STATE OF NEW YORK
________________________________________________________________________
7193
IN SENATE
March 19, 2010
___________
Introduced by Sen. DUANE -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to establishing the
New York state home care quality of care innovations initiative; and
to amend the state finance law, in relation to establishing New York
state home care quality innovations initiative fund
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new section
2 3616-b to read as follows:
3 § 3616-b. New York state home care quality of care innovations initi-
4 ative. 1. The legislature hereby finds and declares that with the
5 advancement of clinical techniques and the improvements in data, tech-
6 nology and measurement of clinical practices and outcomes, new and
7 significant opportunities exist for quality of care innovation, with
8 consequent benefits for patients, the health care system and potential
9 for cost-savings for all payers. The legislature further finds that with
10 the increasing, central role of home care in the total care of all types
11 of patients, the support of quality innovation in connection with care
12 in the home should be a vital focus for advancing these opportunities.
13 The legislature finds that methods of advancing these opportunities
14 through home care, both directly through home care agencies and through
15 home care's collaboration with hospitals, physicians and others, include
16 but are not limited to: (a) the development, targeted application and
17 utilization of clinical guidelines and evidence based practices tailored
18 to specific conditions, populations and circumstances of care; (b) the
19 application of specific technology as a basic standard of care for
20 certain conditions; (c) identifying and addressing gaps and other
21 aspects affecting transitions in care, especially transitions to and
22 from home care and hospitals, nursing homes, rehabilitation centers and
23 other settings; and (d) targeting the contributing factors to hospital
24 readmissions and promoting appropriate interventions to prevent and
25 reduce such readmissions.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD16497-01-0
S. 7193 2
1 The legislature finds that such innovations necessitate the state's
2 investment in and voluntary engagement of home care agencies, their
3 patients and collaborative providers, and that the active support and
4 partnership of the department is conducive to the goal of these inno-
5 vations and, as such, in the strong interest of the citizens of the
6 state.
7 The legislature therefore concludes that the state establish the "home
8 care quality of care innovations initiative" to promote and support
9 these activities and interventions.
10 2. There is hereby created the New York state home care quality of
11 care innovations initiative, which hereinafter may be referred to as
12 "initiative." Such initiative is created for the purpose of promoting
13 quality innovations in the care of patients at home to improve overall
14 care management, patient outcomes, patient/caregiver self-management of
15 chronic conditions and potential cost-effectiveness of care. Such initi-
16 ative shall be undertaken to inform and support, and not be employed to
17 supersede clinical judgment about the provision or management of care.
18 3. Such initiative shall include but not be limited to: (a) promoting
19 the development, application, utilization and research of clinical
20 guidelines and evidence based practices in connection with the care of
21 patients at home;
22 (b) promoting the use of technology in conjunction with clinical
23 criteria and evidence based practices for the advancement of quality
24 care;
25 (c) promoting quality transitions in care, including but not limited
26 to transitions to and from home-based care and to hospitals, nursing
27 homes, rehabilitation centers and other settings, as well as transitions
28 to and from different home care programs;
29 (d) identifying gaps and other elements of the system which contribute
30 to avoidable hospital readmissions, including medication reconciliation,
31 and targeting intervention to prevent and reduce such readmissions;
32 (e) identifying the cost-effectiveness of the application of such
33 quality innovations for governmental and nongovernmental payers; and
34 (f) researching clinical protocols, programs, practices and outcomes
35 to identify additional areas and methods for developing and promoting
36 quality innovations.
37 4. (a) Such initiative shall be undertaken with voluntarily partic-
38 ipating certified home health agencies, long term home health care
39 programs, licensed home care services agencies and AIDS home care
40 programs, and shall include such agencies or programs contained within
41 or under contract with managed long term care plans. Such initiatives
42 may include such agencies' and programs' collaboration with physicians,
43 hospitals and other providers or entities.
44 (b) Such initiative may also include the participation of: a non-pro-
45 vider entity with expertise in performing quality and utilization review
46 for home health care as well as studies or demonstrations for improved
47 transitions in care; an entity which serves as a national accrediting
48 body for home health agencies; and, a statewide trade association most
49 broadly representative of home care agencies and programs certified by
50 Medicare and Medicaid in the state, including certified home health
51 agencies and long term home health care programs.
52 5. The department shall convene an advisory group of representatives
53 of participating providers and programs as well as statewide associ-
54 ations representative of such providers and their consumers to guide the
55 implementation of each component of the initiative. The advisory group
56 may also include representatives of physicians, hospitals and third-par-
S. 7193 3
1 ty payors and others which the department deems appropriate and consist-
2 ent with the purposes of this section.
