S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1208
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 14, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, RAIA, LUPARDO, D'URSO, WOERNER, STECK,
   TAGUE  --  Multi-Sponsored  by  -- M. of A. PALMESANO -- read once and
   referred to the Committee on Health
 
 AN ACT to amend the public health law, in relation to authorizing colla-
   borative programs for community paramedicine services

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  2805-x  of  the  public  health law, as added by
 section 48 of part B of chapter 57 of the laws of 2015,  is  amended  to
 read as follows:
   §  2805-x.  Hospital-home care-physician collaboration program. 1. The
 purpose of this section shall be to facilitate innovation  in  hospital,
 home  care agency and physician collaboration in meeting the community's
 health care needs. It shall provide a  framework  to  support  voluntary
 initiatives  in collaboration to improve patient care access and manage-
 ment, patient health outcomes, cost-effectiveness in the use  of  health
 care services and community population health. Such collaborative HOSPI-
 TAL-HOME  CARE-PHYSICIAN  initiatives  may  also include payors, skilled
 nursing facilities, EMERGENCY MEDICAL SERVICES and other  interdiscipli-
 nary  providers,  practitioners  and  service  entities  AS PART OF SUCH
 HOSPITAL-HOME CARE-PHYSICIAN COLLABORATIVE PROVIDED,  HOWEVER,  THAT  IN
 THE  CASE  OF  COLLABORATIVE COMMUNITY PARAMEDICINE AS SET FORTH IN THIS
 SECTION AND ARTICLE THIRTY OF  THIS  CHAPTER,  THE  COLLABORATIVE  SHALL
 MINIMALLY COMPRISE HOSPITAL, HOME CARE, PHYSICIAN, AND EMERGENCY MEDICAL
 SERVICES PARTNERS.
   2. For purposes of this section:
   (a)  "Hospital"  shall  include  a general hospital as defined in this
 article or other inpatient facility for rehabilitation or specialty care
 within the definition of hospital in this article.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03394-01-9

              

 A. 1208                             2
 
   (b) "Home care agency" shall mean a certified home health agency, long
 term home health care program or licensed home care services  agency  as
 defined in article thirty-six of this chapter.
   (c)  "Payor"  shall  mean  a  health plan approved pursuant to article
 forty-four of this chapter, or article thirty-two or forty-three of  the
 insurance law.
   (d)  "Practitioner"  shall  mean  any  of the health, mental health or
 health related professions licensed  pursuant  to  title  eight  of  the
 education law.
   (E)  "EMERGENCY  MEDICAL SERVICES" (EMS) SHALL MEAN THE SERVICES OF AN
 AMBULANCE SERVICE OR AN ADVANCED LIFE  SUPPORT  FIRST  RESPONSE  SERVICE
 CERTIFIED  UNDER  ARTICLE  THIRTY  OF  THIS CHAPTER STAFFED BY EMERGENCY
 MEDICAL TECHNICIANS OR ADVANCED EMERGENCY MEDICAL TECHNICIANS TO PROVIDE
 BASIC OR ADVANCED LIFE SUPPORT AND, FOR THE PURPOSES  OF  THE  COMMUNITY
 PARAMEDICINE  COLLABORATION  MODEL SET FORTH IN SUBDIVISION FOUR OF THIS
 SECTION, ALSO TO PROVIDE  SUCH  SERVICES  PURSUANT  TO  SUCH  MODELS  IN
 CIRCUMSTANCES  OTHER  THAN THE INITIAL EMERGENCY MEDICAL CARE AND TRANS-
 PORTATION OF SICK AND INJURED PERSONS.
   3. The commissioner is authorized to provide financing including,  but
 not  limited  to,  grants  or positive adjustments in medical assistance
 rates or premium payments, to the extent of funds  available  and  allo-
 cated  or  appropriated  therefor, including funds provided to the state
 through federal waivers, funds made available  through  state  appropri-
 ations  and/or  funding  through section twenty-eight hundred seven-v of
 this article, as well as waivers of regulations under title ten  of  the
 New  York  codes, rules and regulations, to support the voluntary initi-
 atives and objectives of this section.  NOTHING IN THIS SECTION SHALL BE
 CONSTRUED TO LIMIT, OR TO IMPLY THE NEED FOR STATE APPROVAL OF, COLLABO-
 RATIVE INITIATIVES  ENUMERATED  IN  THIS  SECTION  WHICH  ARE  OTHERWISE
 PERMISSIBLE  UNDER LAW OR REGULATION, PROVIDED HOWEVER THAT THE APPROVAL
 OF THE COMMISSIONER SHALL BE REQUIRED FOR EITHER STATE FUNDING OR  REGU-
 LATORY WAIVERS AS PROVIDED FOR UNDER THIS SECTION.
   4.  Hospital-home  care-physician collaborative initiatives under this
 section may include, but shall not be limited to:
   (a) Hospital-home care-physician  integration  initiatives,  including
 but not limited to:
   (i)  transitions  in  care  initiatives to help effectively transition
 patients to post-acute care  at  home,  coordinate  follow-up  care  and
 address issues critical to care plan success and readmission avoidance;
   (ii)  clinical  pathways  for  specified conditions, guiding patients'
 progress and outcome goals, as well as effective health services use;
   (iii) application of telehealth/telemedicine  services  in  monitoring
 and  managing  patient  conditions,  and promoting self-care/management,
 improved outcomes and effective services use;
   (iv) facilitation of  physician  house  calls  to  homebound  patients
 and/or  to  patients  for whom such home visits are determined necessary
 and effective for patient care management;
   (v) additional models for prevention of  avoidable  hospital  readmis-
 sions and emergency room visits;
   (vi) health home development;
   (vii)  development  and  demonstration  of new models of integrated or
 collaborative care and care management not otherwise achievable  through
 existing models; [and]
   (viii)  bundled payment demonstrations for hospital-to-post-acute-care
 for specified conditions or categories  of  conditions,  in  particular,
 conditions  predisposed  to  high  prevalence  of readmission, including

