S. 4355 2
3912. DISEASE MANAGEMENT DEMONSTRATION PROGRAMS.
3913. HOME TELEHEALTH.
S 3910. DEFINITIONS. FOR THE PURPOSES OF THIS ARTICLE, THE FOLLOWING
TERMS SHALL HAVE THE FOLLOWING MEANINGS:
1. "DISTANT SITE HOSPITAL" MEANS A HOSPITAL LICENSED PURSUANT TO THIS
ARTICLE OR A HOSPITAL LICENSED BY ANOTHER STATE, THAT HAS ENTERED INTO
AN AGREEMENT WITH AN ORIGINATING HOSPITAL TO MAKE AVAILABLE ONE OR MORE
HEALTH CARE PRACTITIONERS THAT ARE MEMBERS OF ITS CLINICAL STAFF TO THE
ORIGINATING HOSPITAL FOR THE PURPOSES OF PROVIDING TELEMEDICINE
SERVICES. TO QUALIFY AS A DISTANT SITE HOSPITAL FOR PURPOSES OF THIS
ARTICLE, A HOSPITAL LICENSED BY ANOTHER STATE MUST COMPLY WITH THE
FEDERAL REGULATIONS GOVERNING PARTICIPATION BY HOSPITALS IN MEDICARE.
2. "HEALTH CARE PRACTITIONER" SHALL MEAN A PERSON LICENSED PURSUANT TO
ARTICLE ONE HUNDRED THIRTY-ONE, ONE HUNDRED THIRTY-ONE-B, ONE HUNDRED
THIRTY-THREE, ONE HUNDRED THIRTY-NINE, ONE HUNDRED FORTY, ONE HUNDRED
FORTY-ONE, ONE HUNDRED FORTY-THREE, ONE HUNDRED FORTY-FOUR, ONE HUNDRED
FIFTY-THREE, ONE HUNDRED FIFTY-FOUR OR ONE HUNDRED FIFTY-NINE OF THE
EDUCATION LAW, OR AS OTHERWISE AUTHORIZED BY THE COMMISSIONER.
3. "ORIGINATING HOSPITAL" MEANS THE HOSPITAL AT WHICH A PATIENT IS
LOCATED AT THE TIME TELEMEDICINE SERVICES ARE PROVIDED TO HIM OR HER.
4. "TELEMEDICINE" MEANS THE DELIVERY OF CLINICAL HEALTH CARE SERVICES
BY MEANS OF REAL TIME TWO-WAY ELECTRONIC AUDIO-VISUAL COMMUNICATIONS
WHICH FACILITATE THE ASSESSMENT, DIAGNOSIS, CONSULTATION, TREATMENT,
EDUCATION, CARE MANAGEMENT AND SELF MANAGEMENT OF A PATIENT'S HEALTH
CARE WHILE SUCH PATIENT IS AT THE ORIGINATING SITE AND THE HEALTH CARE
PROVIDER IS AT A DISTANT SITE.
S 3911. CREDENTIALING AND PRIVILEGING OF HEALTH CARE PRACTITIONERS.
