A06367 Summary:

BILL NOA06367
 
SAME ASNo Same As
 
SPONSORButtenschon
 
COSPNSRCruz, Jackson, Williams
 
MLTSPNSR
 
Amd §§4406-c & 2801-a, Pub Health L; amd §3224-a, Ins L; amd §§1676 & 1680, Pub Auth L
 
Requires contracts with home care service providers to provide sufficient resources to ensure compensation to a qualified workforce providing high quality care; authorizes the commissioner of health to establish a program to provide loans, through the dormitory authority, to home care facilities to finance health care reform efforts.
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A06367 Actions:

BILL NOA06367
 
03/04/2025referred to health
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A06367 Committee Votes:

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A06367 Floor Votes:

There are no votes for this bill in this legislative session.
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A06367 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A6367
 
SPONSOR: Buttenschon
  TITLE OF BILL: An act to amend the public health law, the insurance law and the public authorities law, in relation to payments to home care services providers and authorizing the commissioner of health to establish a program to provide loans, through the dormitory authority, to home care to finance health care reform efforts   PURPOSE OR GENERAL IDEA OF BILL: This bill will address payment challenges for home care during the tran- sition from fee for service to managed care by ensuring managed care contracts support wage parity, providing for prompt payments, authoriz- ing the Department of Health and the Dormitory Authority to establish a program offering credit enhancement to allow access to capital for home care providers that are unable to borrow money from conventional lenders to invest in necessary health reform initiatives.   SUMMARY OF PROVISIONS: Section one adds a new § 4406-c.(9) to the PHL to ensure that funds made available to licensed home care service programs, certified home health agencies, long term home health care programs and consumer directed personal assistance services through contracts with health care plans shall provide compensation sufficient to support compensation for persons providing such home care aide services and consumer directed personal assistance services to ensure the retention of a qualified workforce. Section two amends § 3224-a of the insurance law to provide for payment for services to health care providers licensed under article thirty six of the public health law or fiscal intermediaries operating pursuant to section three hundred sixty-five-f of the social services law rendered during the transition from fee for service to Medicaid managed long term. This section also requires payment to such providers of disputed claims and provides for access to arbitration pursuant article seventy five of the civil practice law and rules by insurers or organizations or corporations licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law. Section three adds a new subdivision (17) to Public Health Law (PHL) § 2801-a. This subdivision authorizes the commissioner of Health to create the program and specifies that it applies to health care providers licensed or certified pursuant to article thirty-six of the public health law that lack the credit resources necessary to transition from fee for service to managed long term etre consistent with the goals of the state's Medicaid program multi-year action as adopted by the Medi- caid Redesign team. Applicants to the program must submit a comprehen- sive program and business plan, and such plan must promote agreed objec- tives of transition. The credit enhancement program shall be administered by the Dormitory Authority, or a not-for-profit designated by the Dormitory Authority. This section also authorizes an optional debt service reserve fund to pre-fund potential obligations in the event of a default. In the event of a default by a borrower, funds would be drawn from health reform funding made available to New York by the federal government under the proposed Section 1115 waiver funds, other ACA health reform funds provided to N.Y, or other allocated funds. This paragraph clarifies that under no circumstances are the potential State payments to be considered a general obligation of the State. Sections four and five amend Public Authorities Law 1676(b) (2) and 1680(1), respectively, to health care providers licensed or certified by article thirty-six as are approved for the credit enhancement program pursuant to PHL § 2801-a(17). Section six provides that this act shall take effect immediately.   JUSTIFICATION: This legislation aims to ensure that the home care system in New York, which has been hit with hundreds of millions of dollars in cuts, unfunded wage mandates, the transition to managed long term care, a devastating storm and rate recoupments in 2012 of $250 million, has the necessary system supports to ensure a stable and successful transition from fee for service medicaid to managed long term care. Providers, workers and patients are,shifting into a new system of managed long term care with fewer resources while working hard to maintain the high quali- ty of home care which New York State is regarded for across the country. Currently, agencies seeking to pay home care wage parity rates or other wages and benefits as required by law are not guaranteed the proper payment amounts by managed long term care entities. In addition, agen- cies are reporting exploding accounts receivables from lags in the payment of claims under managed care and the frequent rejection of the payment of claims. The transition from fee for service to managed care has created myriad complications with billing and payment for services rendered and the providers of services are often left unpaid because of transition issues. This has led many agencies into financial and cash flow crises impacting workers and more importantly the patients they serve. This legislation will provide for more timely cash flow and payments while disputes are arbitrated by insurers if deemed appropri- ate. This proposal also facilitates access to capital to support reform initiatives as it relates to transitions from fee for service to Medi- caid managed long term care. It includes capital financing to providers that have chronic financial challenges and are consequently unsuccessful in accessing capital to undertake reform initiatives. It would allow home care providers to finance capital investments at a lower cost, therefore providing added savings for the New York health care system. Funding under the program would be for the full spectrum of transition needs including operational/business changes to adapt to the new care management system, health information technology, "soft" costs, working capital, and care management infrastructure development. The provisions of this legislation combined attempts to assist patients, workers and providers in keeping the promise to people facing illness or disability - maintaining their independence in the comfort, security and privacy of their homes - by providing system support during this time of transition and financial uncertainty.   PRIOR LEGISLATIVE HISTORY: 2023-2024: A.1331 - Referred to Health 2021-2022: A.1137 - Referred to Health 2019-2020: A.7180 - Referred to Health 2017-2018: A.3312 - Referred to Health 2015-2016: A.2332 - Referred to Health/S.3262- Referred to Health 2013-2014: A.7530 - Referred to Health/S.5331- Referred to Health   FISCAL IMPLICATIONS: No net fiscal impact. The State obligation to pay any funds is contin- gent upon a borrower's default in repayment to a lender, which may never occur. In the event a default did occur, payments by the State would be made to the lender solely from allocated funds from the 1115 waiver or other federal health reform funds, or other allocated funds.   EFFECTIVE DATE: This act shall take effect immediately.
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A06367 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6367
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                      March 4, 2025
                                       ___________
 