3 6. The department shall work with the advisory group to: (a) identify
4 clinical guidelines and evidence based practices to be researched and/or
5 promoted through the initiative, which shall include the consideration
6 of nationally developed guidelines and practices as well as those devel-
7 oped or evidenced on a provider-specific basis;
8 (b) identify types of technology and areas where the application and
9 coverage of such technology should be considered as a standard of care;
10 (c) identify elements to be addressed in improving transitions of care
11 as well as for preventing avoidable rehospitalizations, and the corre-
12 sponding methods for addressing such elements;
13 (d) conduct provider/consumer education, including that of provider
14 quality improvement personnel, relative to the utilization of clinical
15 guidelines, evidence based practices, application of technology, the
16 implementation of strategies to improve transitions in care and inter-
17 ventions to prevent or reduce hospital readmissions;
18 (e) determine data to be shared with providers which would further the
19 goals of clinical guideline identification, development and/or use and
20 improvement in transitions in care;
21 (f) identify and respond as practicable to the technical assistance
22 needs of providers participating in the initiative;
23 (g) implement the grant program provided for in subdivision seven of
24 this section;
25 (h) determine and recommend positive adjustments in the Medicaid rate
26 methodology to enable and encourage desired provider behavior and goals
27 with regard to quality innovation and enhancement pursuant to this
28 section; and
29 (i) identify areas for research pursuant to this section and foster
30 such other activities as the department in conjunction with the work-
31 group deem to be necessary, appropriate and consistent with the goals of
32 this section.
33 7. (a) The department is hereby authorized, from any funds appropri-
34 ated therefor, including funds from the New York state home care quality
35 of care innovations initiative fund pursuant to section ninety-nine-t of
36 the state finance law, to issue grants to providers and participating
37 entities to assist in meeting the costs of planning, implementing,
38 and/or conducting quality innovations pursuant to this section.
39 (b) The department shall award such grants based on criteria and
40 priorities established in consultation with the advisory group estab-
41 lished pursuant to subdivision four of this section.
42 (c) Grants awarded under this section may be renewed subject to the
43 availability of funds.
44 (d) Notwithstanding the provisions of section one hundred twelve or
45 one hundred thirteen of the state finance law, the department may issue
46 grants to participants specified in paragraph (b) of subdivision four of
47 this section without a competitive bid process.
48 8. Notwithstanding the provisions of subdivisions seven and seven-a of
49 section three thousand fourteen of this article, provider costs associ-
50 ated with the participation in the quality innovations initiative pursu-
51 ant to this section shall not be included in or subject to the statewide
52 average administrative and general cost limitation applied pursuant to
53 such subdivisions.
54 9. The commissioner is authorized to waive provisions of the depart-
55 ment's rules and regulations, as well as rules and regulations promul-
56 gated pursuant to the social services law, as may be necessary and
S. 7193 4
1 appropriate to facilitate the implementation and goals of this section,
2 including the goal of improving the cost-effectiveness to payers;
3 provided however that no rules or regulations shall be waived which
4 would remove or diminish rights afforded to providers or consumers of
5 care.
6 10. The department shall report to the governor and legislature
7 regarding the effects on quality, cost and utilization under the initi-
8 ative. Such report shall be filed on or before December first, two thou-
9 sand eleven.
10 § 2. The state finance law is amended by adding a new section 99-t to
11 read as follows:
12 § 99-t. New York state home care quality of care innovations initi-
13 ative fund. 1. There is hereby established in the joint custody of the
14 state comptroller and commissioner of taxation and finance a special
15 fund to be known as the "New York state home care quality of care inno-
16 vations initiative fund".
17 2. Such fund shall consist of all moneys appropriated for the purpose
18 of such fund and any grant, gift or bequest made for purposes of home
19 care quality of care innovations pursuant to section thirty-six hundred
20 sixteen-b of the public health law.
21 3. Monies of the fund shall be made available to the commissioner of
22 health for the purpose of providing grants and for the expenses of the
23 department pursuant to the New York state home care quality of care
24 innovations initiative as added by section thirty-six hundred sixteen-b
25 of the public health law.
26 4. The monies of the fund shall be paid out on the audit and warrant
27 of the comptroller on vouchers certified or approved by the commissioner
28 of health, or by an officer or employee of the department of health
29 designated by such commissioner.
30 § 3. This act shall take effect immediately.
