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.
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.
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.
