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

                                  2902

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            January 30, 2015
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to enacting the "home
  care stabilization act"

  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. The public health law is amended by adding a new  section  3614-d
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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04830-02-5

              

S. 2902                             2

EXECUTIVE LAW OR THE INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STAND-
ARDS:
  (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  3.  Section  4406-c of the public health law is amended by adding a
new subdivision 9 to read as follows:
  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-

S. 2902                             3

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.