S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  9262

                          I N  A S S E M B L Y

                              April 4, 2014
                               ___________

Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
  tee on Health

AN ACT to amend the public health law, in relation to enacting the "home
  care  stabilization  act";  and  providing  for  the repeal of certain
  provisions upon expiration thereof

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Short  title. This act shall be known and may be cited as
the "home care stabilization act".
  S 2. Section 3622 of the public health law, as renumbered  by  section
22  of  part  C of chapter 58 of the laws of 2004, is renumbered section
3625 and two new sections 3614-d and 3622 are added to read as follows:
  S 3614-D. STANDARDS FOR  PROMPT,  FAIR  AND  EQUITABLE  SETTLEMENT  OF
CLAIMS  FOR  PAYMENTS  FOR  PERSONAL  CARE, HOME HEALTH CARE SERVICES OR
OTHER LONG TERM CARE SERVICES. 1. IN THE PROCESSING OF CLAIMS  SUBMITTED
UNDER  CONTRACTS  OR AGREEMENTS ISSUED OR ENTERED INTO OR BETWEEN CERTI-
FIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, LICENSED
HOME CARE SERVICES PROGRAMS, FISCAL INTERMEDIARIES OPERATING PURSUANT TO
SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW, INSURERS,
MANAGED LONG TERM  CARE  PLANS,  MANAGED  CARE  PLANS  OR  ORGANIZATIONS
LICENSED  OR  OPERATED  PURSUANT  TO THE PROVISIONS OF THIS CHAPTER, THE
SOCIAL SERVICES LAW OR THE INSURANCE LAW AND FOR ALL BILLS FOR  PERSONAL
CARE,  HOME  HEALTH CARE SERVICES, CONSUMER DIRECTED PERSONAL ASSISTANCE
SERVICES OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE
SOCIAL SERVICES LAW  OR  OTHER  LONG  TERM  CARE  SERVICES  RENDERED  BY
LICENSED  HOME  CARE  SERVICES PROGRAMS, CERTIFIED HOME HEALTH AGENCIES,
LONG TERM HOME HEALTH CARE PROGRAMS OR A FISCAL  INTERMEDIARY  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME  HEALTH
CARE  AGENCY,  LONG TERM HOME HEALTH CARE PROGRAM, INSURER, MANAGED LONG
TERM CARE PLAN, MANAGED CARE PLAN OR ORGANIZATION LICENSED  OR  OPERATED
PURSUANT TO THE PROVISIONS OF THIS CHAPTER, THE SOCIAL SERVICES LAW, THE
EXECUTIVE LAW OR THE INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STAND-
ARDS:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD09417-06-4

