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Major Legislative Opportunities and Challenges in Session Wind Down

Major opportunities and challenges alike mark the next two, closing weeks of the State Legislative Session, scheduled to conclude June 17.

In this wind down of the annual legislative calendar, the state Senate and Assembly will be considering significant issues that both directly and indirectly impact home and community-based care, many with huge implications for this sector.

The full array of possible home care-impacting bills from among the thousands introduced in the Legislature are too numerous to include in this article, and we have summarized some of the most significant below.

Over the next two weeks, HCA will continue strenuously advocating on areas of both priority support and concern, while also working to effect the passage or the reconsideration of other bills of potential assistance or set-back to home and hospice care patients, agencies and plans.

Most of the priority bills below have been previously and extensively described in HCA communications, and members are encouraged to refer to those more detailed pieces for further information.

Episodic Payment System – HCA is leading discussions to craft and seek introduction of legislation to avert state Medicaid cuts nearing 30 percent to home health agencies. The cuts would stem from a rebasing of the episodic pricing system (EPS) for Certified Home Health Agencies. That process is being administratively implemented by the State Department of Health. The extent of the reduction may exceed $70 million, most of which is outside the state fiscal plan adopted with the budget. HCA is developing legislation that would avert this huge cut at the very time that the state should be investing in home care, particularly given home care’s critical role in virtually all of the new models and policies the state is advancing.

Community Paramedicine – S.5481 (Hannon)/A.7503 (Gottfried). This legislation would authorize emergency medical technicians (EMTs) to provide services to individuals in other than emergency circumstances. HCA worked throughout the week with key legislative offices and with the bill’s backers to address critical concerns for home care providers and patients. HCA has formulated and submitted amendments to the Legislature and advocates for the bill to ensure that the proposed “community paramedicine program” does not crossover into the licensure domains of home care, hospice and behavioral health, and that EMTs providing services under this model coordinate and refer, as applicable, to patients’ physicians and appropriate community care services. This bill has passed in the Assembly and was referred to the Senate Floor Calendar.

Hospital/Clinic “Offsite Services” – S.5522 (Hannon)/A.7714 (Gottfried). This legislation would authorize hospitals and clinics to provide their licensed services “offsite” to chronically ill individuals in their homes. Similar to the paramedicine bill described above, HCA continues to work intensively with legislative offices and with the bill’s supporters to address “crossover” issues with home care, hospice and behavioral health. HCA has exchanged amendments with the Legislature and supporters, principally the Healthcare Association of New York State (HANYS), and discussions have produced initial amendment drafts which will go a long way toward achieving the goals of the legislation (primarily focused on housecalls by physicians and other primary care practitioners) within appropriate parameters. Discussions are continuing. This bill was reported to the Senate Floor Calendar and to the Assembly Rules Committee.

Home Care Insurance Modernization – S.5076(Seward)/A.7706 (Cahill). This bill developed by HCA would modernize parts of the Insurance Law to update provisions for coverage for home care services with the current and evolving dynamics of the health care system. HCA will discuss and continue to advocate the advancement of this important bill with the Senate and Assembly sponsors and others. S.5076 and A.7706 are currently in the Senate and Assembly Insurance Committees, respectively.

Payment Adequacy for Managed Care/Home Care – HCA continued discussions this week with the Senate and Assembly on legislation for payment adequacy for managed care and home care. HCA has submitted a comprehensive payment adequacy bill for consideration by Senator Hannon and Assemblyman Gottfried. Meanwhile, additional legislation has been introduced by colleagues at the New York State Association of Health Care Providers (HCP) that would approach payment adequacy through a determination of “actuarial” soundness of the rates made through an independent contractor to the state (S.5489 Hannon/A.7687 Gottfried). These bills are in the Senate and Assembly Health Committees.

Advanced Home Health Aide – A.7188 (Glick), which would authorize Advanced Home Health Aides, passed the Assembly on May 19 but is still at an impasse in the State Senate where companion legislation is not yet introduced. The legislation amends the Nurse Practice Act in ways that have been objectionable to the Senate. The legislation also contains provisions and fails to include others which are of critical concern and/or need in relation to successful implementation by home care agencies. HCA strongly supports enactment of an agreeable bill that would enable agencies and home health aides to offer these enhanced, more flexible services.

Telehealth Amendments – HCA has been working extensively with key legislative staff on the development and introduction of legislation to address areas of concern in the telehealth insurance coverage legislation, Chapter 6 of the laws of 2015, passed and signed earlier this year, refining an earlier version passed in December. Key areas addressed by the amendments include aspects of insurance law which may inadvertently prevent the new telehealth coverage from being practically delivered through home care, as well as the inclusion of telehealth under long term care insurance policies, similar to how the new law includes telehealth under general insurance. If introduced and passed, the amendments would take effect in time for the implementation of the new coverage law, which is January 1, 2016.

Licensing of Fiscal Intermediaries for Consumer Directed Services – S.5565-A (Hannon)/A.7535-A (Gottfried). This legislation would require licensure of fiscal intermediaries for consumer directed personal assistance services. The legislation would require an additional layer of approval, licensure, fees and regulation for the many already-licensed agencies, including licensed home care services agencies, who are currently serving as fiscal intermediaries. HCA has communicated our concerns to the Legislature and urged reconsideration and amendment of the bill to avoid such duplication and additional administrative burden on agencies serving as fiscal intermediaries. S.5565-A has been amended on the Senate Floor Calendar and recommitted to Senate Finance. A.7535-A is in the Assembly Codes Committee.

CARE Act – S.676-B (Hannon)/A.1323 (Rosenthal): The Caregiver, Advise, Record and Enable (CARE) Act. This bill completed passage of both houses of the Legislature this week and was returned to the Assembly, awaiting delivery to the Governor for his signature. The CARE act would specify requirements for caregiver identification, training and support in conjunction with the discharge planning process. HCA supported the intent and goals of the legislation to support more patient-centered and effective care transition from hospital to home.

Essential Personnel – S.3482-B (Lanza)/A.5125-B (Cusick). HCA’s legislation to provide “essential personnel” status for home care and hospice personnel in emergency situations continued to be focus of HCA advocacy this week. The legislation passed the Assembly unanimously on May 11, and remains in the Senate Committee on Homeland Security. Senator Lanza continues to work to champion Senate passage prior to the conclusion of the session. The bill passed unanimously in the Senate as well last year.

Veterans Home and Community Based Care Pilot – S.5780 (Croci). This HCA-authored legislation would establish a Veterans Home and Community Based Care Pilot program. The legislation is the result of collaboration by HCA, the New York State Health Foundation and a roundtable of HCA providers and other experts. HCA is working with Assembly Veterans Committee chairman, Assemblyman Dendekker, on Assembly sponsorship and on positioning of the legislation for passage prior to session’s end. Introduction of the legislation has also triggered a number of other steps for increased support of this concept and improved home care access for veterans overall.