S T A T E   O F   N E W   Y O R K
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                                  2332

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            January 16, 2015
                               ___________

Introduced by M. of A. BRINDISI, ABINANTI, RAIA, McDONALD -- Multi-Spon-
  sored  by  --  M.  of A.   McLAUGHLIN -- 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:

  Section 1. Section 4406-c of the  public  health  law  is  amended  by
adding a new subdivision 9 to read as follows:
  9.  NOTWITHSTANDING  ANY INCONSISTENT PROVISION OF LAW, CONTRACTS WITH
CERTIFIED HOME HEALTH AGENCIES, LONG TERM  HOME  HEALTH  CARE  PROGRAMS,
LICENSED  HOME CARE SERVICES PROGRAMS OR FISCAL INTERMEDIARIES OPERATING
PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL  SERVICES
LAW  TO PROVIDE HOME CARE AIDE SERVICES AS DEFINED IN SECTION THIRTY-SIX
HUNDRED FOURTEEN-C  OF  THIS  CHAPTER,  OR  CONSUMER  DIRECTED  PERSONAL
ASSISTANCE  SERVICES  AS  AUTHORIZED  PURSUANT  TO SECTION THREE HUNDRED
SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW SHALL AT A MINIMUM  ENSURE  THAT
THE  RESOURCES  MADE  AVAILABLE  BY SUCH CONTRACTS SHALL SUPPORT COMPEN-
SATION FOR PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES  AND  CONSUMER
DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUAL-
IFIED  WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS OF
SUCH SERVICES CONSISTENT WITH THE PROVISIONS OF SUCH SECTION.
  S 2. Subsection (a) of section 3224-a of the insurance law, as amended
by chapter 237 of the laws of 2009, is amended to read as follows:
  (a) Except in a case where the obligation of an insurer or  an  organ-
ization  or corporation licensed or certified pursuant to article forty-
three or forty-seven of this chapter or article forty-four of the public
health law to pay a claim submitted by a policyholder or person  covered

