education,
47 training, child day care, career ladder, peer support, and other
48 supports which the commissioner may determine.
49 (c) On or before October first, two thousand twenty-six, the commis-
50 sioner shall report to the governor and legislature on the effectiveness
51 of this section in recruitment and retention of direct care home care
52 personnel, and in addressing community need, and shall make recommenda-
53 tions for the continuation or modification of the program. The commis-
54 sioner shall seek the input of representatives of the providers, plans,
55 consumers and workers in examining and reporting on the program.
S. 2931--B 5
1 15. Subject to the availability of federal financial participation and
2 approval of the state director of the budget, for home care services
3 provided on and after July first, two thousand twenty-five, the commis-
4 sioner shall adjust Medicaid rates of payment for home care service
5 agencies to address increases in reimbursement as may be required by
6 implementation of amendments to this article and subdivision eleven of
7 section three hundred sixty-five-a of the social services law made by
8 the chapter of the laws of two thousand twenty-four that added this
9 subdivision.
10 § 6. Subdivision 8 of section 4403-f of the public health law, as
11 amended by section 21 of part B of chapter 59 of the laws of 2016, is
12 amended to read as follows:
13 8. Payment rates for managed long term care plan enrollees eligible
14 for medical assistance. The commissioner shall establish payment rates
15 for services provided to enrollees eligible under title XIX of the
16 federal social security act. Such payment rates shall be subject to
17 approval by the director of the division of the budget and shall reflect
18 savings to both state and local governments when compared to costs which
19 would be incurred by such program if enrollees were to receive compara-
20 ble health and long term care services on a fee-for-service basis in the
21 geographic region in which such services are proposed to be provided.
22 Payment rates shall be risk-adjusted to take into account the character-
23 istics of enrollees, or proposed enrollees, including, but not limited
24 to: frailty, disability level, health and functional status, age,
25 gender, the nature of services provided to such enrollees, and other
26 factors as determined by the commissioner. The risk adjusted premiums
27 may also be combined with disincentives or requirements designed to
28 mitigate any incentives to obtain higher payment categories. In setting
29 such payment rates, the commissioner shall consider costs borne by the
30 managed care program to ensure actuarially sound and adequate rates of
31 payment to ensure quality of care shall comply with all applicable laws
32 and regulations, state and federal, including [regulations as to], but
33 not limited to, those relating to wages, labor and actuarial soundness
34 [for medicaid managed care]. For premiums effective on and after April
35 first, two thousand twenty-five, the commissioner shall further consider
36 increases to premiums to address cost and reimbursement adjustments
37 required by the department's implementation of the amendments to article
38 thirty-six of this chapter and section three hundred sixty-five-a of the
39 social services law made by the chapter of the laws of two thousand
40 twenty-four that amended this subdivision.
41 § 7. The superintendent of financial services, in consultation with
42 the commissioner of health, and representatives of state-licensed health
43 insurers, home care service agencies and consumers (including family
44 members of consumers), labor organizations representing home care
45 service workers, and respective statewide associations or organizations,
46 shall examine the terms of coverage for home care services as specified
47 in articles 32 and 43 of the insurance law and, on or before December 1,
48 2025, report to the legislature and governor on the following:
49 a. The extent to which these coverage terms, including coverage exclu-
50 sions as well as riders that permit the purchase of expanded coverage,
51 are aligned with state of the art medical and health system practice for
52 providing in-home care;
53 b. The extent to which state incentives for purchase of home care
54 service coverage, including expanded coverage, may be cost-beneficial to
55 recipients, to the health care system, and state medical assistance
56 program specifically; and
S. 2931--B 6
1 c. Recommendations for modifications of articles 32 and 43 of the
2 insurance law, and such other laws, including the public health law,
3 workers' compensation law, social services law, mental hygiene law and
4 elder law, as would align the terms of home care coverage with state of
5 the art medical and health system practices.
6 § 8. This act shall take effect immediately; provided, however, that
7 the amendments to subdivision 8 of section 4403-f of the public health
8 law made by section six of this act shall be subject to the repeal of
9 such section and shall be deemed repealed therewith.
