HLT-33-12-00014-E Episodic Pricing for Certified Home Health Agencies (CHHAs)
8/15/12 N.Y. St. Reg. HLT-33-12-00014-E
NEW YORK STATE REGISTER
VOLUME XXXIV, ISSUE 33
August 15, 2012
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
EMERGENCY RULE MAKING
I.D No. HLT-33-12-00014-E
Filing No. 761
Filing Date. Jul. 31, 2012
Effective Date. Jul. 31, 2012
Episodic Pricing for Certified Home Health Agencies (CHHAs)
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of section 86-1.44 of Title 10 NYCRR.
Statutory authority:
Public Health Law, section 3614(13)
Finding of necessity for emergency rule:
Preservation of public health.
Specific reasons underlying the finding of necessity:
It is necessary to issue the proposed regulations on an emergency basis in order to ensure an appropriate level of reimbursement to those Certified Home Health Agencies (CHHAs) that provide services to a special needs population of medically complex children, adolescents and young disabled adults and to those CHHAs that serve primarily patients who are eligible for OPWDD services.
Section 111 of Part H of Chapter 59 of the Laws of 2011 provides the Commissioner of Health with authority to issue regulations such as these emergency regulations.
Further, there is compelling interest in enacting these regulations immediately in order to secure federal approval of the associated Medicaid State Plan Amendment.
Subject:
Episodic Pricing for Certified Home Health Agencies (CHHAs).
Purpose:
To exempt services to a special needs population from the episodic payment system for CHHAs.
Text of emergency rule:
Subdivisions (a) and (c) and the opening paragraph of subdivision (b) of section 86-1.44 of title 10 of NYCRR are amended to read as follows:
(a) Effective for services provided on and after [April 1] May 2, 2012, Medicaid payments for certified home health care agencies ("CHHA"), except for such services provided to children under eighteen years of age and except for services provided to a special needs population of medically complex and fragile children, adolescents and young disabled adults by a CHHA operating under a pilot program approved by the Department, shall be based on payment amounts calculated for 60-day episodes of care.
(b) An initial statewide episodic base price, to be effective [April 1] May 2, 2012, will be calculated based on paid Medicaid claims, as determined by the Department, for services provided by all certified home health agencies in New York State during the base period of January 1, 2009 through December 31, 2009.
(c) The base price paid for 60-day episodes of care shall be adjusted by an individual patient case mix index as determined pursuant to subdivision (f) of this section; and also by a regional wage index factor as determined pursuant to subdivision (h) of this section. Such case mix adjustments shall include an adjustment factor for CHHAs providing care primarily to a special needs patient population coming under the jurisdiction of the Office of People With Developmental Disabilities (OPWDD) and consisting of no fewer than two hundred such patients.
This notice is intended
to serve only as a notice of emergency adoption. This agency intends to adopt this emergency rule as a permanent rule and will publish a notice of proposed rule making in the State Register at some future date. The emergency rule will expire October 28, 2012
Text of rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, (518) 473-7488, email: regsqna@health.state.ny.us
Regulatory Impact Statement
Statutory Authority:
The authority for implementation of an episodic payment system for Certified Home Health Agency services pursuant to regulations is set forth in section 3614(13) of the Public Health Law.
Legislative Objectives:
The Legislature chose to address the issue of over-utilization of Certified Home Health Agency services as a result of the recommendations submitted by the Medicaid Redesign Team and accepted by the Governor. Pursuant to statute, an episodic payment system based on 60-day episodes of care, with payments tied to patient acuity, was chosen as one of the vehicles to address this issue.
Needs and Benefits:
The proposed amendment will exempt services provided to a special needs population of medically complex children, adolescents and young disabled adults by a CHHA operating under a pilot program approved by the Department from the episodic payment system and will also provide for an adjustment of the case mix index for CHHAs serving primarily patients who are eligible for OPWDD services when such CHHAs have over 200 such patients. This amendment will help assure that agencies primarily serving certain special needs populations will receive a level of reimbursement from the Medicaid system to maintain both adequate access and quality of care for members of these populations.
Costs:
The regulated parties (providers) are not expected to incur any additional costs as a result of the proposed rule change. There are no additional costs to local governments for the implementation of and continuing compliance with this amendment. It is anticipated there will be a slight decrease to the total state fiscal savings which were budgeted for the Episodic Payment System.