        Introduced by M. of A. BUTTENSCHON, CRUZ, JACKSON, WILLIAMS -- read once
          and referred to the Committee on Health
 
        AN  ACT to amend the public health law, the insurance law and the public
          authorities law, in relation to payments to home care services provid-
          ers and authorizing the commissioner of health to establish a  program
          to  provide  loans,  through  the dormitory authority, to home care to
          finance health care reform efforts
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Section  4406-c  of  the  public health law is amended by
     2  adding a new subdivision 14 to read as follows:
     3    14. Notwithstanding any inconsistent provision of law, contracts  with
     4  certified  home  health  agencies,  long term home health care programs,
     5  licensed home care services programs or fiscal intermediaries  operating
     6  pursuant  to  section  three hundred sixty-five-f of the social services
     7  law to provide home care aide services as defined in section  thirty-six
     8  hundred  fourteen-c  of  this  chapter,  or  consumer  directed personal
     9  assistance services as authorized  pursuant  to  section  three  hundred
    10  sixty-five-f  of  the social services law shall at a minimum ensure that
    11  the resources made available by such  contracts  shall  support  compen-
    12  sation  for  persons providing such home care aide services and consumer
    13  directed personal assistance services to ensure the retention of a qual-
    14  ified workforce capable of providing high quality care to recipients  of
    15  such services consistent with the provisions of such section.
    16    § 2. Subsection (a) of section 3224-a of the insurance law, as amended
    17  by chapter 237 of the laws of 2009, is amended to read as follows:
    18    (a)  Except  in a case where the obligation of an insurer or an organ-
    19  ization or corporation licensed or certified pursuant to article  forty-
    20  three or forty-seven of this chapter or article forty-four of the public
    21  health  law to pay a claim submitted by a policyholder or person covered
    22  under such policy ("covered person") or make a payment to a health  care
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10353-01-5

        A. 6367                             2
 
     1  provider  is  not  reasonably clear, or when there is a reasonable basis
     2  supported by specific information available for  review  by  the  super-
     3  intendent  that such claim or bill for health care services rendered was
     4  submitted  fraudulently,  such  insurer  or  organization or corporation
     5  shall pay the claim to a  policyholder  or  covered  person  or  make  a
     6  payment  to  a  health  care provider within thirty days of receipt of a
     7  claim or bill for services rendered that is transmitted via the internet
     8  or electronic mail, or forty-five days of receipt of a claim or bill for
     9  services rendered that is submitted by other means,  such  as  paper  or
    10  facsimile.  Provided,  however,  any payment for services to health care
    11  providers licensed under article thirty-six of the public health law  or
    12  fiscal  intermediaries  operating  pursuant  to  section  three  hundred
    13  sixty-five-f of the social services law shall  be  paid  within  fifteen
    14  days  of  the  receipt of a claim or a bill for services rendered during
    15  the transition period from fee for service to Medicaid managed long term
    16  care consistent with the  state  Medicaid  plan  for  such  health  care
    17  providers and for the twelve month period beyond the final transition of
    18  Medicaid  beneficiaries  in  that  county. In addition, payments for any
    19  disputed claim or bill for services shall be paid to  such  health  care
    20  providers  by  an  insurer or an organization or corporation licensed or
    21  certified pursuant to article forty-three or forty-seven of this chapter
    22  or article forty-four of the public health law within twenty days of the
    23  receipt of a claim or a bill for services; provided that at  the  option
    24  of  such  insurer  or  organization or corporation licensed or certified
    25  pursuant to article forty-three or forty-seven of this chapter or  arti-
    26  cle forty-four of the public health law, such claim or bill for services
    27  shall  subsequently be subject to arbitration pursuant to article seven-
    28  ty-five of the civil practice law and rules.
    29    § 3. Section 2801-a of the public health law is amended  by  adding  a
    30  new subdivision 18 to read as follows:
    31    18.  (a)  The  commissioner  is  authorized  to establish a program to
    32  assist in restructuring long term home health care delivery  systems  by
    33  providing  credit enhancement to health care providers licensed pursuant
    34  to article thirty-six of this chapter that  lack  the  credit  resources
    35  necessary  to  transition from fee for service to managed long term care
    36  consistent with the goals of the  state's  Medicaid  program  multi-year
    37  action as adopted by the Medicaid redesign team. The program shall apply
    38  to  health care providers who can demonstrate financial need and advance
    39  the state's health reform agenda of better care, better health for popu-
    40  lations, lower costs, and  transitioning  the  state's  long  term  care
    41  system.
    42    (b)  Applicants must commit that the uses of the credit-enhanced loans
    43  will promote agreed upon goals  of  transitioning  the  long  term  home
    44  health  care  delivery  systems. Applicants shall submit a comprehensive
    45  program and business plan, and such plan must promote agreed  objectives
    46  of  transition.  Loan  documents  shall contain health reform covenants,
    47  milestone dates and statistical targets to be attained by the  borrower.
    48  The  application  must  address  how  the  applicant  will undertake the
    49  improvements in formal or informal cooperation with  other  health  care
    50  providers  in  the  region.  To  the  extent  required  to provide legal
    51  protection for such cooperative endeavors, the commissioner shall  exer-
    52  cise  all  necessary  powers  pursuant  to article twenty-nine-F of this
    53  chapter and any fees associated with such oversight may be  included  in
    54  the project financing costs.
    55    (c) The credit enhancement program shall be administered by the dormi-
    56  tory authority, or a not-for-profit corporation designated by the dormi-