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03537-01-5
              

A. 2332                             2

under  such policy ("covered person") or make a payment to a health care
provider is not reasonably clear, or when there is  a  reasonable  basis
supported  by  specific  information  available for review by the super-
intendent  that such claim or bill for health care services rendered was
submitted fraudulently, such  insurer  or  organization  or  corporation
shall  pay  the  claim  to  a  policyholder  or covered person or make a
payment to a health care provider within thirty days  of  receipt  of  a
claim or bill for services rendered that is transmitted via the internet
or electronic mail, or forty-five days of receipt of a claim or bill for
services  rendered  that  is  submitted by other means, such as paper or
facsimile. PROVIDED, HOWEVER, ANY 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 SHALL BE PAID WITHIN FIFTEEN
DAYS OF THE RECEIPT OF A CLAIM OR A BILL FOR  SERVICES  RENDERED  DURING
THE TRANSITION PERIOD FROM FEE FOR SERVICE TO MEDICAID MANAGED LONG TERM
CARE  CONSISTENT  WITH  THE  STATE  MEDICAID  PLAN  FOR SUCH HEALTH CARE
PROVIDERS AND FOR THE TWELVE MONTH PERIOD BEYOND THE FINAL TRANSITION OF
MEDICAID BENEFICIARIES IN THAT COUNTY. IN  ADDITION,  PAYMENTS  FOR  ANY
DISPUTED  CLAIM  OR  BILL FOR SERVICES SHALL BE PAID TO SUCH HEALTH CARE
PROVIDERS BY AN INSURER OR AN ORGANIZATION OR  CORPORATION  LICENSED  OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER
OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW WITHIN TWENTY DAYS OF THE
RECEIPT  OF  A CLAIM OR A BILL FOR SERVICES; PROVIDED THAT AT THE OPTION
OF SUCH INSURER OR ORGANIZATION OR  CORPORATION  LICENSED  OR  CERTIFIED
PURSUANT  TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW, SUCH CLAIM OR BILL FOR SERVICES
SHALL SUBSEQUENTLY BE SUBJECT TO ARBITRATION PURSUANT TO ARTICLE  SEVEN-
TY-FIVE OF THE CIVIL PRACTICE LAW AND RULES.
  S  3.  Section  2801-a of the public health law is amended by adding a
new subdivision 17 to read as follows:
  17. (A) THE COMMISSIONER IS  AUTHORIZED  TO  ESTABLISH  A  PROGRAM  TO
ASSIST  IN  RESTRUCTURING LONG TERM HOME HEALTH CARE DELIVERY SYSTEMS BY
PROVIDING CREDIT ENHANCEMENT TO HEALTH CARE PROVIDERS LICENSED  PURSUANT
TO  ARTICLE  THIRTY-SIX  OF  THIS CHAPTER THAT LACK THE CREDIT RESOURCES
NECESSARY TO TRANSITION FROM FEE FOR SERVICE TO MANAGED LONG  TERM  CARE
CONSISTENT  WITH  THE  GOALS  OF THE STATE'S MEDICAID PROGRAM MULTI-YEAR
ACTION AS ADOPTED BY THE MEDICAID REDESIGN TEAM. THE PROGRAM SHALL APPLY
TO HEALTH CARE PROVIDERS WHO CAN DEMONSTRATE FINANCIAL NEED AND  ADVANCE
THE STATE'S HEALTH REFORM AGENDA OF BETTER CARE, BETTER HEALTH FOR POPU-
LATIONS,  LOWER  COSTS,  AND  TRANSITIONING  THE  STATE'S LONG TERM CARE
SYSTEM.
  (B) APPLICANTS MUST COMMIT THAT THE USES OF THE CREDIT-ENHANCED  LOANS
WILL  PROMOTE  AGREED  UPON  GOALS  OF  TRANSITIONING THE LONG TERM HOME
HEALTH CARE DELIVERY SYSTEMS. APPLICANTS SHALL  SUBMIT  A  COMPREHENSIVE
PROGRAM  AND BUSINESS PLAN, AND SUCH PLAN MUST PROMOTE AGREED OBJECTIVES
OF TRANSITION. LOAN DOCUMENTS SHALL  CONTAIN  HEALTH  REFORM  COVENANTS,
MILESTONE  DATES AND STATISTICAL TARGETS TO BE ATTAINED BY THE BORROWER.
THE APPLICATION MUST  ADDRESS  HOW  THE  APPLICANT  WILL  UNDERTAKE  THE
IMPROVEMENTS  IN  FORMAL  OR INFORMAL COOPERATION WITH OTHER HEALTH CARE
PROVIDERS IN THE  REGION.  TO  THE  EXTENT  REQUIRED  TO  PROVIDE  LEGAL
PROTECTION  FOR SUCH COOPERATIVE ENDEAVORS, THE COMMISSIONER SHALL EXER-
CISE ALL NECESSARY POWERS PURSUANT  TO  ARTICLE  TWENTY-NINE-F  OF  THIS
CHAPTER  AND  ANY FEES ASSOCIATED WITH SUCH OVERSIGHT MAY BE INCLUDED IN
THE PROJECT FINANCING COSTS.