1. WHEN TELEMEDICINE SERVICES ARE PROVIDED TO AN ORIGINATING HOSPITAL'S
PATIENTS PURSUANT TO AN AGREEMENT WITH A DISTANT SITE HOSPITAL, THE
ORIGINATING HOSPITAL MAY, IN LIEU OF SATISFYING THE REQUIREMENTS SET
FORTH IN SECTION TWENTY-EIGHT HUNDRED FIVE-K OF THIS ARTICLE, RELY ON
THE CREDENTIALING AND PRIVILEGING DECISIONS MADE BY THE DISTANT SITE
HOSPITAL IN GRANTING OR RENEWING PRIVILEGES TO A HEALTH CARE PRACTITION-
ER WHO IS A MEMBER OF THE CLINICAL STAFF OF THE DISTANT SITE HOSPITAL,
PROVIDED THAT:
(A) THE DISTANT SITE HOSPITAL PARTICIPATES IN MEDICARE AND MEDICAID;
(B) EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE IS LICENSED
TO PRACTICE IN THIS STATE;
(C) THE DISTANT SITE HOSPITAL, IN ACCORDANCE WITH REQUIREMENTS OTHER-
WISE APPLICABLE TO THAT HOSPITAL, COLLECTS AND EVALUATES ALL CREDENTIAL-
ING INFORMATION CONCERNING EACH HEALTH CARE PRACTITIONER PROVIDING TELE-
MEDICINE SERVICES, PERFORMS ALL REQUIRED VERIFICATION ACTIVITIES, AND
ACTS ON BEHALF OF THE ORIGINATING SITE HOSPITAL FOR SUCH CREDENTIALING
PURPOSES;
(D) THE DISTANT SITE HOSPITAL REVIEWS PERIODICALLY, AT LEAST EVERY TWO
YEARS, AND AS OTHERWISE WARRANTED BASED ON OUTCOMES, COMPLAINTS OR OTHER
CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL AND MENTAL CAPACI-
TY, AND COMPETENCE IN DELIVERING HEALTH CARE SERVICES OF EACH HEALTH
CARE PRACTITIONER PROVIDING TELEMEDICINE SERVICES, CONSISTENT WITH
REQUIREMENTS OTHERWISE APPLICABLE TO THAT HOSPITAL; REPORTS THE RESULTS
OF SUCH REVIEW TO THE ORIGINATING HOSPITAL; AND NOTIFIES THE ORIGINATING
HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCATION, OR LIMITATION OF
SUCH PRIVILEGES;
(E) WITH RESPECT TO EACH DISTANT SITE HEALTH CARE PRACTITIONER WHO
HOLDS PRIVILEGES AT THE ORIGINATING HOSPITAL, THE ORIGINATING HOSPITAL
CONDUCTS A PERIODIC INTERNAL REVIEW, AT LEAST EVERY TWO YEARS, OF THE
S. 4355 3
DISTANT SITE PRACTITIONER'S PERFORMANCE OF THESE PRIVILEGES AND PROVIDES
THE DISTANT SITE HOSPITAL WITH SUCH PERFORMANCE INFORMATION FOR USE IN
THE DISTANT HOSPITAL'S PERIODIC APPRAISAL OF THE DISTANT SITE PHYSICIAN
OR HEALTH CARE PRACTITIONER. SUCH INFORMATION SHALL INCLUDE, AT A MINI-
MUM, ALL ADVERSE EVENTS THAT RESULT FROM THE TELEMEDICINE SERVICES
PROVIDED BY THE DISTANT SITE HEALTH CARE PRACTITIONER TO THE ORIGINATING
HOSPITAL'S PATIENTS, ALL COMPLAINTS THE ORIGINATING HOSPITAL HAS
RECEIVED ABOUT THE DISTANT SITE PRACTITIONER, AND ANY REVOCATION,
SUSPENSION OR LIMITATION OF THE DISTANT SITE PRACTITIONER'S PRIVILEGES
BY THE ORIGINATING HOSPITAL; AND
(F) THE AGREEMENT ENTERED INTO BETWEEN THE ORIGINATING SITE HOSPITAL
AND DISTANT SITE HOSPITAL SHALL BE IN WRITING AND SHALL, AT A MINIMUM:
(I) PROVIDE THE CATEGORIES OF HEALTH CARE PRACTITIONERS THAT ARE
