BILL NUMBER: S8620

SPONSOR: HANNON
 
TITLE OF BILL:

An act to amend the public health law, in relation to integrating home
care into the state's public health and prevention efforts

 
PURPOSE:

To amend the Public Health Law, in relation to addressing priority
public health needs of the state through strategic integration of home
care services and skills.

 
SUMMARY OF PROVISIONS:

Section one of the bill adds a new section § 3620-a to the Public Health
Law to promote strategic integration of home care skills and capacities
into the state's health continuum strategy to address public health
priorities in disease prevention, intervention, population health
improvement, associated health care cost reduction and research. The
              

section establishes that priority public health areas may include
sepsis, asthma, diabetes, health disparities, obesity, polypharmacy,
falls, pressure injuries, and other areas associated with major health
consequences and costs. It directs the commissioner to seek advice from
home care and/or public health expertise, authorizes the commissioner to
calculate cost-savings from home care intervention initiatives and, upon
state budget director approval, to reinvest a portion of the "shared
savings" of the state into the home care public health effort. Lastly,
it directs the department to report its findings to the Legislature
within 18 months following enactment.

Section two of the bill establishes the effective date.

 
JUSTIFICATION:

Disease prevention, management and health promotion are priorities for
individual and population health, as well as for controlling the domi-
nant public and private costs of health care. This legislation seeks to
access the unique skills and assets offered by home care in addressing
priority public health problems, with the aim of bettering health and
reducing costs.

Sepsis, asthma and heart health are amongst the prevalent and high cost-
ing examples targeted in the bill. Sepsis is both an individual and
public health emergency. In the individual, it is the body's dysregulat-
ed, life-threatening response to an infection - triggered by infections
from minor cuts or insults, a consequence of the flu, pneumonia, urinary
tract infection, cancer, etc. Sepsis can often be prevented, and when
symptoms are identified early, it can usually be treated successfully.
However, the failure of individuals and health professionals to recog-
nize early symptoms leads to catastrophic consequences, where sepsis is
not identified and treated until it has reached an emergent and life-
threatening stage. Sepsis is the number one cause of hospital deaths,
the number one hospital expense in the country (at $2.7 Nihau annually),
the number one in hospital 30 day readmissions, and the number one in
Medicaid avoidable hospital expense in NYS for the overall Medicaid
population. Every two minutes someone dies of sepsis, every 20 minutes

someone is hospitalized with sepsis, and one in four discharged from
sepsis care are hospitalized within 30 days.

With 80 - 90% percent of sepsis related infections estimated to occur in
home and community settings, this bill would harness home care in help-
ing to educate, screen, prevent, refer, and collaborate with doctors,
EMS and hospitals, for swift treatment. The Home Care Association of New
York State (HCA), in conjunction with the state-federal Quality Improve-
ment Organization contractor ("IPRO"), and state and national sepsis
leaders, including the Rory Staunton Foundation and the national Sepsis
Alliance, has implemented a first-of-a-kind, first-in-the-nation sepsis
screening and intervention initiative through home care. HCA and these
partners are presently conducting trainings for statewide adoption and
use of this tool at the community level. This legislation would support
this statewide effort.

In the case of asthma, a State Comptroller report cites Department of
Health estimates of $1.3 billion in direct medical costs and lost
productivity due to asthma in NYS. The report also indicates that hospi-
talizations account for $660 million of these costs, a 61% increase
since 2002, and further that as of 2012, an estimated 1.4 million adult
New Yorkers suffered from asthma (according to CDC data), and 315,000
children had asthma in 2010. Home care providers are demonstrating
extraordinary success in preventing and controlling asthma episodes and
the hospitalizations and emergencies that would otherwise occur; this
legislation would build upon that success.

In cardiac care, congestive heart failure is often a revolving door to
the hospital, emergency room and catastrophic health care costs. Home
care has proven highly effective in averting hospitalizations and emer-
gency visits for patients with CHF, particularly with the use of home
telehealth.

Home care agencies and clinicians bring unique competencies and capabil-
ities to the public health effort in disease prevention, health
promotion, and medical management. Home care agencies and clinicians are
in communities, in the neighborhoods, in patients' homes, working with
families, and providing and navigating services across the continuum.
Home care personnel are expert assessors of need, expert care managers,
system navigators and health educators.  They go where the patient is,
which is precisely where many of these public health conditions must be
addressed.

The priority conditions targeted in the bill could be more fully
addressed by home care's integration into state strategies. Home care
offers angles of support and intervention that complement clinical part-
ners, and provide capacities that other providers are neither equipped
nor oriented to execute. This legislation would tap a vital resource for
the state, communities and individuals in combatting major public health
issues, costs and population health improvement challenges.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:


Anticipate savings to state and private payors from home care inte-
gration in the prevention, public health and primary care effort.

 
EFFECTIVE DATE:
This act shall take effect immediately.