What's happening
Writing a plain-English summary… Track this bill to get it by email.
Why it matters
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Sponsors
1 Co-sponsor
History
- Referred to health
- Committed to rules
- Advanced to third reading
- 2nd report cal.
- Amended 4297a
- 1st report cal.256
- Referred to health
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S4297A
Title of bill
An act to amend the public health law, in relation to universal standards for coding of payment of claims for long term care and electronic payment of claims
Purpose
Requires contracts or agreements for the payment of long term care services to utilize universal standards of coding similar to other health care providers and the payment of such claims to be via electronic funds transfer.
Read the full memo (713 words)
Summary of provisions
Section one of the bill by adding a new section 3614-d of the public health law providing for contracts or agreements issued or entered into or between certified home health agencies, long term home health care programs, licensed home care services programs, fiscal intermediaries, insurers, managed long term care plans, managed care plans or organizations licensed or operated pursuant to the provisions of the public health, social services, or insurance law and for all bills for personal care, home health care services or other long term care services rendered by licensed home care services programs, certified home health agencies or long term home health care programs pursuant to such contracts or agreements, any certified home health care agency, long term home health care program, fiscal intermediary, insurer, managed long term care plans, managed care plan, or organizations licensed or operated pursuant to the provisions of the public health, social services, executive or insurance law shall be based on universal billing codes approved by the department or a nationally accredited organization.
Section two of the bill adds a new section 3614-e to provide that the payment of claims for long term care services must be by electronic funds transfer.
Justification
The State's transition to managed long term care (MLTC) has now been underway for over two years. During that time, home care agencies have experienced ongoing - and mounting - challenges related to an overall lack of standardization and efficiency in procedures and billing processes when working with various MLTC plans. These inefficiencies have created significant obstacles for providers to secure prompt reimbursement for services which threaten their ability to continue the high standard of long term care to the elderly and disabled.
Surveys of providers were conducted in September 2013 and in 2015 to document and analyze over time how the transition to managed care has impacted home care providers across the State. Topping the list of concerns of home care providers in both years is the inability to secure adequate and timely reimbursement for services provided under contract with Medicaid managed care and MLTC plans.
In 2015, 50% of the respondents indicated that they were contracting with eight or more MLTCs, up from 32% in 2013. Each of these plans has different billing codes for services and different procedures for submitting claims. This has significantly added to the administrative
burden of home care providers, draining home care resources and contributing to delays in payments.
When asked how agencies could use financial assistance to support the MLTC transition and other large-scale health-related State policy initiatives underway, 43% of survey respondents in 2015 said that they would hire additional administrative staff and 36% responded they would enhance their agency's IT capabilities. This reflects the significant increase in administrative burdens that home care providers have experienced with the transition to manager care. When asked the same question in 2013, none of the respondents selected these categories.
Inefficiencies and delays in the managed care system have led to serious cash flow problems for home care agencies and threaten their viability to continue to provide care to all parts of the State. More than 60% of respondents in 2015 indicated that they are currently experiencing cash flow issues or have faced cash flow issues in the past.
This legislation will help relieve the administrative burden on providers by requiring the Department of Health to establish universal billing codes that will be used by all of the managed care plans and providers with whom they have contracts or agreements. It will also expedite the reimbursement process by requiring payments to be made via electronic funds transfer, as is currently done in the Medicaid system.
Legislative history
New legislation.
Fiscal implications
None.
Effective date
Immediately, provided it shall apply to any coding of payment of claims for long term care on or after January 1, 2016.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.