ELIGIBLE CANDIDATES FOR APPOINTMENT TO THE ORIGINATING HOSPITAL'S CLIN-
ICAL STAFF,
(II) REQUIRE THE GOVERNING BODY OF THE DISTANT SITE HOSPITAL TO COMPLY
WITH THE MEDICARE CONDITIONS OF PARTICIPATION GOVERNING THE APPOINTMENT
OF MEDICAL STAFF WITH REGARD TO THE HEALTH CARE PRACTITIONERS PROVIDING
TELEMEDICINE SERVICES,
(III) ITEMIZE THE CREDENTIALING INFORMATION TO BE COLLECTED AND THE
REQUIRED VERIFICATION ACTIVITIES TO BE PERFORMED BY THE DISTANT SITE
HOSPITAL AND RELIED UPON BY THE ORIGINATING HOSPITAL IN CONSIDERING THE
RECOMMENDATIONS OF THE DISTANT SITE HOSPITAL,
(IV) REQUIRE EACH DISTANT SITE HEALTH CARE PRACTITIONER PROVIDING
TELEMEDICINE SERVICES TO BE LICENSED TO PRACTICE IN THIS STATE AND PRIV-
ILEGED AT THE DISTANT SITE HOSPITAL,
(V) REQUIRE THE DISTANT SITE HOSPITAL TO PROVIDE TO THE ORIGINATING
HOSPITAL A CURRENT LIST OF EACH DISTANT SITE HEALTH CARE PRACTITIONER'S
PRIVILEGES AT THE DISTANT SITE HOSPITAL, AND
(VI) REQUIRE THE DISTANT SITE HOSPITAL TO CONDUCT A PERIODIC REVIEW
CONSISTENT WITH REQUIREMENTS OTHERWISE APPLICABLE TO THAT HOSPITAL, AT
LEAST EVERY TWO YEARS, AND AS OTHERWISE WARRANTED BASED ON OUTCOMES,
COMPLAINTS OR OTHER CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL
AND MENTAL CAPACITY, AND COMPETENCE IN DELIVERING HEALTH CARE SERVICES
OF EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE SERVICES; TO
PROVIDE THE ORIGINATING HOSPITAL WITH THE RESULTS OF SUCH REVIEW; AND TO
NOTIFY THE ORIGINATING HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCA-
TION, OR LIMITATION OF SUCH PRIVILEGES.
2. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS ALLOWING AN ORIGINAT-
ING HOSPITAL TO DELEGATE ITS AUTHORITY OVER AND RESPONSIBILITY FOR DECI-
SIONS CONCERNING THE CREDENTIALING AND GRANTING STAFF MEMBERSHIP OR
PROFESSIONAL PRIVILEGES TO HEALTH CARE PRACTITIONERS PROVIDING TELEMEDI-
CINE SERVICES.
3. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, AN ORIGINATING
HOSPITAL SHALL NOT BE REQUIRED TO PROVIDE A PHYSICAL EXAMINATION OR TO
MAINTAIN RECORDED MEDICAL HISTORY INCLUDING IMMUNIZATIONS FOR A HEALTH
CARE PROVIDER PROVIDING CONSULTATIONS SOLELY THROUGH TELEMEDICINE FROM A
DISTANT SITE HOSPITAL.
S 3912. DISEASE MANAGEMENT DEMONSTRATION PROGRAMS. 1. THE DEPARTMENT
MAY ESTABLISH DISEASE MANAGEMENT DEMONSTRATION PROGRAMS THROUGH A
REQUEST FOR PROPOSALS PROCESS TO ENHANCE THE QUALITY AND COST-EFFECTIVE-
NESS OF CARE RENDERED TO MEDICAID-ELIGIBLE PERSONS WITH CHRONIC HEALTH
PROBLEMS WHOSE CARE AND TREATMENT, BECAUSE OF ONE OR MORE HOSPITALIZA-
TIONS, MULTIPLE DISABLING CONDITIONS REQUIRING RESIDENTIAL TREATMENT OR
OTHER HEALTH CARE REQUIREMENTS, RESULTS IN HIGH MEDICAID EXPENDITURES.