 A. 1208                             3
 
 those currently subject to federal/state penalty, and  other  discharges
 with extensive post-acute needs; AND
   (IX) MODELS OF COMMUNITY PARAMEDICINE, UNDER WHICH HOSPITALS, EMERGEN-
 CY  MEDICAL SERVICES WHO UTILIZE EMPLOYED OR VOLUNTEER EMERGENCY MEDICAL
 TECHNICIANS OR ADVANCED EMERGENCY MEDICAL  TECHNICIANS,  PHYSICIANS  AND
 HOME  CARE  AGENCIES,  IN JOINT PARTNERSHIP, MAY DEVELOP AND IMPLEMENT A
 PLAN FOR THE COLLABORATIVE PROVISION OF SERVICES IN COMMUNITY  SETTINGS.
 IN  ADDITION TO EMERGENCY SERVICES PROVIDED UNDER ARTICLE THIRTY OF THIS
 CHAPTER, MODELS OF  COMMUNITY  PARAMEDICINE  MAY  INCLUDE  COLLABORATIVE
 SERVICES TO AT-RISK INDIVIDUALS LIVING IN THE COMMUNITY TO PREVENT EMER-
 GENCIES,  AVOIDABLE  EMERGENCY ROOM NEED, AVOIDABLE TRANSPORT AND POTEN-
 TIALLY AVOIDABLE HOSPITAL ADMISSIONS AND READMISSIONS; COMMUNITY  PARAM-
 EDICINE  SERVICES  TO  INDIVIDUALS WITH BEHAVIORAL HEALTH CONDITIONS, OR
 DEVELOPMENTAL OR INTELLECTUAL DISABILITIES, SHALL  FURTHER  INCLUDE  THE
 COLLABORATION  OF  APPROPRIATE  PROVIDERS  OF BEHAVIORAL HEALTH SERVICES
 LICENSED OR CERTIFIED UNDER THE MENTAL HYGIENE LAW;
   (b) Recruitment, training and retention of hospital/home  care  direct
 care  staff  and  physicians,  in geographic or clinical areas of demon-
 strated need. Such initiatives may include, but are not limited to,  the
 following activities:
   (i)  outreach and public education about the need and value of service
 in health occupations;
   (ii) training/continuing education  and  regulatory  facilitation  for
 cross-training  to  maximize  flexibility  in  the utilization of staff,
 including:
   (A) training of hospital nurses in home care;
   (B) dual certified nurse aide/home health aide certification; [and]
   (C) dual personal care aide/HHA certification; AND
   (D) ORIENTATION AND/OR COLLABORATIVE TRAINING OF EMS,  HOSPITAL,  HOME
 CARE, PHYSICIAN AND, AS NECESSARY, OTHER PARTICIPATING PROVIDER STAFF IN
 COMMUNITY PARAMEDICINE;
   (iii) salary/benefit enhancement;
   (iv) career ladder development; and
   (v) other incentives to practice in shortage areas; and
   (c)  Hospital  - home care - physician collaboratives for the care and
 management of special needs, high-risk and high-cost patients, including
 but not limited to best practices, and training and education of  direct
 care practitioners and service employees.
   5.  Hospitals  and  home care agencies which are provided financing or
 waivers pursuant to this section shall report to the commissioner on the
 patient, service and cost experiences pursuant to this section,  includ-
 ing the extent to which the project goals are achieved. The commissioner
 shall  compile  and  make  such  reports  available  on the department's
 website.
   § 2. The public health law is amended by adding a new  section  3001-a
 to read as follows:
   §  3001-A. COMMUNITY PARAMEDICINE SERVICES. NOTWITHSTANDING ANY INCON-
 SISTENT PROVISION OF THIS ARTICLE, AN EMERGENCY  MEDICAL  TECHNICIAN  OR
 ADVANCED EMERGENCY MEDICAL TECHNICIAN IN COURSE OF HIS OR HER WORK AS AN
 EMPLOYEE  OR  VOLUNTEER  OF  AN  AMBULANCE  SERVICE  OR AN ADVANCED LIFE
 SUPPORT FIRST RESPONSE SERVICE CERTIFIED UNDER THIS ARTICLE  TO  PROVIDE
 EMERGENCY  MEDICAL  SERVICES MAY ALSO PARTICIPATE IN MODELS OF COMMUNITY
 PARAMEDICINE PURSUANT TO SECTION TWENTY-EIGHT  HUNDRED  FIVE-X  OF  THIS
 CHAPTER.
   § 3. This act shall take effect immediately.