S T A T E O F N E W Y O R K
________________________________________________________________________
6447
I N S E N A T E
January 24, 2014
___________
Introduced by Sen. RIVERA -- 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 rate of payment
for home health care programs using statewide average calculation
excluding certain costs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 7 of section 3614 of the public health law, as
added by chapter 41 of the laws of 1992, the opening paragraph as
amended by section 18 of part C of chapter 109 of the laws of 2006, the
second undesignated paragraph as added by chapter 170 of the laws of
1994 and the third undesignated paragraph as added and the closing para-
graph as amended by chapter 59 of the laws of 1993, is amended to read
as follows:
7. (A) Notwithstanding any inconsistent provision of law or regu-
lation, for purposes of establishing rates of payment by governmental
agencies for certified home health agencies for the period April first,
nineteen hundred ninety-five through December thirty-first, nineteen
hundred ninety-five and for rate periods beginning on or after January
first, nineteen hundred ninety-six, the reimbursable base year adminis-
trative and general costs of a provider of services shall not exceed the
statewide average of total reimbursable base year administrative and
general costs of such providers of services; PROVIDED, HOWEVER, THAT FOR
PURPOSES OF ESTABLISHING SUCH RATES OF PAYMENT FOR PERIODS ON AND AFTER
APRIL FIRST, TWO THOUSAND FIFTEEN, SUCH STATEWIDE AVERAGE CALCULATION
SHALL EXCLUDE ANY OTHERWISE REIMBURSABLE COSTS, INCLUDING STEP DOWN
COSTS, REPORTED AND ALLOCABLE AS ADMINISTRATIVE AND GENERAL BUT ATTRIB-
UTABLE TO THE PROVISION AND MANAGEMENT OF PATIENT CARE INCLUDING, BUT
NOT LIMITED TO, COSTS ATTRIBUTABLE TO: PATIENT OUTREACH; ASSESSMENT;
COORDINATION AND MANAGEMENT OF SERVICES; TELEPHONE AND OTHER TELEHEALTH
MONITORING AND COMMUNICATION; MEDICAL SUPPLIES; STAFF TRANSPORTATION AND
ESCORT SERVICES; FAMILY AND/OR INFORMAL CAREGIVER SUPPORT SERVICES;
PATIENT RECORDKEEPING; AND TECHNOLOGY INVESTMENTS FOR PATIENT CARE.
SUCH EXCLUDED COSTS SHALL BE CONVEYED BY THE PROVIDER AS A SEPARATE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01599-04-4
S. 6447 2
DOCUMENT OF SUPPLEMENTAL INFORMATION ATTACHED TO THE PROVIDER'S COST
REPORT, AS SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL PROVIDE A
RATE COMPUTATION SHEET TO EACH CERTIFIED HOME HEALTH AGENCY WITH
DISTINCT LINES FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
(I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
(II) THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT ALLOCABLE
TO THE RATE FOR THE SERVICE;
(III) SUCH TOTAL ADMINISTRATIVE AND GENERAL AMOUNT EXCLUSIVE OF THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(V) ANY ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE RATE BASED
ON SUCH LIMITATION; AND
(VI) THE ADJUSTED RATE BASED ON THE APPLICATION OF THE ADMINISTRATIVE
AND GENERAL COST LIMITATION.
The amount of such reduction in certified home health agency rates of
payments made during the period April first, nineteen hundred ninety-
five through March thirty-first, nineteen hundred ninety-six shall be
adjusted in the nineteen hundred ninety-six rate period on a pro-rata
basis, if it is determined upon post-audit review by June fifteenth,
nineteen hundred ninety-six and reconciliation that the savings for the
state share, excluding the federal and local government shares, of
medical assistance payments pursuant to title eleven of article five of
the social services law based on the limitation of such payment pursuant
to this subdivision is in excess of one million five hundred thousand
dollars or is less than one million five hundred thousand dollars for
payments made on or before March thirty-first, nineteen hundred ninety-
six to reflect the amount by which such savings are in excess of or
lower than one million five hundred thousand dollars. For rate periods
on and after January first, two thousand five through December thirty-
first, two thousand six, there shall be no such reconciliation of the
amount of savings in excess of or lower than one million five hundred
thousand dollars.
(B) No such limit shall be applied to a provider of services reim-
bursed on an initial budget basis, or a new provider, excluding changes
in ownership or changes in name, who begins operations in the year prior
to the year which is used as a base year in determining rates of
payment.