IN ORDER TO BE ELIGIBLE TO SPONSOR AND TO UNDERTAKE A DISEASE MANAGEMENT
S. 4355 4
DEMONSTRATION PROGRAM, THE PROPOSED SPONSOR MAY BE A NOT-FOR-PROFIT,
FOR-PROFIT OR LOCAL GOVERNMENT ORGANIZATION THAT HAS DEMONSTRATED EXPER-
TISE IN THE MANAGEMENT OR COORDINATION OF CARE TO PERSONS WITH CHRONIC
DISEASES OR THAT HAS THE EXPERIENCE OF PROVIDING COST-EFFECTIVE COMMUNI-
TY-BASED CARE TO SUCH PATIENTS, OR IN THE CASE OF A LOCAL GOVERNMENT
ORGANIZATION, HAS EXPRESSED A STRONG WILLINGNESS TO SPONSOR SUCH A
PROGRAM. THE DEPARTMENT MAY ALSO APPROVE DISEASE MANAGEMENT DEMON-
STRATION PROGRAMS WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE PROMOTION
OF ADHERENCE TO EVIDENCE-BASED GUIDELINES, IMPROVEMENT OF PROVIDER AND
PATIENT COMMUNICATION AND PROVIDE INFORMATION ON PROVIDER AND BENEFICI-
ARY UTILIZATION OF SERVICES. THE DEPARTMENT SHALL GRANT NO FEWER THAN
SIX DEMONSTRATION PROGRAMS, NO MORE THAN ONE-THIRD OF SUCH PROGRAMS
SHALL BE SELECTED TO PROVIDE THESE SERVICES IN ANY SINGLE SOCIAL
SERVICES DISTRICT; PROVIDED FURTHER, WHERE THE DEPARTMENT GRANTS LESS
THAN SIX DEMONSTRATION PROGRAMS, NO MORE THAN ONE SUCH PROGRAM SHALL BE
SELECTED TO PROVIDE THESE SERVICES IN ANY SINGLE SOCIAL SERVICES
DISTRICT. THE DEPARTMENT SHALL APPROVE DISEASE MANAGEMENT DEMONSTRATION
PROGRAMS WHICH ARE GEOGRAPHICALLY DIVERSE AND REPRESENTATIVE OF BOTH
URBAN AND RURAL SOCIAL SERVICES DISTRICTS. THE PROGRAM SPONSOR MUST
ESTABLISH, TO THE SATISFACTION OF THE DEPARTMENT, ITS CAPACITY TO ENROLL
AND SERVE SUFFICIENT NUMBERS OF ENROLLEES TO DEMONSTRATE THE COST-EFFEC-
TIVENESS OF THE DEMONSTRATION PROGRAM.
2. THE DEPARTMENT SHALL ESTABLISH THE CRITERIA BY WHICH INDIVIDUALS
WILL BE IDENTIFIED AS ELIGIBLE FOR ENROLLMENT IN THE DEMONSTRATION
PROGRAMS. PERSONS ELIGIBLE FOR ENROLLMENT IN THE DISEASE MANAGEMENT
DEMONSTRATION PROGRAM SHALL BE LIMITED TO INDIVIDUALS WHO: RECEIVE
MEDICAL ASSISTANCE PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE
SOCIAL SERVICES LAW AND MAY BE ELIGIBLE FOR BENEFITS PURSUANT TO TITLE
18 OF THE SOCIAL SECURITY ACT (MEDICARE); ARE NOT ENROLLED IN A MEDICAID
MANAGED CARE PLAN, INCLUDING INDIVIDUALS WHO ARE NOT REQUIRED OR NOT
ELIGIBLE TO PARTICIPATE IN MEDICAID MANAGED CARE PROGRAMS PURSUANT TO
SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW; ARE DIAG-
NOSED WITH CHRONIC HEALTH PROBLEMS AS MAY BE SPECIFIED BY THE ENTITY
UNDERTAKING THE DEMONSTRATION PROGRAM, INCLUDING, BUT NOT LIMITED TO ONE
OR MORE OF THE FOLLOWING: CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE
PULMONARY DISEASE, ASTHMA, DIABETES OR OTHER CHRONIC HEALTH CONDITIONS
AS MAY BE SPECIFIED BY THE DEPARTMENT; OR HAVE EXPERIENCED OR ARE LIKELY
TO EXPERIENCE ONE OR MORE HOSPITALIZATIONS OR ARE OTHERWISE EXPECTED TO
INCUR EXCESSIVE COSTS AND HIGH UTILIZATION OF HEALTH CARE SERVICES.
3. ENROLLMENT IN A DEMONSTRATION PROGRAM SHALL BE VOLUNTARY. A PARTIC-
IPATING INDIVIDUAL MAY DISCONTINUE HIS OR HER ENROLLMENT AT ANY TIME
WITHOUT CAUSE. THE COMMISSIONER SHALL REVIEW AND APPROVE ALL ENROLLMENT
AND MARKETING MATERIALS FOR A DEMONSTRATION PROGRAM.
