BILL NUMBER: S7052A
SPONSOR: WEBB
 
TITLE OF BILL:
An act to amend the public health law, in relation to rates of payment
for certified home health agencies
 
PURPOSE:
The bill would authorize the Commissioner of Health to adjust Episodic
Payment System (EPS) rates and notify health plans about the EPS for
certified home health agency (CHHA) services.
 
SUMMARY OF PROVISIONS:
Section 1: Makes EPS available to Medicaid managed care, Child Health
Plus, and Essential Plans, enabling these plans recognize EPS as the
standard payment method while still allowing alternative payment models.
Section 2: Establishes the effective date.
 
JUSTIFICATION:
CHHAs provide vital post-acute care but currently face financial strain,
leading to many closures and reduced patient access. Since 2019, 20+
CHHAs have closed. Additionally, according to the Center for Medicare
and Medicaid Services, Medicare CHHA admissions have dropped in New York
State by nearly 25% and Medicaid access has also declined significantly.
When compared to patients who receive CHHA services, those who do not
receive services stay in hospitals longer and are more likely to be
readmitted, resulting in higher cost. They also have higher mortality
rates.
EPS has been the standard Medicaid payment for CHHAs in New York since
2012 but has not been updated despite rising costs. Managed care plans,
which cover the vast majority of CHHA Medicaid patients, often underpay
CHHAs due to using other ways to reimburse home health care services.
CHHAs cannot afford to admit poorly reimbursed cases, resulting in fewer
CHHA admissions for low-in-come patients. This bill allows the Depart-
ment of Health to modify the payment system to be responsive to current
factors and provides for managed care plans to use that EPS system as a
default for payment. Managed Care plans are free to implement alterna-
tive payment systems as well as the EPS.
 
LEGISLATIVE HISTORY:
2025: S.7052 - New bill
 
FISCAL IMPLICATIONS:
This bill has no immediate fiscal impact
 
LOCAL FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
Immediately.

Statutes affected:
S7052: 3614 public health law, 3614(13) public health law
S7052A: 3614 public health law, 3614(13) public health law