Establishes the New York state home care quality of care innovations initiative and the New York State Home Care Quality Innovations Initiative Fund

The Home Care Quality of Care Innovations Initiative would include, but not be limited to:

a. Promoting the development, application, utilization and research of clinical guidelines and evidenced based practices in connection with the care of patients at home;

b. Promoting the use of technology in conjunction with clinical criteria and evidence based practice for the advancement of quality care;

c. Promoting quality transitions in care, including but not limited to transitions to and from home-based care and to hospitals, nursing homes, rehabilitation centers and other settings, as well as transitions to and from different home care programs;

d. Identifying gaps and other elements of the system which contribute to avoidable hospital readmissions, including medication reconciliation, and targeting intervention to prevent and reduce such readmissions;

e. Identifying the cost-effectiveness of the application of such quality innovations for governmental and nongovernmental payers; and

f. Researching clinical protocols, programs, practices and outcomes to identify additional areas and methods for developing and promoting quality innovations.

Participating entities would include voluntarily participating certified home health agencies, long term home health care programs, licensed home care services agencies, AIDS home care programs, agencies/programs under managed long term care plans, collaborative initiatives with physicians, hospitals and other providers or entities, as well as entities with expertise in quality review, home health agency accreditation, and statewide home care representation.

The bill establishes an advisory group to consult on program implementation. The Health Department would work with the advisory group to:

a. Identify clinical guidelines and evidence based practices to be researched and/or promoted through the initiative, which would include the consideration of nationally developed guidelines and practices as well as those developed or evidenced on a provider-specific basis;

b. Identify types of technology and areas where the application and coverage of such technology would be considered as a standard of care;

c. Identify elements to be addressed in improving transitions of care as well as for preventing avoidable rehospitalizations, and the corresponding methods for addressing such elements;

d. Conduct provider/consumer education, including that of provider quality improvement personnel, relative to the utilization of clinical guidelines, evidence based practices, application of technology, the implementation of strategies to improve transitions in care and interventions to prevent or reduce hospital readmissions;

e. Determine data to be shared with providers which would further the goals of clinical guideline identification, development and/or use and improvement in transitions in care;

f. Identify and respond as practicable to the technical assistance needs of providers participating in the initiative;

g. Implement a grant program to support the quality initiative;

h. Determine and recommend positive adjustments in the Medicaid rate methodology to enable and encourage desired provider behavior and goals with regard to quality innovation and enhancement pursuant to this section;

i. Identify areas for research and foster such other activities as the Department in conjunction with the workgroup deem necessary, appropriate and consistent with the goals of the program.

A grant program would be established to support the home care quality innovations initiatives, with funding also set aside to support the administrative and implementation expenses of the Health Department.

A New York State Home Care Quality of Care Innovations Fund would be established under the state finance law to include appropriations as well as any grants, gifts or other philanthropic, private or governmental sources of funding to support the program.

The Commissioner of Health would be provided with waiver authority for purposes of promoting the implementation and goals of the program. The legislation would exclude costs associated with the provision of home care quality of care innovations from the calculation of providers' administrative and general cost cap under section 3614 of the public health law.

The Department would report experiences and recommendations to the Governor and Legislature on or before December 1, 2011.

Justification

With the advancement of clinical techniques and the improvements in data, technology and measurement of clinical practices and outcomes, new and significant opportunities exist for quality of care innovation, with consequent benefits for patients, the health care system and potential for cost-savings for all payers. Given home care's increasing, central role in the total care of all types of patients, the support of quality innovation in connection with care in the home should be a vital focus for advancing these opportunities. Many critical elements that affect patient health and the functioning of the system, including transitions in care, avoidable hospital admissions and readmissions and other critical problems and needs, can be address through such innovations.

The ability to impact the system, patients' lives and health care costs through such innovations necessitates the state's support for and investment in the engagement of home care agencies, their patients and collaborating providers and entities. The creation of the proposed New York State Home Care Quality of Care Innovations Initiative would break new ground in health care, and serve the strong interests of the state and its citizens.

Legislative history

New bill.

Fiscal implications

Creates opportunities for cost savings to Medicaid and other payors. The program would be financed through both external sources of funds (private, philanthropic, federal grants) and any state appropriations that might be provided in the budget.

Effective date

Immediately.