A. 2332                             3

  (C) THE CREDIT ENHANCEMENT PROGRAM SHALL BE ADMINISTERED BY THE DORMI-
TORY AUTHORITY, OR A NOT-FOR-PROFIT CORPORATION DESIGNATED BY THE DORMI-
TORY AUTHORITY.   THE COMMISSIONER SHALL CHAIR  THE  CREDIT  ENHANCEMENT
APPLICATION  AND  APPROVAL  COMMITTEE.  THE COMMISSIONER SHALL DESIGNATE
THREE  OR  MORE  MEMBERS  OF  THE  MEDICAID  REDESIGN TEAM AS ADDITIONAL
MEMBERS OF THE CREDIT ENHANCEMENT APPLICATION  AND  APPROVAL  COMMITTEE.
THE CHAIR OF THE DORMITORY AUTHORITY SHALL ALSO SERVE AS A MEMBER OF THE
COMMITTEE,  AND  SHALL  DETERMINE  ALL RULES FOR REVIEWING AND APPROVING
APPLICATIONS, AND ADMINISTERING APPROVED CREDIT ENHANCEMENTS.   NOTWITH-
STANDING  ANY  OTHER  LAW,  NO  PERSON SERVING AS A MEMBER OF THE CREDIT
ENHANCEMENT APPLICATION AND APPROVAL COMMITTEE SHALL HAVE  ANY  PERSONAL
LIABILITY,  OR  INCUR  LIABILITY  FOR THEIR EMPLOYER, BY VIRTUE OF THEIR
ROLE OR VOTE IN THE CREDIT ENHANCEMENT APPLICATION AND APPROVAL PROCESS.
  (D) A DEBT SERVICE RESERVE FUND MAY BE CREATED TO FACILITATE THE CRED-
IT ENHANCEMENT.
  (E)(I) IN THE EVENT OF A DEFAULT BY A BORROWER TO A LENDER, THE AMOUNT
OF THE DEFAULTED PAYMENT SHALL BE PAID BY THE COMMISSIONER TO THE  LEND-
ER.   TO  FINANCE  THE  COMMISSIONER'S  REMITTANCE  OF  THOSE  DEFAULTED
PAYMENTS, THE COMMISSIONER SHALL FIRST DRAW  UPON  FUNDS  ALLOCATED  FOR
SUCH  POTENTIAL DEFAULTS, INCLUDING BUT NOT LIMITED TO FUNDS MADE AVAIL-
ABLE FOR THAT PURPOSE PURSUANT TO THE STATE'S AUGUST SIXTH, TWO THOUSAND
TWELVE SECTION 1115 PARTNERSHIP PLAN WAIVER APPLICATION  AND  ADDITIONAL
FEDERAL  FUNDS  MADE  AVAILABLE  THROUGH  IMPLEMENTATION  OF THE FEDERAL
AFFORDABLE CARE ACT (HEALTH REFORM).
  (II) ALL PAYMENTS OF DEFAULTED AMOUNTS SHALL BE MADE SOLELY  FROM  THE
ALLOCATED  FUNDS  AND  AS  SUCH  AMOUNTS ARE ACTUALLY COLLECTED AND MADE
AVAILABLE TO THE COMMISSIONER FOR  REMITTANCE  TO  LENDERS  PURSUANT  TO
SUBPARAGRAPH (I) OF THIS PARAGRAPH. NEITHER THE STATE, THE COMMISSIONER,
THE  DEPARTMENT,  THE DORMITORY AUTHORITY, NOR ANY OTHER INSTRUMENTALITY
OF THE STATE, SHALL BE LEGALLY RESPONSIBLE FOR PAYMENT OF THE  DEFAULTED
AMOUNTS,  OTHER  THAN  PURSUANT  TO  THE PROCESS AND FINANCIAL RESOURCES
DESCRIBED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH.  NO ASSETS OR RESOURCES
OF THE STATE SHALL BE PLEDGED, OR CONSIDERED TO BE PLEDGED OR  OBLIGATED
IN  ANY  FORM,  TO  PAYMENT  OF THE DEFAULTS, OTHER THAN PURSUANT TO THE
PROCESS AND FINANCIAL RESOURCES DESCRIBED IN SUBPARAGRAPH  (I)  OF  THIS
PARAGRAPH,  AS ACTUALLY COLLECTED AND MADE AVAILABLE TO THE COMMISSIONER
FOR THE PURPOSES OF PAYING DEFAULTED AMOUNTS  PURSUANT  TO  SUBPARAGRAPH
(I) OF THIS PARAGRAPH.
  S  4.  Paragraph  (b)  of  subdivision 2 of section 1676 of the public
authorities law is amended by adding a  new  undesignated  paragraph  to
read as follows:
  SUCH  HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX OF
THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
PURSUANT TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED  ONE-A
OF THE PUBLIC HEALTH LAW.
  S  5.  Subdivision  1 of section 1680 of the public authorities law is
amended by adding a new undesignated paragraph to read as follows:
  SUCH HEALTH CARE PROVIDERS LICENSED PURSUANT TO ARTICLE THIRTY-SIX  OF
THE PUBLIC HEALTH LAW AS ARE APPROVED FOR THE CREDIT ENHANCEMENT PROGRAM
PURSUANT  TO SUBDIVISION SEVENTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A
OF THE PUBLIC HEALTH LAW.
  S 6. This act shall take effect immediately.