Provides increases in the rates of payment for certified home health agencies; directs the commissioner of health to establish minimum standards and a minimum benchmark for home care service payments by any Medicaid payor.
STATE OF NEW YORK
________________________________________________________________________
2117--A
2021-2022 Regular Sessions
IN SENATE
January 19, 2021
___________
Introduced by Sens. RIVERA, COMRIE, HOYLMAN, JACKSON, SAVINO, SEPULVEDA,
STAVISKY -- read twice and ordered printed, and when printed to be
committed to the Committee on Health -- 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, 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 to read as follows:
4 (b) Initial base year episodic payments shall be based on Medicaid
5 paid claims, as determined and adjusted by the commissioner to achieve
6 savings comparable to the prior state fiscal year, for services provided
7 by all certified home health agencies in the base year two thousand
8 nine. Subsequent base year episodic payments may be based on Medicaid
9 paid claims for services provided by all certified home health agencies
10 in a base year subsequent to two thousand nine, as determined by the
11 commissioner, provided, however, that such base year adjustment shall be
12 made not less frequently than every three years. In determining case
13 mix, each patient shall be classified using a system based on measures
14 which may include, but not limited to, clinical and functional measures,
15 as reported on the federal Outcome and Assessment Information Set
16 (OASIS), as may be amended. Notwithstanding any inconsistent provision
17 of law or regulation, in addition to the base year adjustment provided
18 for in this paragraph, for the rate year commencing April first, two
19 thousand twenty-two, the commissioner shall provide for a ten percent
20 increase in the base episodic payment, and in the individual rates for
21 services exempt from episodic payments under paragraph (a) of this
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00388-03-2
S. 2117--A 2
1 subdivision, from funds available for the Medical Assistance program.
2 Provided, further, that for rate years beginning April first, two thou-
3 sand twenty-two and after, the commissioner is authorized to increase
4 the episodic payment level for costs not reflected in the statewide
5 base, subject to the approval of the state budget director, including
6 the cost of: inflationary increases in the health care market basket
7 and/or consumer price index impacting providers; new state or federally
8 mandated program regulatory requirements; home care staff recruitment
9 and retention needs, particularly in shortage areas and disciplines;
10 facilitating provider capability to further align with state health
11 reform models and policy goals; health care clinical and information
12 technology investments approved by the commissioner; and other matters
13 the commissioner determines appropriate.
14 § 2. The public health law is amended by adding a new section 3614-f
15 to read as follows:
16 § 3614-f. Standards for home care services payments. 1. Legislative
17 intent. Adequate reimbursement for home care services is essential to
18 the policies set forth in section thirty-six hundred of this article as
19 well as state policies contingent on access, availability and quality of
20 these services. The degree of variability across state regulated home
21 care rates, episodic payments, fees for individual home care services,
22 and negotiated payments, leaves the home care system without a standard
23 basis of payment and stable revenue necessary to budget, plan and ensure
24 sustainability. To help ensure the home care system's viability to
25 deliver the needed services, the commissioner shall establish minimum
26 standards and a minimum benchmark within the Medicaid program for
27 payment of home health agency services, including the services of
28 subcontracting licensed home care services agencies, that can also serve
29 as the benchmark to be considered in rates paid by non-Medicaid third-
30 party payors.
31 2. Establishment of standards. Effective for rates issued April first,
32 two thousand twenty-two and for each rate year thereafter, the commis-
33 sioner shall establish minimum standards and a minimum benchmark for
34 home care service payment by any Medicaid payor. The commissioner shall
35 also post such standards and benchmark in an administrative directive to
36 the attention of all other third-party payors of home care services in
37 the state for considered use in payment of home care services. In estab-
38 lishing the benchmark, the commissioner shall utilize the rates estab-
39 lished under the episodic payment system under subdivision thirteen of
40 section thirty-six hundred fourteen of this article, and the individual
41 services rates established under such section.
42 § 3. This act shall take effect immediately.