STATE OF NEW YORK ________________________________________________________________________ 1331 2023-2024 Regular Sessions IN ASSEMBLY January 17, 2023 ___________ Introduced by M. of A. BUTTENSCHON, CRUZ, DARLING, JACKSON, WILLIAMS -- read once and referred to the Committee on Health AN ACT to amend the public health law, the insurance law and the public authorities law, in relation to payments to home care services provid- ers and authorizing the commissioner of health to establish a program to provide loans, through the dormitory authority, to home care to finance health care reform efforts The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 4406-c of the public health law is amended by 2 adding a new subdivision 13 to read as follows: 3 13. Notwithstanding any inconsistent provision of law, contracts with 4 certified home health agencies, long term home health care programs, 5 licensed home care services programs or fiscal intermediaries operating 6 pursuant to section three hundred sixty-five-f of the social services 7 law to provide home care aide services as defined in section thirty-six 8 hundred fourteen-c of this chapter, or consumer directed personal 9 assistance services as authorized pursuant to section three hundred 10 sixty-five-f of the social services law shall at a minimum ensure that 11 the resources made available by such contracts shall support compen- 12 sation for persons providing such home care aide services and consumer 13 directed personal assistance services to ensure the retention of a qual- 14 ified workforce capable of providing high quality care to recipients of 15 such services consistent with the provisions of such section. 16 § 2. Subsection (a) of section 3224-a of the insurance law, as amended 17 by chapter 237 of the laws of 2009, is amended to read as follows: 18 (a) Except in a case where the obligation of an insurer or an organ- 19 ization or corporation licensed or certified pursuant to article forty- 20 three or forty-seven of this chapter or article forty-four of the public 21 health law to pay a claim submitted by a policyholder or person covered 22 under such policy ("covered person") or make a payment to a health care EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04856-01-3 A. 1331 2 1 provider is not reasonably clear, or when there is a reasonable basis 2 supported by specific information available for review by the super- 3 intendent that such claim or bill for health care services rendered was 4 submitted fraudulently, such insurer or organization or corporation 5 shall pay the claim to a policyholder or covered person or make a 6 payment to a health care provider within thirty days of receipt of a 7 claim or bill for services rendered that is transmitted via the internet 8 or electronic mail, or forty-five days of receipt of a claim or bill for 9 services rendered that is submitted by other means, such as paper or 10 facsimile. Provided, however, any payment for services to health care 11 providers licensed under article thirty-six of the public health law or 12 fiscal intermediaries operating pursuant to section three hundred 13 sixty-five-f of the social services law shall be paid within fifteen 14 days of the receipt of a claim or a bill for services rendered during 15 the transition period from fee for service to Medicaid managed long term 16 care consistent with the state Medicaid plan for such health care 17 providers and for the twelve month period beyond the final transition of 18 Medicaid beneficiaries in that county. In addition, payments for any 19 disputed claim or bill for services shall be paid to such health care 20 providers by an insurer or an organization or corporation licensed or 21 certified pursuant to article forty-three or forty-seven of this chapter 22 or article forty-four of the public health law within twenty days of the 23 receipt of a claim or a bill for services; provided that at the option 24 of such insurer or organization or corporation licensed or certified 25 pursuant to article forty-three or forty-seven of this chapter or arti- 26 cle forty-four of the public health law, such claim or bill for services 27 shall subsequently be subject to arbitration pursuant to article seven- 28 ty-five of the civil practice law and rules. 29 § 3. Section 2801-a of the public health law is amended by adding a 30 new subdivision 17 to read as follows: 31 17. (a) The commissioner is authorized to establish a program to 32 assist in restructuring long term home health care delivery systems by 33 providing credit enhancement to health care providers licensed pursuant 34 to article thirty-six of this chapter that lack the credit resources 35 necessary to transition from fee for service to managed long term care 36 consistent with the goals of the state's Medicaid program multi-year 37 action as adopted by the Medicaid redesign team. The program shall apply 38 to health care providers who can demonstrate financial need and advance 39 the state's health reform agenda of better care, better health for popu- 40 lations, lower costs, and transitioning the state's long term care 41 system. 