NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7013A
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 the Commissioner of Health to adjust Episodic
Payment System (EPS) rates and notify health plans about the EPS for
CHHA services. This should help create more CHHA capacity, better enabl-
ing hospitals to safely discharge patients.
SUMMARY OF PROVISIONS:
Section 1: Authorizes the Commissioner of Health to adjust Medicaid
Episodic Payment System (EPS) rates for CHHAs based on factors like
inflation, regulatory changes, and workforce needs.
*Section 2: 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.
*Section 3: 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 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--A
2025-2026 Regular Sessions
IN ASSEMBLY
March 18, 2025
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Health -- committee discharged, bill amended, 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. 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 and a new paragraph (d) is added to read as
4 follows:
5 (b) Initial base year episodic payments shall be based on Medicaid
6 paid claims, as determined and adjusted by the commissioner to achieve
7 savings comparable to the prior state fiscal year, for services provided
8 by all certified home health agencies in the base year two thousand
9 nine. Subsequent base year episodic payments may be based on Medicaid
10 paid claims for services provided by all certified home health agencies
11 in a base year subsequent to two thousand nine, as determined by the
12 commissioner, provided, however, that such base year adjustment shall be
13 made not less frequently than every three years. In determining case
14 mix, each patient shall be classified using a system based on measures
15 which may include, but not limited to, clinical and functional measures,
16 as reported on the federal Outcome and Assessment Information Set
17 (OASIS), as may be amended. Notwithstanding any inconsistent provision
18 of law or regulation to the contrary, the commissioner is authorized to
19 increase, as necessary, the episodic payment level for costs not
20 reflected in the statewide base, subject to the approval of the director
21 of the state division of budget, including the cost of: inflationary
22 increases in the health care market basket and/or consumer price index
23 impacting providers; new state or federally mandated program regulatory
24 requirements; home care staff recruitment and retention needs, partic-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10053-02-5
A. 7013--A 2
1 ularly in shortage areas and disciplines; facilitating provider capabil-
2 ity to further align with state health reform models and policy goals;
3 health care clinical and information technology investments; and any
4 other matters the commissioner determines appropriate.
5 (d) Notwithstanding any inconsistent law or regulation, by October
6 first, two thousand twenty-five and annually thereafter, the commis-
7 sioner shall make the system of episodic payments, including all pricing
8 mechanisms, available to all Medicaid managed care plans licensed to
9 operate in New York state, all child health insurance plans licensed to
10 operate under section twenty-five hundred eleven of this chapter, and
11 all Essential Plans authorized by section three hundred sixty-nine-gg of
12 the social services law. By October first, two thousand twenty-five and
13 annually thereafter, the commissioner shall notify all such managed care
14 plans of their responsibilities for ensuring that their enrolled members
15 have access to certified home health agency services; that such services
16 are critical to improving patient care and reducing overall costs,
17 particularly costs related to avoidable hospital use; and that episodic
18 payments as described in paragraph (a) of this subdivision are consid-
19 ered the standard method of certified home health agency payment by New
20 York state government agencies. Nothing in this paragraph shall preclude
21 a managed care plan and certified home health agency from agreeing upon
22 an alternative rate methodology and payment rate, including value-based
23 payments related to health outcome measurements.
24 § 2. This act shall take effect immediately.