4. THE DEMONSTRATION PROGRAM SHALL OFFER EVIDENCE-BASED SERVICES AND
INTERVENTIONS DESIGNED TO ENSURE THAT THE ENROLLEES RECEIVE HIGH QUALI-
TY, PREVENTATIVE AND COST-EFFECTIVE CARE, AIMED AT REDUCING THE NECESSI-
TY FOR HOSPITALIZATION OR EMERGENCY ROOM CARE OR AT REDUCING LENGTHS OF
STAY WHEN HOSPITALIZATION IS NECESSARY. THE DEMONSTRATION PROGRAM MAY
INCLUDE SCREENING OF ELIGIBLE ENROLLEES, DEVELOPING AN INDIVIDUALIZED
CARE MANAGEMENT PLAN FOR EACH ENROLLEE AND IMPLEMENTING THAT PLAN.
DISEASE MANAGEMENT DEMONSTRATION PROGRAMS THAT UTILIZE INFORMATION TECH-
NOLOGY SYSTEMS THAT ALLOW FOR CONTINUOUS APPLICATION OF EVIDENCE-BASED
GUIDELINES TO MEDICAL ASSISTANCE CLAIMS DATA AND OTHER AVAILABLE DATA TO
IDENTIFY SPECIFIC INSTANCES IN WHICH CLINICAL INTERVENTIONS ARE JUSTI-
FIED AND COMMUNICATE INDICATED INTERVENTIONS TO PHYSICIANS, HEALTH CARE
PROVIDERS AND/OR PATIENTS, AND MONITOR PHYSICIAN AND HEALTH CARE PROVID-
S. 4355 5
ER RESPONSE TO SUCH INTERVENTIONS, SHALL HAVE THE ENROLLEES, OR GROUPS
OF ENROLLEES, APPROVED BY THE DEPARTMENT FOR PARTICIPATION. THE SERVICES
PROVIDED BY THE DEMONSTRATION PROGRAM AS PART OF THE CARE MANAGEMENT
PLAN MAY INCLUDE, BUT ARE NOT LIMITED TO, CASE MANAGEMENT, SOCIAL WORK,
INDIVIDUALIZED HEALTH COUNSELORS, MULTI-BEHAVIORAL GOALS PLANS, CLAIMS
DATA MANAGEMENT, HEALTH AND SELF-CARE EDUCATION, DRUG THERAPY MANAGEMENT
AND OVERSIGHT, PERSONAL EMERGENCY RESPONSE SYSTEMS AND OTHER MONITORING
TECHNOLOGIES, TELEMEDICINE, TELEHEALTH AND SIMILAR SERVICES DESIGNED TO
IMPROVE THE QUALITY AND COST-EFFECTIVENESS OF HEALTH CARE SERVICES.
5. THE DEPARTMENT SHALL BE RESPONSIBLE FOR MONITORING THE QUALITY,
APPROPRIATENESS AND COST-EFFECTIVENESS OF A DEMONSTRATION PROGRAM. THE
DEPARTMENT SHALL UTILIZE, TO THE EXTENT POSSIBLE, ALL POTENTIAL SOURCES
OF FUNDING FOR DEMONSTRATION PROGRAMS, INCLUDING, BUT NOT LIMITED TO,
PRIVATE PAYMENTS AND DONATIONS. ALL SUCH FUNDS SHALL BE DEPOSITED BY THE
COMMISSIONER AND CREDITED TO THE DISEASE MANAGEMENT ACCOUNT WHICH SHALL
BE ESTABLISHED BY THE COMPTROLLER IN THE SPECIAL REVENUE-OTHER FUND.
ADDITIONALLY, TO THE EXTENT OF FUNDS APPROPRIATED THEREFOR, MEDICAL
ASSISTANCE FUNDS, INCLUDING ANY FUNDING OR SHARED SAVINGS AS MAY BECOME
AVAILABLE THROUGH FEDERAL WAIVERS OR OTHERWISE UNDER TITLES 18 AND 19 OF
THE FEDERAL SOCIAL SECURITY ACT, MAY BE USED BY THE DEPARTMENT FOR
EXPENDITURES IN SUPPORT OF THE DISEASE MANAGEMENT PROGRAM.
