S 7052: Relates to the rates of payment for certified home health agencies.

  
  STATE OF NEW YORK ________________________________________________________________________ 7052 2025-2026 Regular Sessions  IN SENATE March 31, 2025 ___________ Introduced by Sen. WEBB -- read twice and ordered printed, and when printed to be committed to the Committee on Health 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- 25 ularly in shortage areas and disciplines; facilitating provider capabil- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10053-03-5 
 S. 7052 2 1 ity to further align with state health reform models and policy goals; 2 health care clinical and information technology investments; and any 3 other matters the commissioner determines appropriate. 4 (d) Notwithstanding any inconsistent law or regulation, by October 5 first, two thousand twenty-five and annually thereafter, the commis- 6 sioner shall make the system of episodic payments, including all pricing 7 mechanisms, available to all Medicaid managed care plans licensed to 8 operate in New York state, all child health insurance plans licensed to 9 operate under section twenty-five hundred eleven of this chapter, and 10 all Essential Plans authorized by section three hundred sixty-nine-gg of 11 the social services law. By October first, two thousand twenty-five and 12 annually thereafter, the commissioner shall notify all such managed care 13 plans of their responsibilities for ensuring that their enrolled members 14 have access to certified home health agency services; that such services 15 are critical to improving patient care and reducing overall costs, 16 particularly costs related to avoidable hospital use; and that episodic 17 payments as described in paragraph (a) of this subdivision are consid- 18 ered the standard method of certified home health agency payment by New 19 York state government agencies. Nothing in this paragraph shall preclude 20 a managed care plan and certified home health agency from agreeing upon 21 an alternative rate methodology and payment rate, including value-based 22 payments related to health outcome measurements. 23 § 2. This act shall take effect immediately.