Requires contracts with home care service providers to provide sufficient resources to ensure compensation to a qualified workforce providing high quality care

Summary of provisions

Section one adds a new § 4406-c(9) to the PHL to ensure that funds made available to licensed home care service programs, certified home health agencies, long term home health care programs and consumer directed personal assistance services through contracts with health care plans shall provide compensation sufficient to support compensation for persons providing such home care aide services and consumer directed personal assistance services to ensure the retention of a qualified workforce.

Section two amends § 3224-a of the insurance law to provide for 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 rendered during the transition from fee for service to Medicaid managed long term. This section also requires payment to such providers of disputed claims and provides for access to arbitration pursuant article seventy five of the civil practice law and rules by insurers or organizations or corporations licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law.

Section three adds a new subdivision (17) to Public Health Law (PHL) 2801-a. This subdivision authorizes the Commissioner of Health to create the program and specifies that it applies to health care providers licensed or certified pursuant to article thirty-six of the public health law 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. Applicants to the program must submit a comprehensive program and business plan, and such plan must promote agreed objectives of transition. The credit enhancement program shall be administered by the Dormitory Authority, or a not-for-profit designated by the Dormitory Authority.

This section also authorizes an optional debt service reserve fund to pre-fund potential obligations in the event of a default. In the event of a default by a borrower, funds would be drawn from health reform

funding made available to New York by the federal government under the proposed Section 1115 waiver funds, other ACA health reform funds provided to N.Y, or other allocated funds. This paragraph clarifies that under no circumstances are the potential State payments to be considered a general obligation of the State.

Sections four and five amend Public Authorities Law § 1676(b)(2) and 1680(1), respectively, to health care providers licensed or certified by article thirty-six as are approved for the credit enhancement program pursuant to PHL § 2801-a(17).

Section six provides that this act shall take effect immediately,

Justification

This legislation aims to ensure that the home care system in New York, which has been hit with hundreds of millions of dollars in cuts, unfunded wage mandates, the transition to managed long term care, a devastating storm and rate recoupments in 2012 of $250 million, has the necessary system supports to ensure a stable and successful transition from fee for service Medicaid to managed long term care. Providers, workers and patients are shifting into a new system of managed long term care with fewer resources while working hard to maintain the high quality of home care which New York State is regarded for across the country.

Currently, agencies seeking to pay home care wage parity rates or other wages and benefits as required by law are not guaranteed the proper payment amounts by managed long term care entities. In addition, agencies are reporting exploding accounts receivables from lags in the payment of claims under managed care and the frequent rejection of the payment of claims. The transition from fee for service to managed care has created myriad complications with billing and payment for services rendered and the providers of services are often left unpaid because of transition issues. This has led many agencies into financial and cash flow crises impacting workers and more importantly the patients they serve. This legislation will provide for more timely cash flow and payments while disputes are arbitrated by insurers if deemed appropriate.

This proposal also facilitates access to capital to support reform initiatives as it relates to transitions from fee for service to Medicaid managed long term care. It includes capital financing to providers have chronic financial challenges and are consequently unsuccessful in accessing capital to undertake reform initiatives. It would allow home care providers to finance capital investments at a lower cost, therefore providing added savings for the New York health care system.

Funding under the program would be for the full spectrum of transition needs including operational/business changes to adapt to the new care management system, health information technology, "soft" costs, working capital, and care management infrastructure development.

The provisions of this legislation combined attempts to assist patients, workers and providers in keeping the promise to people facing illness or disability - maintaining their independence in the

comfort, security and privacy of their homes -by providing system supports during this time of transition and financial uncertainty.

Legislative history

New bill.

Fiscal implications

No net fiscal impact. The State obligation to pay any funds is contingent upon a borrower's default in repayment to a lender, which may never occur. In the event a default did occur, payments by the State would be made to the lender solely from allocated funds from the 1115 waiver or other federal health reform funds, or other allocated funds.

Effective date

Immediately.