Bill S5459-2015

Relates to a review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services

Relates to a review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services.

Details

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  • May 14, 2015: REFERRED TO HEALTH

Memo

BILL NUMBER:S5459

TITLE OF BILL:

An act to amend the social services law, in relation to the review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services

PURPOSE:

Directs the Department of Health to provide for the study and review of adequate reimbursement methodologies under managed care contracts and fee-for-service Medicaid rates to ensure such are sufficient to support compensation for persons providing home care aide services and consumer directed personal assistance services.

SUMMARY OF PROVISIONS:

Section one adds a new paragraph (e) to section 364-j of the Social Services Law requiring the Department of Health to select and contract with an independent actuary to study and review adequate reimbursement methodologies for home and community based long term care providers. In addition, it provides that the Department shall report to the Governor, the Temporary President of the Senate, the Speaker of the Assembly, the Health Chairs on or before January 1, 2016 on the findings of such study and review.

JUSTIFICATION:

New York State has long recognized the importance of home care services as a critical component of the State's health care delivery system. Home care plays an important role in reducing health care costs and improving consumer satisfaction by providing cost-effective care at a fraction of the cost of institutional settings - all in the patient-preferred setting of the home. However, compliance with existing State and Federal wage and benefit mandates, and the implementation of new requirements going into effect, are putting an enormous strain on home care providers operating within both the Medicaid fee-for-service and managed care environments.

This legislation aims to ensure that the home care industry in New York, whether provided by a agencies or through consumer directed care, can continue to provide a high level of quality care to the state's Medicaid population.

The review will assist the State in determining the overall adequacy of current home care reimbursement rates. Results will offer insight and a better understanding of the reimbursement needs of the home care system within the context of the changing health care delivery system and implementation of new and rising wage and benefit requirements, and help to identify reimbursement gaps or areas in need of additional oversight and/or State intervention.

LEGISLATIVE HISTORY:

New bill.

FISCAL IMPLICATIONS:

No net fiscal impact the state currently contracts with actuaries.

EFFECTIVE DATE:

Immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 5459 2015-2016 Regular Sessions IN SENATE May 14, 2015 ___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law, in relation to the review of reimbursement methodologies under contracts or agreements with insur- ers under the medical assistance program for home and community-based long term care services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 18 of section 364-j of the social services law, as amended by chapter 649 of the laws of 1996, paragraph (b) as amended by chapter 433 of the laws of 1997, paragraph (c) as added by section 40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d) as added by section 55 of part B of chapter 57 of the laws of 2015, is amended to read as follows: 18. (a) The department of health may, where not inconsistent with the rate setting authority of other state agencies and subject to approval of the director of the division of the budget, develop reimbursement methodologies and fee schedules for determining the amount of payment to be made to managed care providers under the managed care program. Such reimbursement methodologies and fee schedules may include provisions for payment of managed care fees and capitation arrangements. (b) The department of health in consultation with organizations representing managed care providers shall select an independent actuary to review any such reimbursement rates. Such independent actuary shall review and make recommendations concerning appropriate actuarial assump- tions relevant to the establishment of rates including but not limited to the adequacy of the rates in relation to the population to be served adjusted for case mix, the scope of services the plans must provide, the utilization of services and the network of providers necessary to meet state standards. The independent actuary shall issue a report no later than December thirty-first, nineteen hundred ninety-eight and annually
thereafter. Such report shall be provided to the governor, the temporary president and the minority leader of the senate and the speaker and the minority leader of the assembly. The department of health shall assess managed care providers under the managed care program on a per enrollee basis to cover the cost of such report. (c) In setting such reimbursement methodologies, the department shall consider costs borne by the managed care program to ensure actuarially sound and adequate rates of payment to ensure quality of care. [(c)] (D) The department of health shall require the independent actu- ary selected pursuant to paragraph (b) of this subdivision to provide a complete actuarial memorandum, along with all actuarial assumptions made and all other data, materials and methodologies used in the development of rates, to managed care providers thirty days prior to submission of such rates to the centers for medicare and medicaid services for approval. Managed care providers may request additional review of the actuarial soundness of the rate setting process and/or methodology. [(d)] (E)(I) THE DEPARTMENT OF HEALTH SHALL SELECT AND CONTRACT WITH AN INDEPENDENT ACTUARY TO STUDY AND REVIEW ADEQUATE REIMBURSEMENT METH- ODOLOGIES UNDER CONTRACTS OR AGREEMENTS WITH INSURERS UNDER THE MEDICAL ASSISTANCE PROGRAM FOR HOME AND COMMUNITY-BASED LONG TERM CARE SERVICES PROVIDED UNDER THIS ARTICLE, BY FISCAL INTERMEDIARIES OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE OR RATES OF PAYMENT FOR SUCH SERVICES UNDER THE MEDICAL ASSISTANCE PROGRAM TO ENSURE SUCH CONTRACTS OR RATES SHALL SUPPORT COMPENSATION FOR PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES AND CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUALIFIED WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS OF SUCH SERVICES IN BOTH WAGE PARITY AND NON-WAGE PARITY REGIONS. SUCH COMPENSATION SHALL AT A MINIMUM INCLUDE WAGE PARITY COMPENSATION AS REQUIRED UNDER SECTION THIRTY-SIX HUNDRED FOURTEEN-C OF THE PUBLIC HEALTH LAW OR SUCH WAGE AS REQUIRED UNDER ARTICLE NINETEEN OR NINETEEN-A OF THE LABOR LAW AS REQUIRED TOGETHER WITH THE FOLLOWING COSTS: RECRUITMENT, TRAINING AND RETENTION OF DIRECT CARE PERSONNEL INCLUDING WAGE; SALARY; MANDATORY CONTRIBUTIONS PURSUANT TO TITLE 26, SUBTITLE C, CHAPTER 21 OF THE UNITED STATES CODE (FICA); COSTS ATTRIBUTED TO WORKERS COMPENSATION; COUNTY LIVING WAGE LAWS AS APPROPRIATE; AND A SUPPLEMENTAL BENEFIT RATE. (II) THE DEPARTMENT OF HEALTH SHALL REPORT ON THE RESULTS OF THE INDE- PENDENT ACTUARY FINDINGS UNDER THIS PARAGRAPH TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE CHAIRS OF THE SENATE HEALTH COMMITTEE AND ASSEMBLY HEALTH COMMITTEE ON OR BEFORE JANUARY FIRST, TWO THOUSAND SIXTEEN. (F) The department of health shall annually provide to the temporary president of the senate and the speaker of the assembly the annual Medi- caid managed care operating reports submitted to the department from managed care plans that contract with the state to manage services provided under the Medicaid program. S 2. This act shall take effect immediately; provided that the amend- ments made to section 364-j of the social services law by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.

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