(C) For the purposes of this subdivision, reimbursable base year oper-
ational costs shall mean those base year operational costs remaining
after application of all other efficiency standards, including, but not
limited to, peer group cost ceilings or guidelines.
(D) The limitation on reimbursement for provider administrative and
general expenses provided by this subdivision shall be expressed as a
percentage reduction for the rate promulgated by the commissioner to
each certified home health agency and long term home health care program
provider; PROVIDED, HOWEVER, THAT SUCH REDUCTION PERCENTAGE SHALL NOT BE
INCREASED FOR ANY PROVIDER AS A CONSEQUENCE OF THE EXCLUSIONS PROVIDED
FOR IN PARAGRAPH (A) OF THIS SUBDIVISION.
S 2. The opening paragraph of subdivision 7 of section 3614 of the
public health law, as amended by chapter 170 of the laws of 1994, is
amended to read as follows:
(A) Notwithstanding any inconsistent provision of law or regulation to
the contrary, for purposes of establishing rates of payment by govern-
S. 6447 3
mental agencies for certified home health agencies and long term home
health care programs for rate [period] PERIODS beginning on or after
January first, nineteen hundred ninety-five, the department of health
may not by rule or regulation limit the reimbursable base year adminis-
trative and general costs of a provider of services to a percentage
which is other than thirty percent of total reimbursable base year oper-
ational costs of such provider of services; PROVIDED, HOWEVER, THAT FOR
PURPOSES OF ESTABLISHING SUCH RATES OF PAYMENT FOR PERIODS ON AND AFTER
APRIL FIRST, TWO THOUSAND FIFTEEN, SUCH STATEWIDE AVERAGE CALCULATION
SHALL EXCLUDE ANY OTHERWISE REIMBURSABLE COSTS, INCLUDING STEP DOWN
COSTS, REPORTED AND ALLOCABLE AS ADMINISTRATIVE AND GENERAL BUT ATTRIB-
UTABLE TO THE PROVISION AND MANAGEMENT OF PATIENT CARE INCLUDING, BUT
NOT LIMITED TO, COSTS ATTRIBUTABLE TO: PATIENT OUTREACH; ASSESSMENT;
COORDINATION AND MANAGEMENT OF SERVICES; TELEPHONE AND OTHER TELEHEALTH
MONITORING AND COMMUNICATION; MEDICAL SUPPLIES; STAFF TRANSPORTATION AND
ESCORT SERVICES; FAMILY AND/OR INFORMAL CAREGIVER SUPPORT SERVICES;
PATIENT RECORDKEEPING; AND TECHNOLOGY INVESTMENTS FOR PATIENT CARE.
SUCH EXCLUDED COSTS SHALL BE CONVEYED BY THE PROVIDER AS A SEPARATE
DOCUMENT OF SUPPLEMENTAL INFORMATION ATTACHED TO THE PROVIDER'S COST
REPORT, AS SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL PROVIDE A
RATE COMPUTATION SHEET TO EACH CERTIFIED HOME HEALTH AGENCY WITH
DISTINCT LINES FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
(I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
(II) THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT ALLOCABLE
TO THE RATE FOR THE SERVICE;
(III) SUCH TOTAL ADMINISTRATIVE AND GENERAL AMOUNT EXCLUSIVE OF THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(V) ANY ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE RATE BASED
ON SUCH LIMITATION; AND
(VI) THE ADJUSTED RATE BASED ON THE APPLICATION OF THE ADMINISTRATIVE
AND GENERAL COST LIMITATION.