6. PAYMENTS SHALL BE MADE BY THE DEPARTMENT TO THE ENTITY RESPONSIBLE
FOR THE OPERATION OF THE DEMONSTRATION PROGRAM ON A FIXED AMOUNT PER
MEMBER PER MONTH OF ENROLLMENT AND SHALL REIMBURSE THE PROGRAM SPONSOR
FOR THE SERVICES RENDERED PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
THE AMOUNT PAID SHALL BE AN AMOUNT REASONABLY NECESSARY TO MEET THE
COSTS OF PROVIDING SUCH SERVICES, PROVIDED THAT THE TOTAL AMOUNT PAID
FOR MEDICAL ASSISTANCE TO ENROLLEES IN ANY SUCH DISEASE MANAGEMENT
DEMONSTRATION PROGRAM, INCLUDING ANY DEMONSTRATION PROGRAM EXPENDITURES,
SHALL NOT EXCEED NINETY-FIVE PERCENT OF THE MEDICAL ASSISTANCE EXPENDI-
TURE RELATED TO SUCH ENROLLEE THAT WOULD REASONABLY HAVE BEEN ANTIC-
IPATED IF THE ENROLLEE HAD NOT BEEN ENROLLED IN SUCH DEMONSTRATION
PROGRAM. THE DEPARTMENT MAY MAKE PAYMENTS TO DEMONSTRATION PROGRAMS THAT
PROVIDE ADMINISTRATIVE SERVICES ONLY, PROVIDED THAT EXPENDITURES MADE
FOR ENROLLEES, OR A GROUP OF ENROLLEES, PARTICIPATING IN THE DEMON-
STRATION PROGRAM SHALL PROVIDE SUFFICIENT SAVINGS AS DETERMINED BY THE
DEPARTMENT, HAD THE ENROLLEES, OR GROUPS OF ENROLLEES, NOT BEEN ENROLLED
IN SUCH DEMONSTRATION. THE DEPARTMENT SHALL PROVIDE AN INTERIM REPORT TO
THE GOVERNOR, AND THE LEGISLATURE ON OR BEFORE DECEMBER THIRTY-FIRST,
TWO THOUSAND SIX AND A FINAL REPORT ON OR BEFORE DECEMBER THIRTY-FIRST,
TWO THOUSAND SEVEN ON THE RESULTS OF DEMONSTRATION PROGRAMS. BOTH
REPORTS SHALL INCLUDE FINDINGS AS TO THE DEMONSTRATION PROGRAMS'
CONTRIBUTION TO IMPROVING QUALITY OF CARE AND THEIR COST-EFFECTIVENESS.
IN THE FINAL REPORT, THE DEPARTMENT SHALL OFFER RECOMMENDATIONS AS TO
WHETHER DEMONSTRATION PROGRAMS SHOULD BE EXTENDED, MODIFIED, ELIMINATED
OR MADE PERMANENT.
S 3913. HOME TELEHEALTH. 1. DEMONSTRATION RATES OF PAYMENT OR FEES
SHALL BE ESTABLISHED FOR TELEHEALTH PROVIDED BY A CERTIFIED HOME HEALTH
AGENCY, A LONG TERM HOME HEALTH CARE PROGRAM OR AIDS HOME CARE PROGRAM,
OR FOR TELEMEDICINE BY A LICENSED HOME CARE SERVICES AGENCY UNDER
CONTRACT WITH SUCH AN AGENCY OR PROGRAM, IN ORDER TO ENSURE THE AVAIL-
ABILITY OF TECHNOLOGY-BASED PATIENT MONITORING, COMMUNICATION AND HEALTH
MANAGEMENT. REIMBURSEMENT FOR TELEHEALTH PROVIDED PURSUANT TO THIS
SECTION SHALL BE PROVIDED ONLY IN CONNECTION WITH FEDERAL FOOD AND DRUG
ADMINISTRATION-APPROVED AND INTEROPERABLE DEVICES, AND INCORPORATED AS
S. 4355 6
PART OF THE PATIENT'S PLAN OF CARE. THE COMMISSIONER SHALL SEEK FEDERAL
FINANCIAL PARTICIPATION WITH REGARD TO THIS DEMONSTRATION INITIATIVE.