        A. 6367                             3
 
     1  tory  authority.    The  commissioner shall chair the credit enhancement
     2  application and approval committee.  The  commissioner  shall  designate
     3  three  or  more  members  of  the  Medicaid  redesign team as additional
     4  members  of  the  credit enhancement application and approval committee.
     5  The chair of the dormitory authority shall also serve as a member of the
     6  committee, and shall determine all rules  for  reviewing  and  approving
     7  applications,  and administering approved credit enhancements.  Notwith-
     8  standing any other law, no person serving as  a  member  of  the  credit
     9  enhancement  application  and approval committee shall have any personal
    10  liability, or incur liability for their employer,  by  virtue  of  their
    11  role or vote in the credit enhancement application and approval process.
    12    (d) A debt service reserve fund may be created to facilitate the cred-
    13  it enhancement.
    14    (e)(i) In the event of a default by a borrower to a lender, the amount
    15  of  the defaulted payment shall be paid by the commissioner to the lend-
    16  er.  To  finance  the  commissioner's  remittance  of  those   defaulted
    17  payments,  the  commissioner  shall  first draw upon funds allocated for
    18  such potential defaults, including but not limited to funds made  avail-
    19  able for that purpose pursuant to the state's August sixth, two thousand
    20  twelve  section  1115 partnership plan waiver application and additional
    21  federal funds made  available  through  implementation  of  the  federal
    22  Affordable Care Act (health reform).
    23    (ii)  All  payments of defaulted amounts shall be made solely from the
    24  allocated funds and as such amounts  are  actually  collected  and  made
    25  available  to  the  commissioner  for  remittance to lenders pursuant to
    26  subparagraph (i) of this paragraph. Neither the state, the commissioner,
    27  the department, the dormitory authority, nor any  other  instrumentality
    28  of  the state, shall be legally responsible for payment of the defaulted
    29  amounts, other than pursuant to  the  process  and  financial  resources
    30  described in subparagraph (i) of this paragraph.  No assets or resources
    31  of  the state shall be pledged, or considered to be pledged or obligated
    32  in any form, to payment of the defaults,  other  than  pursuant  to  the
    33  process  and  financial  resources described in subparagraph (i) of this
    34  paragraph, as actually collected and made available to the  commissioner
    35  for  the  purposes  of paying defaulted amounts pursuant to subparagraph
    36  (i) of this paragraph.
    37    § 4. Paragraph (b) of subdivision 2 of  section  1676  of  the  public
    38  authorities  law  is  amended  by adding a new undesignated paragraph to
    39  read as follows:
    40    Such health care providers licensed pursuant to article thirty-six  of
    41  the public health law as are approved for the credit enhancement program
    42  pursuant  to  subdivision eighteen of section twenty-eight hundred one-a
    43  of the public health law.
    44    § 5. Subdivision 1 of section 1680 of the public  authorities  law  is
    45  amended by adding a new undesignated paragraph to read as follows:
    46    Such  health care providers licensed pursuant to article thirty-six of
    47  the public health law as are approved for the credit enhancement program
    48  pursuant to subdivision eighteen of section twenty-eight  hundred  one-a
    49  of the public health law.
    50    § 6. This act shall take effect immediately.
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A06367 LFIN:

 NO LFIN
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