S 3. Subdivision 7-a of section 3614 of the public health law, as
amended by section 89 of part C of chapter 58 of the laws of 2007 and
the opening paragraph as amended by section 18 of part B of chapter 56
of the laws of 2013, is amended to read as follows:
7-a. (A) Notwithstanding any inconsistent provision of law or regu-
lation, for the purposes of establishing rates of payment by govern-
mental agencies for long term home health care programs for the period
April first, two thousand five, through December thirty-first, two thou-
sand five, and for the period January first, two thousand six through
March thirty-first, two thousand seven, and on and after April first,
two thousand seven through March thirty-first, two thousand nine, and on
and after April first, two thousand nine through March thirty-first, two
thousand eleven, and on and after April first, two thousand eleven
through March thirty-first, two thousand thirteen and on and after April
first, two thousand thirteen through March thirty-first, two thousand
fifteen, the reimbursable base year administrative and general costs of
a provider of services shall not exceed the statewide average of total
reimbursable base year administrative and general costs of such provid-
ers of services[.]; PROVIDED, HOWEVER, THAT FOR THE PURPOSES OF ESTAB-
LISHING SUCH RATES OF PAYMENT FOR PERIODS ON AND AFTER APRIL FIRST, TWO
THOUSAND FIFTEEN, SUCH STATEWIDE AVERAGE CALCULATION SHALL EXCLUDE ANY
S. 6447 4
OTHERWISE REIMBURSABLE COSTS, INCLUDING STEP DOWN COSTS, REPORTED AND
ALLOCABLE AS ADMINISTRATIVE AND GENERAL BUT ATTRIBUTABLE TO THE
PROVISION AND MANAGEMENT OF PATIENT CARE INCLUDING, BUT NOT LIMITED TO,
COSTS ATTRIBUTABLE TO: PATIENT OUTREACH; ASSESSMENT; COORDINATION AND
MANAGEMENT OF SERVICES; TELEPHONE AND OTHER TELEHEALTH MONITORING AND
COMMUNICATION; MEDICAL SUPPLIES; STAFF TRANSPORTATION AND ESCORT
SERVICES; FAMILY AND/OR INFORMAL CAREGIVER SUPPORT SERVICES; PATIENT
RECORDKEEPING; AND TECHNOLOGY INVESTMENTS FOR PATIENT CARE. SUCH
EXCLUDED COSTS SHALL BE CONVEYED BY THE PROVIDER AS A SEPARATE DOCUMENT
OF SUPPLEMENTAL INFORMATION ATTACHED TO THE PROVIDER'S COST REPORT, AS
SUBMITTED TO THE DEPARTMENT. THE DEPARTMENT SHALL PROVIDE A RATE COMPU-
TATION SHEET TO EACH CERTIFIED HOME HEALTH AGENCY WITH DISTINCT LINES
FOR EACH SERVICE AND RATE WHICH SHALL INCLUDE:
(I) THE RATE PRIOR TO THE APPLICATION OF THE ADMINISTRATIVE AND GENER-
AL COST LIMITATION PROVIDED FOR IN THIS SUBDIVISION;
(II) THE PROVIDER'S TOTAL ADMINISTRATIVE AND GENERAL AMOUNT ALLOCABLE
TO THE RATE FOR THE SERVICE;
(III) SUCH TOTAL ADMINISTRATIVE AND GENERAL AMOUNT EXCLUSIVE OF THE
PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(IV) THE ALLOWABLE ADMINISTRATIVE AND GENERAL COST AMOUNT BASED ON THE
LIMITATION PROVIDED FOR IN THIS SECTION CALCULATED TO REFLECT THE EXCLU-
SION OF PATIENT CARE RELATED COSTS DESCRIBED IN THIS PARAGRAPH;
(V) ANY ADMINISTRATIVE AND GENERAL COST DISALLOWED TO THE RATE BASED
ON SUCH LIMITATION; AND
(VI) THE ADJUSTED RATE BASED ON THE APPLICATION OF THE ADMINISTRATIVE
AND GENERAL COST LIMITATION.
(B) No such limit shall be applied to a provider of services reim-
bursed on an initial budget basis, or a new provider, excluding changes
in ownership or changes in name, who begins operations in the year prior
to the year which is used as a base year in determining rates of
payment.
(C) For the purposes of this subdivision, reimbursable base year oper-
ational costs shall mean those base year operational costs remaining
after application of all other efficiency standards, including, but not
limited to, cost guidelines.
(D) The limitation on reimbursement for provider administrative and
general expenses provided by this subdivision shall be expressed as a
percentage reduction for the rate promulgated by the commissioner to
each long term home health care program provider; PROVIDED, HOWEVER,
THAT SUCH REDUCTION PERCENTAGE SHALL NOT BE INCREASED FOR ANY PROVIDER
AS A CONSEQUENCE OF THE EXCLUSIONS PROVIDED FOR IN PARAGRAPH (A) OF THIS
SUBDIVISION.
S 4. This act shall take effect on the first of April next succeeding
the date on which it shall have become law; provided, however, that the
amendments to the opening paragraph of subdivision 7 of section 3614 of
the public health law made by section one of this act shall be subject
to the expiration and reversion of such opening paragraph pursuant to
section 64-b and subdivision 5-a of section 246 of chapter 81 of the
laws of 1995, as amended, when upon such date the provisions of section
two of this act shall take effect.