42 (b) Applicants must commit that the uses of the credit-enhanced loans 43 will promote agreed upon goals of transitioning the long term home 44 health care delivery systems. Applicants shall submit a comprehensive 45 program and business plan, and such plan must promote agreed objectives 46 of transition. Loan documents shall contain health reform covenants, 47 milestone dates and statistical targets to be attained by the borrower. 48 The application must address how the applicant will undertake the 49 improvements in formal or informal cooperation with other health care 50 providers in the region. To the extent required to provide legal 51 protection for such cooperative endeavors, the commissioner shall exer- 52 cise all necessary powers pursuant to article twenty-nine-F of this 53 chapter and any fees associated with such oversight may be included in 54 the project financing costs. 55 (c) The credit enhancement program shall be administered by the dormi- 56 tory authority, or a not-for-profit corporation designated by the dormi-
A. 1331 3 1 tory authority. The commissioner shall chair the credit enhancement 2 application and approval committee. The commissioner shall designate 3 three or more members of the Medicaid redesign team as additional 4 members of the credit enhancement application and approval committee. 5 The chair of the dormitory authority shall also serve as a member of the 6 committee, and shall determine all rules for reviewing and approving 7 applications, and administering approved credit enhancements. Notwith- 8 standing any other law, no person serving as a member of the credit 9 enhancement application and approval committee shall have any personal 10 liability, or incur liability for their employer, by virtue of their 11 role or vote in the credit enhancement application and approval process. 12 (d) A debt service reserve fund may be created to facilitate the cred- 13 it enhancement. 14 (e)(i) In the event of a default by a borrower to a lender, the amount 15 of the defaulted payment shall be paid by the commissioner to the lend- 16 er. To finance the commissioner's remittance of those defaulted 17 payments, the commissioner shall first draw upon funds allocated for 18 such potential defaults, including but not limited to funds made avail- 19 able for that purpose pursuant to the state's August sixth, two thousand 20 twelve section 1115 partnership plan waiver application and additional 21 federal funds made available through implementation of the federal 22 Affordable Care Act (health reform). 23 (ii) All payments of defaulted amounts shall be made solely from the 24 allocated funds and as such amounts are actually collected and made 25 available to the commissioner for remittance to lenders pursuant to 26 subparagraph (i) of this paragraph. Neither the state, the commissioner, 27 the department, the dormitory authority, nor any other instrumentality 28 of the state, shall be legally responsible for payment of the defaulted 29 amounts, other than pursuant to the process and financial resources 30 described in subparagraph (i) of this paragraph. No assets or resources 31 of the state shall be pledged, or considered to be pledged or obligated 32 in any form, to payment of the defaults, other than pursuant to the 33 process and financial resources described in subparagraph (i) of this 34 paragraph, as actually collected and made available to the commissioner 35 for the purposes of paying defaulted amounts pursuant to subparagraph 36 (i) of this paragraph. 37 § 4. Paragraph (b) of subdivision 2 of section 1676 of the public 38 authorities law is amended by adding a new undesignated paragraph to 39 read as follows: 40 Such health care providers licensed pursuant to article thirty-six of 41 the public health law as are approved for the credit enhancement program 42 pursuant to subdivision seventeen of section twenty-eight hundred one-a 43 of the public health law. 44 § 5. Subdivision 1 of section 1680 of the public authorities law is 45 amended by adding a new undesignated paragraph to read as follows: 46 Such health care providers licensed pursuant to article thirty-six of 47 the public health law as are approved for the credit enhancement program 48 pursuant to subdivision seventeen of section twenty-eight hundred one-a 49 of the public health law. 50 § 6. This act shall take effect immediately.