2. THE PURPOSES OF SUCH SERVICES SHALL BE TO ASSIST IN THE EFFECTIVE
MONITORING AND MANAGEMENT OF PATIENTS WHOSE MEDICAL, FUNCTIONAL AND/OR
ENVIRONMENTAL NEEDS CAN BE APPROPRIATELY AND COST-EFFECTIVELY MET AT
HOME THROUGH THE APPLICATION OF TELEHEALTH INTERVENTION. REIMBURSEMENT
PROVIDED PURSUANT TO THIS SECTION SHALL BE FOR SERVICES TO PATIENTS WITH
CONDITIONS OR CLINICAL CIRCUMSTANCES ASSOCIATED WITH THE NEED FOR
FREQUENT MONITORING, AND/OR THE NEED FOR FREQUENT PHYSICIAN, SKILLED
NURSING OR ACUTE CARE SERVICES, AND WHERE THE PROVISION OF TELEHEALTH
CAN APPROPRIATELY REDUCE THE NEED FOR ON-SITE OR IN-OFFICE VISITS OR
ACUTE OR LONG TERM CARE FACILITY ADMISSIONS. SUCH CONDITIONS AND CLIN-
ICAL CIRCUMSTANCES SHALL INCLUDE, BUT NOT BE LIMITED TO, CONGESTIVE
HEART FAILURE, DIABETES, CHRONIC PULMONARY OBSTRUCTIVE DISEASE, WOUND
CARE, POLYPHARMACY, MENTAL OR BEHAVIORAL PROBLEMS LIMITING SELF-MANAGE-
MENT, AND TECHNOLOGY-DEPENDENT CARE SUCH AS CONTINUOUS OXYGEN, VENTILA-
TOR CARE, TOTAL PARENTERAL NUTRITION OR ENTERAL FEEDING.
3. DEMONSTRATION RATES OR FEES ESTABLISHED BY THE COMMISSIONER AND
APPROVED BY THE DIRECTOR OF THE BUDGET, FOR SUCH TELEHEALTH SHALL
REFLECT THE COSTS THEREOF ON A MONTHLY BASIS IN ORDER TO ACCOUNT FOR
DAILY VARIATION IN THE INTENSITY AND COMPLEXITY OF PATIENTS' TELEHEALTH
NEEDS; PROVIDED THAT SUCH DEMONSTRATION RATES SHALL FURTHER REFLECT THE
COST OF THE DAILY OPERATION AND PROVISION OF SUCH SERVICES, WHICH COSTS
SHALL INCLUDE THE FOLLOWING FUNCTIONS UNDERTAKEN BY THE PARTICIPATING
CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, AIDS
HOME CARE PROGRAM OR LICENSED HOME CARE SERVICES AGENCY:
(A) MONITORING OF PATIENT VITAL SIGNS;
(B) PATIENT EDUCATION;
(C) MEDICATION MANAGEMENT;
(D) EQUIPMENT MAINTENANCE;
(E) REVIEW OF PATIENT TRENDS AND/OR OTHER CHANGES IN PATIENT CONDITION
NECESSITATING PROFESSIONAL INTERVENTION; AND
(F) SUCH OTHER ACTIVITIES AS THE COMMISSIONER MAY DEEM NECESSARY AND
APPROPRIATE TO THIS SECTION.
4. THE COMMISSIONER SHALL TAKE SUCH ADDITIONAL STEPS AS MAY BE REASON-
ABLY NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SECTION; PROVIDED
HOWEVER THAT THE COMMISSIONER SHALL ESTABLISH INITIAL DEMONSTRATION
RATES OR FEES FOR TELEHEALTH AS PROVIDED FOR IN THIS SECTION BY NO LATER
THAN OCTOBER FIRST, TWO THOUSAND SEVEN; AND PROVIDED, FURTHER, HOWEVER,
THAT THE COMMISSIONER SHALL SEEK THE INPUT OF REPRESENTATIVES FROM
PARTICIPATING PROVIDERS AND OTHER INTERESTED PARTIES IN THE DEVELOPMENT
OF SUCH RATES OR FEES AND ANY APPLICABLE REQUIREMENTS ESTABLISHED PURSU-
ANT TO THIS SUBDIVISION.
