NY Pub Health L § 3614 (2021)
2021 New York Laws PBH - Public Health Article 36 - Home Care Services 3614 - Payments for Certified Home Health Agency Services, Long Term Home Health Care Programs and AIDS Home Care Programs.

§  3614. Payments for certified home health agency services, long term home health care programs and AIDS home care programs. 1. No  government agency  shall  purchase,  pay for or make reimbursement or grants-in-aid for services provided by a home care services agency, a  provider  of  a long  term  home  health care program or a provider of an AIDS home care program unless, at the time the services were provided,  the  home  care services  agency  possessed  a  valid  certificate  of  approval  or the provider of a long term home health  care  program  or  AIDS  home  care program had been authorized by the commissioner to provide such program. However,  contractual  arrangements  between  a  certified  home  health agency, provider of a long term home health care program, provider of an AIDS home care program, or government agency and any home care  services agency  shall not be prohibited, provided that the certified home health agency, provider of a long term home health care program, provider of an AIDS  home  care  program,   or   government   agency   maintains   full responsibility for the plan of treatment and the care rendered.   2.  Payments  for  certified  home  health agency services or services provided by long term home  health  care  programs  or  AIDS  home  care programs  made  by government agencies shall be at rates approved by the state director of the budget. No provider of a  long  term  home  health care  program or AIDS home care program shall establish charges for such program in excess of those established pursuant  to  the  provisions  of this  section  and  rules  and  regulations  adopted pursuant to section thirty-six hundred twelve of this article or  subchapter  XVIII  of  the federal Social Security Act (Medicare).   2-a.  Notwithstanding  any  contrary law, rule or regulation, for rate periods on and after April first, two thousand eleven, Medicaid rates of payments for services provided by certified  home  health  agencies,  by long  term  home  health  care  programs or by an AIDS home care program shall not reflect a separate payment  for  home  care  nursing  services provided  to patients diagnosed with Acquired Immune Deficiency Syndrome (AIDS).   3. Prior to  the  approval  of  such  rates,  the  commissioner  shall determine  and  certify  to  the  state  director of the budget that the proposed rate schedules for payments for certified  home  health  agency services  or services provided by long term home health care programs or AIDS home care programs are reasonably  related  to  the  costs  of  the efficient production of such services. In making such certification, the commissioner  shall  take  into  consideration  the  elements  of  cost, geographical differentials in the elements of cost considered,  economic factors  in the area in which the certified home health agency, provider of a long term home health care program or provider of an AIDS home care program is located, costs of certified home health  agencies,  providers of  long  term  home health care programs or providers of AIDS home care programs of comparable size, and the  need  for  incentives  to  improve services and institute economies.   3-a.  Medically  fragile  children.  Rates  of  payment for continuous nursing services for medically fragile children provided by a  certified home  health agency, a licensed home care services agency or a long term home health care program shall be established to ensure the availability of such services, whether provided  by  registered  nurses  or  licensed practical  nurses  who  are  employed  by  or  under  contract with such agencies or programs, and shall be established at  a  rate  that  is  at least  equal  to rates of payment for such services rendered to patients eligible  for  AIDS  home  care  programs;  provided,  however,  that  a certified  home health agency, a licensed home care services agency or a long term home health care program that receives such enhanced rates for continuous nursing services for medically  fragile  children  shall  use  such  enhanced  rates  to  increase  payments  to  registered nurses and licensed practical nurses who provide such  services.  In  the  case  of services  provided  by certified home health agencies and long term home health  care programs through contracts with licensed home care services agencies, rate increases received by such certified home health agencies and long term home health care programs  pursuant  to  this  subdivision shall be reflected in payments made to the registered nurses or licensed practical  nurses  employed by such licensed home care services agencies to render services to these children. In establishing rates  of  payment under  this  subdivision,  the  commissioner  shall  consider  the  cost neutrality of such rates as related to the cost effectiveness of  caring for  medically  fragile  children  in  a  non-institutional  setting  as compared  to  an  institutional  setting.  