NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7013B
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:
The bill would authorize and direct the Commissioner of Health to notify
health plans about the Episodic payment system (EPS) for CHHA services.
This should help create more CHHA capacity, better enabling hospitals to
safely discharge patients.
SUMMARY OF PROVISIONS:
Section 1: Makes EPS available to Medicaid managed care, Child Health
Plus, and Essential Plans, enabling these plans recognize EPS as the
standard payment method while still allowing alternative payment models.
The Commissioner will also be required to notify managed care plans of
their responsibility to ensure enrolled members have access to certified
home health agency services.
Section 2: Establishes an immediate effective date.
JUSTIFICATION:
CHHAs provide vital post-acute care but currently face financial strain,
leading to many closures and reduced patient access. Since 2019:
20+ CHHAs have closed. According to Center for Medicare and Medicaid
services, Medicare CHHA admissions dropped in New York State nearly 25%.
Medicaid access has also reportedly declined significantly.
When compared to patients who receive CHHA services; those referred to
CHHAs who do not receive services stay in hospitals longer, are more
likely to be readmitted to hospitals, have higher mortality rates, and
cost Medicaid more money (largely from hospital readmissions). The
Episodic Payment System (EPS) has been the standard Medicaid payment for
CHHAs in New York since 2012 but has not been updated despite rising
costs. Additionally, managed care plans, which cover the vast majority
of CHHA Medicaid patients, often underpay CHHAs due to using other ways
to reimburse home health care services. CHHAs cannot afford to admit
poorly reimbursed cases, resulting in fewer CHHA admissions for low-in-
come patients. This bill allows the Department to modify the payment
system to be responsive to current factors and provides for managed care
plans to use that EPS system as a default for payment. Managed Care
plans are free to implement alternative payment systems as well as the
EPS.
FISCAL IMPLICATIONS:
This bill has no immediate fiscal impact
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
7013--B
2025-2026 Regular Sessions
IN ASSEMBLY
March 18, 2025
___________
Introduced by M. of A. PAULIN, WEPRIN, REYES, LUNSFORD, TAPIA,
SEAWRIGHT, GONZALEZ-ROJAS, McDONALD -- read once and referred to the
Committee on Health -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee -- again
reported from said committee with amendments, 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. Subdivision 13 of section 3614 of the public health law is
2 amended by adding a new paragraph (d) to read as follows:
3 (d) Notwithstanding any inconsistent law or regulation, by October
4 first, two thousand twenty-five and annually thereafter, the commis-
5 sioner shall make the system of episodic payments, including all pricing
6 mechanisms, available to all Medicaid managed care plans licensed to
7 operate in New York state, all child health insurance plans licensed to
8 operate under section twenty-five hundred eleven of this chapter, and
9 all Essential Plans authorized by section three hundred sixty-nine-gg of
10 the social services law. By October first, two thousand twenty-five and
11 annually thereafter, the commissioner shall notify all such managed care
12 plans of their responsibilities for ensuring that their enrolled members
13 have access to certified home health agency services; that such services
14 are critical to improving patient care and reducing overall costs,
15 particularly costs related to avoidable hospital use; and that episodic
16 payments as described in paragraph (a) of this subdivision are consid-
17 ered the standard method of certified home health agency payment by New
18 York state government agencies. Nothing in this paragraph shall preclude
19 a managed care plan and certified home health agency from agreeing upon
20 an alternative rate methodology and payment rate, including value-based
21 payments related to health outcome measurements.
22 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10053-04-5