5. THE COMMISSIONER SHALL, WITHIN MONIES APPROPRIATED THEREFOR, ESTAB-
LISH A RURAL HOME TELEHEALTH DELIVERY DEMONSTRATION STUDY PROGRAM IN
COUNTIES HAVING A POPULATION OF NOT LESS THAN ONE HUNDRED THIRTY THOU-
SAND AND NOT MORE THAN ONE HUNDRED FORTY THOUSAND, ACCORDING TO THE TWO
THOUSAND TEN DECENNIAL FEDERAL CENSUS. THE COMMISSIONER SHALL DIRECT A
HOME HEALTH ORGANIZATION SERVING IN SUCH COUNTY TO STUDY PATIENTS
RECEIVING TELEMEDICINE, PURSUANT TO THIS SECTION, WHO HAVE BEEN DIAG-
NOSED WITH CONGESTIVE HEART FAILURE, DIABETES AND/OR CHRONIC PULMONARY
OBSTRUCTIVE DISEASE, AND WHOSE MEDICAL, FUNCTIONAL AND/OR ENVIRONMENTAL
NEEDS ARE APPROPRIATELY MET AT HOME THROUGH THE APPLICATION OF TELE-
HEALTH INTERVENTIONS. SUCH A STUDY SHALL DETERMINE THE COST OF PROVIDING
TELEHEALTH, THE QUALITY OF CARE PROVIDED THROUGH TELEHEALTH AND THE
OUTCOMES OF PATIENTS RECEIVING SUCH TELEHEALTH. THE COMMISSIONER SHALL
S. 4355 7
REIMBURSE THE HOME HEALTH ORGANIZATION FOR CONDUCTING THE STUDY WITH
AMOUNTS APPROPRIATED UNDER THIS SECTION. THE HOME HEALTH ORGANIZATION
SHALL EVALUATE THE FINDINGS OF THE STUDY AND REPORT TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE
COMMISSIONER, AND THE CHAIR OF THE LEGISLATIVE COMMISSION ON RURAL
RESOURCES ON ITS FINDINGS OF PROVIDING TELEHEALTH FOR EACH CONDITION, SO
AS TO PROVIDE THE COST BENCHMARKS WITH AND WITHOUT TELEHEALTH CARE, AS
WELL AS PROVIDING COST BENEFIT MEASUREMENTS IN TERMS OF THE QUALITY
BENEFIT OUTCOMES FOR EACH OF THE CONDITIONS ADDRESSED VIA TELEHEALTH.
6. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR REGU-
LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
IPATION, THE COMMISSIONER IS AUTHORIZED AND DIRECTED TO IMPLEMENT A
PROGRAM WHEREBY HE OR SHE SHALL ADJUST MEDICAL ASSISTANCE RATES OF
PAYMENT FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, LONG
TERM HOME HEALTH CARE PROGRAMS, AIDS HOME CARE PROGRAMS AND PROVIDERS OF
PERSONAL CARE SERVICES AND/OR PROVIDERS OF PRIVATE DUTY NURSING SERVICES
UNDER THE SOCIAL SERVICES LAW IN ACCORDANCE WITH THIS SUBDIVISION FOR
PURPOSES OF ENHANCING THE PROVISION, ACCESSIBILITY, QUALITY AND/OR EFFI-
CIENCY OF HOME CARE SERVICES. SUCH RATE ADJUSTMENTS SHALL BE FOR THE
PURPOSES OF ASSISTING SUCH PROVIDERS, LOCATED IN SOCIAL SERVICES
DISTRICTS WHICH DO NOT INCLUDE A CITY WITH A POPULATION OF OVER ONE
MILLION PERSONS, IN MEETING THE COST OF INCREASED USE OF TECHNOLOGY IN
THE DELIVERY OF SERVICES, INCLUDING TELEHEALTH AND CLINICAL AND ADMINIS-
TRATIVE MANAGEMENT INFORMATION SYSTEM.
S 7. This act shall take effect on the first of April next succeeding
the date on which it shall have become a law.