Local Government Mandates:
The proposed amendment does not impose any new programs, services, duties or responsibilities upon any county, city, town, village, school district, fire district or other special district.
Paperwork:
There is no additional paperwork required of providers as a result of this amendment.
Duplication:
These regulations do not duplicate existing state or federal regulations.
Alternatives:
No significant alternatives are available. The Department is required by the Public Health Law section 3614(13) to promulgate implementing regulations.
Federal Standards:
This amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.
Compliance Schedule:
There are no significant actions which are required by the affected providers to comply with the rule change.
Regulatory Flexibility Analysis
Effect of Rule:
The proposed rule is expected to initially affect two Certified Home Health Agencies. Neither agency is a small business and neither is government sponsored.
Compliance Requirements:
There are no additional reporting, recordkeeping or other affirmative acts that small businesses or local governments will need to undertake to comply with the proposed rule. A "small business regulation guide" is not required.
Professional Services:
No new or additional professional services are required in order to comply with the proposed amendments.
Compliance Costs:
The proposed rule will not require providers or local government to incur any additional compliance costs.
Economic and Technological Feasibility:
Compliance by small businesses and local governments is not expected to have economic or technological implications.
Minimizing Adverse Impact:
The proposed amendment reflects statutory intent and requirements.
Small Business and Local Government Participation:
The two affected Certified Home Health Agencies are not small businesses or government sponsored.
Rural Area Flexibility Analysis
Types and Estimated Numbers of Rural Areas:
This rule applies uniformly throughout the state, including rural areas. Rural areas are defined as counties with a population less than 200,000 and counties with a population of 200,000 or greater that have towns with population densities of 150 persons or fewer per square mile. The following 43 counties have a population of less than 200,000 based upon the United States Census estimated county populations for 2010 (http://quickfacts.census.gov). Approximately 17% of small health care facilities are located in rural areas.
Allegany County
Greene County
Schoharie County
Cattaraugus County
Hamilton County
Schuyler County
Cayuga County
Herkimer County
Seneca County
Chautauqua County
Jefferson County
St. Lawrence County
Chemung County
Lewis County
Steuben County
Chenango County
Livingston County
Sullivan County
Clinton County
Madison County
Tioga County
Columbia County
Montgomery County
Tompkins County
Cortland County
Ontario County
Ulster County
Delaware County
Orleans County
Warren County
Essex County
Oswego County
Washington County
Franklin County
Otsego County
Wayne County
Fulton County
Putnam County
Wyoming County
Genesee County
Rensselaer County
Yates County
Schenectady County
The following counties have a population of 200,000 or greater and towns with population densities of 150 persons or fewer per square mile. Data is based upon the United States Census estimated county populations for 2010.
Albany County
Monroe County
Orange County
Broome County
Niagara County
Saratoga County
Dutchess County
Oneida County
Suffolk County
Erie County
Onondaga County
Reporting, Recordkeeping and Other Compliance Requirements; and Professional Services:
No new reporting, recordkeeping, or other compliance requirements are being imposed as a result of this proposal. No additional professional services will be required for compliance.
Costs:
Certified Home Health Agencies are not expected to incur any significant costs as a result of this rule change.
Minimizing Adverse Impact:
The proposed amendment reflects statutory intent and requirements.
Rural Area Participation:
The two affected Certified Home Health Agencies are not rural providers.
Job Impact Statement
Nature of Impact:
The proposed rule change will exempt services to a special needs population of medically complex children, adolescents and young adults from the episodic payment system for Certified Home Health Agencies (CHHAs) and will provide for a positive adjustment of the case mix index for CHHAs serving primarily patients who are eligible for OPWDD services.
These changes are not expected to have a negative impact on jobs or employment opportunities and could slightly increase employment levels at the impacted CHHAs due to higher Medicaid reimbursement levels.
Categories and Numbers Affected:
There are five categories of direct care workers at CHHAs: home health aides, nurses, physical therapists, occupational therapists and speech pathologists. Statewide, 84% of CHHA claims dollars are for home health aide services. The proposed rule changes are not expected to negatively impact any of these five categories.
Regions of Adverse Impact:
No adverse impact is anticipated as a result of this rule change.
Minimizing Adverse Impact:
No adverse impact is anticipated as a result of this rule change.