A. 9262                             2

  (A) SHALL PAY A CLEAN CLAIM SUBMITTED BY A LICENSED HOME CARE SERVICES
PROGRAM,  CERTIFIED  HOME  HEALTH  AGENCY,  LONG  TERM  HOME HEALTH CARE
PROGRAM OR A FISCAL INTERMEDIARY OPERATING  PURSUANT  TO  SECTION  THREE
HUNDRED  SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW WITHIN THIRTY DAYS OF
RECEIPT OF THE CLEAN CLAIM FOR SERVICES RENDERED THAT IS TRANSMITTED VIA
THE  INTERNET  OR  ELECTRONIC MAIL, OR FORTY-FIVE DAYS OF RECEIPT OF THE
CLEAN CLAIM FOR SERVICES RENDERED THAT IS SUBMITTED BY OTHER MEANS, SUCH
AS PAPER OR FACSIMILE;
  (B) SHALL PAY ANY UNDISPUTED PORTION OF A CLAIM AS A  CLEAN  CLAIM  AS
SET  FORTH  IN PARAGRAPH (A) OF THIS SUBDIVISION SUBMITTED BY A LICENSED
HOME CARE SERVICES PROGRAM, CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY OPERATING PURSUANT TO SECTION
THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW;
  (C) NOTIFY ANY SUCH AGENCY, PROGRAM OR FISCAL INTERMEDIARY IN  WRITING
WITHIN  FIFTEEN  CALENDAR DAYS OF THE RECEIPT OF AN INITIAL CLAIM OF ALL
SPECIFIC DEFECTS OR DISPUTES OF SUCH CLAIM AND SPECIFICALLY  REQUEST  IN
WRITING  THE  ADDITIONAL  INFORMATION  OR  REMEDY  NEEDED TO PROCESS ANY
DISPUTED PORTIONS OF THE CLAIM; AND
  (D) ANY DISPUTED CLAIM REMEDIED SHALL BE PAID AS A CLEAN CLAIM AS  SET
FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION.
  2. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" SHALL:
  (A)  IDENTIFY  THE LICENSED HOME CARE SERVICES PROGRAM, CERTIFIED HOME
HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL
SERVICES LAW;
  (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON;
  (C) LIST THE DATE AND PLACE OF SERVICE;
  (D) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
  (E) STATE IF PRIOR AUTHORIZATION IS REQUIRED FOR SUCH ELIGIBLE COVERED
PERSON AND SERVICE; AND
  (F)  STATE  ANY  DOCUMENTATION  AS  REASONABLY  REQUIRED BY ANY ENTITY
REFERENCED IN THIS SECTION.
  3. EACH CLEAN CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION  OF
THIS  SECTION  SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE
PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
FAILS TO ADHERE TO THE STANDARDS CONTAINED  IN  THIS  SECTION  SHALL  BE
OBLIGATED  TO  PAY  TO  CERTIFIED  HOME  HEALTH AGENCIES, LONG TERM HOME
HEALTH CARE PROGRAMS, LICENSED  HOME  HEALTH  CARE  PROGRAMS  OR  FISCAL
INTERMEDIARIES  OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F
OF THE SOCIAL SERVICES LAW IN FULL SETTLEMENT  OF  THE  BILL,  CLAIM  OR
PAYMENT  PLUS  INTEREST  ON THE AMOUNT OF SUCH BILL, CLAIM OR PAYMENT OF
THE GREATER OF THE RATE EQUAL TO THE RATE SET  BY  THE  COMMISSIONER  OF
TAXATION  AND  FINANCE  FOR CORPORATE TAXES PURSUANT TO PARAGRAPH ONE OF
SUBSECTION (E) OF SECTION ONE THOUSAND NINETY-SIX  OF  THE  TAX  LAW  OR
TWELVE  PERCENT  PER ANNUM, TO BE COMPUTED FROM THE DATE THE BILL, CLAIM
OR PAYMENT WAS REQUIRED TO BE MADE.
  S 3622. MEDICAL ASSISTANCE RECOUPMENTS AND REDUCTIONS.   NOTWITHSTAND-
ING  ANY  OTHER  PROVISION  OF  LAW  TO THE CONTRARY, ON AND AFTER APRIL
FIRST, TWO THOUSAND NINE,  ANY  RECOUPMENTS  OR  REDUCTIONS  IN  MEDICAL
ASSISTANCE  PAYMENTS FOR LICENSED HOME CARE SERVICES AGENCIES AND CERTI-
FIED HOME HEALTH AGENCIES LICENSED PURSUANT TO THIS  ARTICLE  OR  FISCAL
INTERMEDIARIES  OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F
OF THE SOCIAL SERVICES LAW SHALL NOT BE SUBJECT TO INTEREST OR  INTEREST
PENALTIES.
  S  3.  Section  4406-c of the public health law is amended by adding a
new subdivision 9 to read as follows:

A. 9262                             3

  9. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW,  CONTRACTS  WITH
CERTIFIED  HOME  HEALTH  AGENCIES,  LONG TERM HOME HEALTH CARE PROGRAMS,
LICENSED HOME CARE SERVICES PROGRAMS OR FISCAL INTERMEDIARIES  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW  TO PROVIDE HOME CARE AIDE SERVICES AS DEFINED IN SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS CHAPTER OR CONSUMER DIRECTED PERSONAL ASSIST-
ANCE  SERVICES  AS  AUTHORIZED  PURSUANT  TO   SECTION   THREE   HUNDRED
SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW SHALL AT A MINIMUM ENSURE THAT
THE RESOURCES MADE AVAILABLE BY SUCH  CONTRACTS  SHALL  SUPPORT  COMPEN-
SATION  FOR  PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES AND CONSUMER
DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUAL-
IFIED WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS  OF
SUCH SERVICES CONSISTENT WITH THE PROVISIONS OF SUCH SECTION.
  S  4.  This  act  shall take effect immediately, provided that section
3622 of the public health law, as added by  section  two  of  this  act,
shall expire and be deemed repealed March 31, 2015.