Establishes the home care accessibility and efficiency improvement act

This comprehensive legislation increases consumer accessibility to home care services, creates efficiencies in the delivery of care, and improves the policy/regulatory environment for the operation of the home care system in the state. This legislation was developed after an intensive policy development process involving experts in the home health field.

The bill's provisions, which benefit consumers, the system and the state, include:

* Establishment of a common assessment/electronic data set and patient placement criteria to streamline, increase accuracy and efficiency, and rationalize patient assessment and placement in home and community based care, aimed at the most appropriate and cost-effective service for the patient; while the state is currently pursuing such a system, there is no legislative framework for this purpose, which this bill would provide;

* An examination of alternate methods of improving the current Medicaid home care payment system with the goals of improved: adequacy of payment; patient access; quality of care and performance incentives; recruitment and retention of personnel; provider financial stability; working capital for the 'home care clinical and information technology infrastructure; cost-effectiveness; and other elements essential to the operation of the home Care agencies and the provision of home care services (the examination would be conducted in consultation with the home care community, consumers and other stakeholders);

* Strengthening of the long-standing statutory mechanism to divert patients from premature and unnecessary institutionalization by building up, monitoring and ensuring the identification, evaluation and referral of patients for home care who are otherwise eligible for nursing home placement;

* Increased access to the Long Term Home Health Care Program (LTHHCP) - also known as the "Nursing Home Without Walls Program," a comprehensive, coordinated and cost-effective alternative to institutional care for individuals of all ages - by converting the statute from a patient-specific expenditure cap to a provider cap;

* Increased efficiency through changes to the LTHHCP patient reassessment interval from a minimum of 120 days to 180 days;

* A reexamination of the future role of local districts in the home care assessment and authorization process and, in the interim, establishment of performance standards for such participation and benchmarks for personal care;

* Criteria for home care agency contracting; * New initiatives for the care of high need/high cost patients, new applications of telehealth for Medicaid efficiencies, and a new initiative for screening and intervention for visually impaired individuals to optimize functioning and safety and prevent injury, medication errors and other situations increasing the risk of medical service need;

* Increased flexibility in the deployment of home health personnel;

* Development of a Federal-State Medicare Shared Savings Partnership, through which the state would be incentivized to further invest in initiatives to promote the care of Medicare beneficiaries in ways that reduce hospitalization, emergency room use and other high cost services use, with a portion of the Medicare savings returned to the state for the support of our health care system;

* Flexibility for collaboration among provider types for improved efficiency, access and service delivery;

* Initiatives to help consumers privately finance home health costs and thus reduce reliance on Medicaid by a modernization of the insurance benefit and providing increased access to long term care insurance;

* Initiatives aimed at improving the regulatory environment for home care development and operation, including expedited Certificate of Need review for home care priority projects and the establishment of a Rural Home Health Flexibility Program; and

* Other related measures.

Justification

This legislation affirmatively taps home care's cost-saving potential to both improve the long term care system and help accomplish the state's goal of making the Medicaid program more efficient. The legislation contains constructive changes, improvements and innovations that would benefit the consumer, the provider community, the health care system, the state's policy goals and the taxpayers.

Prior legislative history

New bill.

Fiscal implications

This legislation has the potential to save millions of dollars for the state's Medicaid program by reforming state statutes, eliminating barriers and establishing innovations that will further enabling home care services to cost-effectively meet the needs of New York State's citizens.

Effective date

This act shall take effect immediately, provided that section 10 of this act shall take effect January 1, 2010 or upon the renewal of contacts regulated pursuant such section, whichever is later and provided further however that sections 19 and 20 of this act shall take effect January 1, 2010 or upon the renewal date of contracts or policies following such date.