NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7798A
SPONSOR: Gottfried TITLE OF BILL:
An act to amend the public health law, in relation to rates of payment
for certified home health agencies
PURPOSE OR GENERAL IDEA OF BILL:
Provide a 10% increase in the base episodic rates and the individual
rates for Medicaid payments to certified home health agencies (CHHA),
and establish suggested rate standards for other third-party payers.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends Public Health Law section 3614 to authorize a ten
percent increase in the base episodic payment and in the individual
rates for other services that are exempt from episodic payments, subject
to inflationary increase in the health care market basket and/or consum-
er price index, and the approval of the State Budget Director.
Section 2 amends Public Health Law section 3614 to establish and make
public for the use of other third-party payers, suggested standards and
benchmark for payments for CHHA services.
JUSTIFICATION:
Certified home health agencies (CHHAs) provide acute and post-acute
nursing and home health aide services other than long term care. In the
Medicaid program, episodic payments relate to a 60 day plan of care.
Other non-episodic service rates are subject to ceiling limitations that
were set in 2009. Unlike other Medicaid service providers, CHHAs have
not received a payment rate trend adjustment to either rate in over ten
years. During this time, unfunded mandates, labor obligations, and oper-
ation costs have escalated.
Beyond Medicaid, other insurers pay rates that vary widely and unpre-
dictably. Hospitals are under pressure to discharge patients sooner and
in more acute condition than in the past. The need to for reliable CHHA
services has increased without a commensurate reimbursement. The vast
majority of New York's CHHAs have incurred ongoing, steep financial
losses
Benchmarking is a method of equalizing payment rates within the Medicaid
service system for purposes of system stability. This bill directs the
Commissioner of Health to establish a minimum benchmark for Medicaid
payers and to post the benchmarks for other third-party payers' use.
This benchmark would ensure that home health agencies are able to oper-
ate at sustainable rates in order to provide services to the state's
frail and vulnerable populations.
PRIOR LEGISLATIVE HISTORY:
New.
FISCAL IMPLICATIONS:
To be determined
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
7798--A
2019-2020 Regular Sessions
IN ASSEMBLY
May 23, 2019
___________
Introduced by M. of A. GOTTFRIED, McDONALD, REYES, PERRY, CRUZ, DICKENS,
NIOU, BENEDETTO, SIMON, ABINANTI, LUPARDO, STIRPE, L. ROSENTHAL,
COLTON, BARRON, CYMBROWITZ, ZEBROWSKI, SEAWRIGHT, BUTTENSCHON, SIMO-
TAS, McDONOUGH, MONTESANO, FRONTUS, CRESPO, HEVESI, JACOBSON, THIELE,
BURKE, DINOWITZ, MOSLEY, ORTIZ, BRONSON, RODRIGUEZ, GRIFFIN, TAGUE,
LENTOL -- read once and referred to the Committee on Health -- recom-
mitted to the Committee on Health in accordance with Assembly Rule 3,
sec. 2 -- 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11759-03-0
A. 7798--A 2
1 thousand twenty, the commissioner shall provide for a ten percent
2 increase in the base episodic payment, and in the individual rates for
3 services exempt from episodic payments under paragraph (a) of this
4 subdivision, from funds available for the Medical Assistance program.
5 Provided, further, that for rate years beginning April first, two thou-
6 sand twenty and after, the commissioner is authorized to increase the
7 episodic payment level for costs not reflected in the statewide base,
8 subject to the approval of the state budget director, including the cost
9 of: inflationary increases in the health care market basket and/or
10 consumer price index impacting providers; new state or federally
11 mandated program regulatory requirements; home care staff recruitment
12 and retention needs, particularly in shortage areas and disciplines;
13 facilitating provider capability to further align with state health
14 reform models and policy goals; health care clinical and information
15 technology investments approved by the commissioner; and other matters
16 the commissioner determines appropriate.
17 § 2. The public health law is amended by adding a new section 3614-f
18 to read as follows:
19 § 3614-f. Standards for home care services payments. 1. Legislative
20 intent. Adequate reimbursement for home care services is essential to
21 the policies set forth in section thirty-six hundred of this article as
22 well as state policies contingent on access, availability and quality of
23 these services. The degree of variability across state regulated home
24 care rates, episodic payments, fees for individual home care services,
25 and negotiated payments, leaves the home care system without a standard
26 basis of payment and stable revenue necessary to budget, plan and ensure
27 sustainability. To help ensure the home care system's viability to
28 deliver the needed services, the commissioner shall establish minimum
29 standards and a minimum benchmark within the Medicaid program for
30 payment of home health agency services, including the services of
31 subcontracting licensed home care services agencies, that can also serve
32 as the benchmark to be considered in rates paid by non-Medicaid third-
33 party payors.
34 2. Establishment of standards. Effective for rates issued April first,
35 two thousand twenty and for each rate year thereafter, the commissioner
36 shall establish minimum standards and a minimum benchmark for home care
37 service payment by any Medicaid payor. The commissioner shall also post
38 such standards and benchmark in an administrative directive to the
39 attention of all other third-party payors of home care services in the
40 state for considered use in payment of home care services. In establish-
41 ing the benchmark, the commissioner shall utilize the rates established
42 under the episodic payment system under subdivision thirteen of section
43 thirty-six hundred fourteen of this article, and the individual services
44 rates established under such section.
45 § 3. This act shall take effect immediately.
