S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7180
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              April 10, 2019
                                ___________
 
 Introduced  by M. of A. BUTTENSCHON, D'URSO, WILLIAMS -- Multi-Sponsored
   by -- M. of A.  SAYEGH -- 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 10 to read as follows:
   10. 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.
   § 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.
              

                                                            LBD10487-01-9

 A. 7180                             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.
   §  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. 7180                             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.
   §  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.
   §  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.
   § 6. This act shall take effect immediately.