Relates to the provision of services by long term home health care programs; repealer

BILL NUMBER:S5671A

Title of bill

An act to amend the public health law and the social services law, in relation to the provision of services by long term home health care programs; and to repeal certain provisions of the public health law relating thereto

Purpose or general idea of bill

To make conforming amendments to the long, term home health care plan statute to further align the long term home health care plan to State Medicaid redesign policies, so as to facilitate long term home health care plan functionality, operation, and continuity under the state's new policies.

Summary of specific provisions

Section one expresses the intent of the Legislature to further align the long term home health care plan (LTHHCP) to function within the evolving model of managed care.

Section two amends the eligibility for the LTHHCP to align it with managed care plan eligibility.

Section two also amends the LTHHCP definition to make explicit its ability to function as a contractor to a managed care plan.

Section three makes a conforming amendment to the Managed Long Term Care (MLTC) statute to make explicit the ability of MLTCs to contract with LTHHCP for LTHHCP services and to stipulate that the MLTC statute (4403-0supersedes any inconsistent provisions between 4403-f and article 36 for LTHHCP -services contracted to MLTC.

Sections 4 and 5 amend the social services law and public health law provisions for authorization and provision of LTHHCP services. The amendments stipulate that these respective provisions of law govern LTHHCP except when LTHHCP services are provided and authorized under MLTC, in which case, the MLTC statute governs.

Section 6 repeals provisions of article 36 that impose patient "slot" limits on LTHHCPs.

Section 7 addresses the changing status of waivers for LTHHCP, further reinforcing existing law to underscore that provision or operation of LTHHCP is not contingent upon the authority to authorize reimbursement for optional waivered services under a federal 1915(c) waiver.

Section 8 establishes an immediate effective date for the bill.

JUSTIFICATIONof : New York State's Long Term Home Health Care ("Nursing Home Without Walls") Program has been an integral part of the state's long term care system for over three decades and is an important service option for the state's citizens with chronic illness, infirmity, and

disability. The program provides quality care to long term care patients at home at approximately half the cost of institutional care.

As the state shifts to a managed care structure for the delivery of health services, this program should continue to fulfill its vital role in the state's health care system. To effectively function in the new system, however, certain changes are necessary to further align this program to the evolving delivery structure.

This legislation provides for the series of conforming changes necessary to facilitate LTHHCP functionality, operation, contracting, and continuity in this evolving system.

These changes provide for sensibility and rationality of structure for MLTC-LTHHCP contracting and partnering in the provision of care.

The legislation will promote achievement of the state's Medicaid redesign goals, continuity of patient care, and continuity of the LTHHCP as a vital component of the needed long term care infrastructure.

Prior legislative history

None.

Fiscal implications

This bill helps ensure efficiency and savings in the state Medicaid program by facilitating the functionality, operation and contracting of the LTHHCP within the evolving infrastructure. The LTHHCP has provided a cost-effective alternative to institutionalization for 35 years, with patient care costs under the LTHHCP averaging approximately 50 percent of nursing home costs.

Effective date

The bill would take effect immediately.