Relates to certified home health agencies.
TITLE OF BILL: An act to amend the public health law, in relation to certified home health agencies
PURPOSE: To allow special needs certified home health agencies to enroll any patient determined to require certified home health agency services under certain circumstances and thereby achieve state Medicaid savings through market efficiencies.
SUMMARY OF PROVISIONS: Amends section 3608 of the public health law to provide that a certified home health agency (CHHA's) which has been issued a certificate of approval for the purpose of serving individuals eligible for care in a facility or program licensed by the Office of Mental Health or the Office of Mental Retardation and Developmental Disabilities may enroll any patient determined to require certified home health agency services if such agency:
- possesses demonstrated clinical expertise in the required treatment; - continues to market, accept and treat members of the special needs population; - contracts with the Department of Health to maintain rates at specified levels.
JUSTIFICATION: Special-needs CHHAs provide high quality care at lower rates than CHHAs that serve the general population. Currently by, DOH policy, special needs CHHAs are restricted in their outreach and marketing efforts to special-needs individuals, but may service the general public. The result is a bifurcated, confusing marketplace that has negatively influenced competition with the effect of a substantial percentage of the Medicaid population not utilizing the lower-cost model of care.
Expanding the scope of the population that they serve will result in significant Medicaid savings.
Special-needs CHHAs were established for the special purpose of delivering Medicaid covered home care services to individuals who otherwise would require more costly institutionalized services by the Office of Mental Health ("OMH") or by the Office of Mental Retardation Developmental Disabilities ("OMRDD"). In this legislation, special needs CHHAs will continue to be required to develop and maintain special care protocols, training and vendor relationships tailored to the population that such CHHA was originally established to service.
Allowing special-needs CHHAs to compete with general-purpose CHHAs without restriction, will yield millions of dollars in savings to the State Medicaid budget effective immediately. Special-needs CHHAs have demonstrated that they have a formula whether measured either from the prospective of low rates, operational efficiencies or compassionate care. The State should make this model available to the general public without restriction or delay.
PRIOR LEGISLATIVE HISTORY: 2010: A.11581/S.8393 Held in Rules
FISCAL IMPLICATIONS: Fiscal year 2010/2011 state Medicaid savings of $1 million to $3 million; Fiscal year 2001/2012 savings could approach $10 million.
EFFECTIVE DATE: Immediately.
STATE OF NEW YORK ________________________________________________________________________ 2390 2013-2014 Regular Sessions IN SENATE January 17, 2013 ___________Introduced by Sen. ADAMS -- 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 certified home health agencies THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3608 of the public health law is amended by adding a new subdivision 7 to read as follows: 7. A CERTIFIED HOME HEALTH AGENCY IN OPERATION AS OF THE EFFECTIVE DATE OF THIS SUBDIVISION AND ISSUED A CERTIFICATE OF APPROVAL BY THE COMMISSIONER FOR THE PURPOSE OF SERVING INDIVIDUALS ELIGIBLE FOR CARE IN A FACILITY OR PROGRAM LICENSED BY THE OFFICE OF MENTAL HEALTH OR THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES OR AS A SPECIAL PILOT PROGRAM HOME HEALTH AGENCY IS AUTHORIZED BY VIRTUE OF SUCH CERTIFICATE TO ENROLL ANY PATIENT DETERMINED TO REQUIRE CERTIFIED HOME HEALTH AGENCY SERVICES; PROVIDED, HOWEVER, THAT SUCH AGENCY (A) POSSESSES DEMONSTRATED CLINICAL EXPERTISE IN THE TREATMENT OF THE POPULATION SPECIFIED IN ITS CERTIFICATE OF APPROVAL, (B) CONTINUES TO MARKET, ACCEPT FOR ENROLLMENT AND TREAT MEMBERS OF SUCH POPULATION, AND (C) ENTERS INTO AN AGREEMENT WITH THE COMMISSIONER THAT DURING THE PERIOD JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN AND FOR EACH CALENDAR YEAR PERIOD COMMENCING ON JANUARY FIRST THEREAFTER, RATES OF PAYMENT BY GOVERNMENTAL AGENCIES ESTABLISHED BY THE COMMISSIONER IN ACCORDANCE WITH THE RATE-SETTING METHODOLOGY THEN IN EFFECT FOR SERVICES BY SUCH CERTIFIED HOME HEALTH AGENCY TO INDIVIDUALS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW SHALL NOT EXCEED THE AVERAGE OF SUCH RATES OF PAYMENT FOR CERTIFIED HOME HEALTH AGENCIES CLASSIFIED IN THE DOWNSTATE REGION, AS DEFINED BY REGULATIONS PROMULGATED PURSUANT TO SECTION THIRTY-SIX HUNDRED TWELVE OF THIS ARTICLE OR SUCCESSOR LEGISLATION. S 2. This act shall take effect immediately.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05548-01-3