For  the  purposes  of   this subdivision, a medically fragile child shall mean a child who is at risk of hospitalization or institutionalization, including but not limited to children who are technologically-dependent for life or health-sustaining functions,  require  complex medication regimen or medical interventions to maintain or to improve their health status or are in need of  ongoing assessment  or  intervention  to  prevent serious deterioration of their health status or medical complications that place their life, health  or development  at  risk, but who are capable of being cared for at home if provided with appropriate home care services, including but not  limited to  case  management  services  and  continuous  nursing  services.  The commissioner shall promulgate regulations  to  implement  provisions  of this  subdivision  and  may  also direct the providers specified in this subdivision to provide such additional information and in such  form  as the  commissioner  shall  determine is reasonably necessary to implement the provisions of this subdivision.   3-c. Home telehealth. (a) Demonstration rates of payment or fees shall be established for telehealth services  provided  by  a  certified  home health  agency,  a  long term home health care program or AIDS home care program, or for telehealth services by a  licensed  home  care  services agency under contract with such an agency or program, in order to ensure the  availability  of technology-based patient monitoring, communication and health management. Reimbursement for  telehealth  services  provided pursuant  to  this  section  shall  be  provided only in connection with Federal Food and Drug Administration-approved and interoperable devices, and incorporated as part of the patient's plan of care. The commissioner shall  seek  federal  financial  participation  with  regard   to   this demonstration initiative.  (b)  The purposes of such services shall be to assist in the effective monitoring and management of patients whose medical,  functional  and/or environmental  needs  can  be  appropriately and cost-effectively met at home through the application of telehealth  intervention.  Reimbursement provided  pursuant to this subdivision shall be for services to patients with conditions or clinical circumstances associated with the  need  for frequent  monitoring,  and/or  the  need for frequent physician, skilled nursing or acute care services, and where the  provision  of  telehealth services  can  appropriately  reduce  the  need for on-site or in-office visits or acute or long term care facility admissions.  Such  conditions and  clinical  circumstances  shall  include,  but  not  be  limited to, congestive  heart  failure,  diabetes,  chronic  pulmonary   obstructive disease,   wound  care,  polypharmacy,  mental  or  behavioral  problems limiting  self-management,  and  technology-dependent   care   such   as continuous  oxygen,  ventilator  care,  total  parenteral  nutrition  or enteral feeding.  (c) Demonstration rates or fees established by  the  commissioner  and approved  by  the  director  of the budget, for such telehealth services  shall reflect telehealth services costs on a monthly basis in  order  to account for daily variation in the intensity and complexity of patients' telehealth  service  needs; provided that such demonstration rates shall further  reflect  the  cost of the daily operation and provision of such services, which costs shall include the following  functions  undertaken by the participating certified home health agency, long term home health care  program,  AIDS  home  care  program or licensed home care services agency:  (i) Monitoring of patient vital signs;  (ii) Patient education;  (iii) Medication management;  (iv) Equipment maintenance;  (v) Review of patient trends and/or other changes in patient condition necessitating professional intervention; and  (vi) Such other activities as the commissioner may deem necessary  and appropriate to this section.  (d)  The  commissioner  shall  take  such  additional  steps as may be reasonably necessary to implement the  provision  of  this  subdivision; provided   however   that   the  commissioner  shall  establish  initial demonstration rates or fees for telehealth services as provided  for  in this subdivision by no later than October first, two thousand seven; and provided,  further,  however, that the commissioner shall seek the input of representatives from participating  providers  and  other  interested parties  in  the  development  of  such rates or fees and any applicable requirements established pursuant to this subdivision.  (e) The  commissioner  shall,  within  monies  appropriated  therefor, establish  a  rural home telehealth delivery demonstration study program in counties having a population of not  less  than  one  hundred  thirty thousand  and not more than one hundred forty thousand, according to the two thousand ten decennial federal census. The commissioner shall direct a home health organization serving in  such  county  to  study  patients receiving  telehealth  services,  pursuant to this subdivision, who have been diagnosed with congestive heart failure,  diabetes  and/or  chronic pulmonary  obstructive  disease,  and  whose  medical, functional and/or environmental  needs  are  appropriately  met  at   home   through   the application  of  telehealth  services  interventions. Such a study shall determine the cost of providing telehealth services, the quality of care provided through  telehealth  services  and  the  outcomes  of  patients receiving such telehealth services. The commissioner shall reimburse the home   health   organization  for  conducting  the  study  with  amounts appropriated under this subdivision. The home health organization  shall evaluate  the  findings  of  the  study  and report to the governor, the temporary president of the senate, the  speaker  of  the  assembly,  the commissioner,  and  the  chair  of  the  legislative commission on rural resources on its findings of  providing  telehealth  services  for  each condition,  so  as  to  provide  the  cost  benchmarks  with and without telehealth care, as well as providing cost benefit measurements in terms of the quality benefit outcomes for each of the conditions addressed via telehealth.   4. The commissioner shall notify each certified  home  health  agency, long  term  home  health  care program and AIDS home care program of its approved rates of  payment  which  shall  be  used  in  reimbursing  for services  provided  to  persons  eligible  for  payments  made  by state governmental agencies at least thirty days prior to the beginning of  an established  rate period for which the rate is to become effective. Such notification shall be made only after approval of rate schedules by  the state director of the budget.    * 5. (a) During the period July first, nineteen hundred ninety through December  thirty-first,  nineteen  hundred  ninety,  the  period January first,  nineteen  hundred  ninety-one  through  December   thirty-first, nineteen hundred ninety-one and for each calendar year period commencing on  January  first thereafter, rates of payment by governmental agencies established  in  accordance  with  subdivision  three  of  this  section applicable  for  services  provided by certified home health agencies to individuals eligible for medical assistance pursuant to title eleven  of article  five  of  the  social  services  law  for certified home health agencies which can demonstrate, on forms provided by  the  commissioner, losses from a disproportionate share of bad debt and charity care during the  base  year  period as used in determining such rates may include an allowance determined in accordance with this subdivision to reflect  the needs  of  the  certified home health agency for the financing of losses resulting from bad debt and the cost of charity care.  Losses  resulting from  bad  debt  and the delivery of charity care shall be determined by the commissioner considering, but not limited to, such  factors  as  the losses resulting from bad debt and the costs of charity care provided by the certified home health agency and the availability of other financial support, including state local assistance public health aid, to meet the losses  resulting  from  bad  debt  and the costs of charity care of the certified home health agency. The bad debt and  charity  care  allowance for a certified home health agency for a rate period shall be determined by  the commissioner in accordance with rules and regulations adopted by the state hospital review and  planning  council  and  approved  by  the commissioner,  and  shall be consistent with the purposes for which such allowances  are  authorized  for  general  hospitals  pursuant  to   the provisions  of  article  twenty-eight  of  this  chapter  and  rules and regulations  promulgated  by   the   commissioner.   For   purposes   of distribution  of  bad  debt  and  charity  care  allowances  to eligible certified home health agencies, the  commissioner,  in  accordance  with rules  and regulations adopted by the state hospital review and planning council and approved by the commissioner, may limit application of a bad debt and charity care allowance to a particular home care services  unit or  units  of  service, such as nursing service. A certified home health agency applying for a bad debt and charity care  allowance  pursuant  to this   subdivision   shall   provide   assurances  satisfactory  to  the commissioner that it shall  undertake  reasonable  efforts  to  maintain financial   support  from  community  and  public  funding  sources  and reasonable efforts to collect payments for  services  from  third  party insurance  payors,  governmental  payors and self-paying patients. To be eligible for an allowance pursuant to this subdivision, a certified home health agency shall: have professional assistance available on  a  seven day  per week, twenty-four hour per day basis to all registered clients; demonstrate  compliance  with   minimum   charity   care   certification obligation  levels established pursuant to rules and regulations adopted by the state hospital review and planning council and  approved  by  the commissioner;  and  provide to the commissioner and maintain a community service plan which outlines  the  agency's  organizational  mission  and commitment  to  meet the home care needs of the community, in accordance with paragraph (h) of this subdivision.  (b) The total amount of funds to be allocated and distributed for  bad debt  and  charity  care  allowances  to  eligible certified home health agencies for a rate period in accordance with this subdivision shall  be limited  to  an annual aggregate amount of six million two hundred fifty thousand dollars; provided, however, that the amount of funds  allocated for  distribution  to  eligible publicly sponsored certified home health agencies for bad debt and  charity  care  allowances  shall  not  exceed  thirty-five  percent of total available funds for all eligible certified home health agencies for  bad  debt  and  charity  care  allowances.  In establishing  an  apportionment of available funds to publicly sponsored certified  home  health  agencies in accordance with this paragraph, the commissioner shall promulgate regulations which may include, but not  be limited  to,  such factors as the ratio of public to nonpublic base year period bad debt and charity care provided  by  eligible  certified  home health  agencies  and differences in costs for delivering such services. Certified home health agencies provided by general hospitals  shall  not be eligible for any portion of the allocation pursuant to this paragraph for  the  period of July first, nineteen hundred ninety through December thirty-first, nineteen hundred ninety-four, or for such longer period if extended by law, based on the projected  availability  of  an  equitable level  of  bad debt and charity care coverage for such agencies provided pursuant to chapter two of the laws of nineteen hundred eighty-eight and any future amendments thereto.  (c) No certified home health agency may receive a bad debt and charity care allowance in accordance with this subdivision in  an  amount  which exceeds  its  need  for  the  financing  of  losses  associated with the delivery of bad debt and charity care.  (d) A nominal payment amount for the financing  of  losses  associated with  the  delivery of bad debt and charity care will be established for each eligible certified home health agency. The nominal  payment  amount shall  be  calculated  as  the  sum  of  the dollars attributable to the application of an incrementally increasing nominal  coverage  percentage of  base year period losses associated with the delivery of bad debt and charity care for percentage increases in the relationship  between  base year  period losses associated with the delivery of bad debt and charity care and base  year  period  total  operating  costs  according  to  the following scale:  % of bad debt and charity care losses to       nominal percentage of         total operating cost                       loss coverage             Up to 3%                                    50%               3 - 6%                                    75%                   6% +                                 100%  If  the  sum  of  the nominal payment amounts for all eligible voluntary non-profit and private proprietary certified home health agencies or for all eligible public certified home health  agencies  is  less  than  the amount  allocated  for  bad debt and charity care allowances pursuant to paragraph (b)  of  this  subdivision  for  such  certified  home  health agencies  respectively,  the  nominal  coverage percentages of base year period losses associated with the delivery of bad debt and charity  care pursuant  to  this  scale  may be increased to not more than one hundred percent for voluntary non-profit and private proprietary certified  home health  agencies  or  for  public  certified  home  health  agencies  in accordance with rules and regulations  adopted  by  the  state  hospital review and planning council and approved by the commissioner.  (e)  The  bad  debt  and  charity  care  allowance  for  each eligible voluntary non-profit  and  private  proprietary  certified  home  health agency  shall be based on the dollar value of the result of the ratio of total funds allocated for bad  debt  and  charity  care  allowances  for certified  home  health  agencies  pursuant  to  paragraph  (b)  of this subdivision to the total  statewide  nominal  payment  amounts  for  all eligible  certified  home  health agencies determined in accordance with paragraph (d) of this subdivision applied to the nominal payment  amount for each such certified home health agency.  (f)  The  bad debt and charity care allowance for each eligible public certified home health agency shall be based on the dollar value  of  the result  of  the  ratio of total funds allocated for bad debt and charity care allowances for public certified home health  agencies  pursuant  to paragraph (b) of this subdivision to the total statewide nominal payment amounts   for   all  eligible  public  certified  home  health  agencies determined in accordance with paragraph (d) of this subdivision  applied to  the  nominal  payment  amount  for  each  such certified home health agency.  (g) Certified home health agencies shall  furnish  to  the  department such  reports  and information as may be required by the commissioner to assess the cost, quality, access to, effectiveness and efficiency of bad debt and charity care provided. The state hospital review  and  planning council  shall  adopt  rules and regulations, subject to the approval of the  commissioner,  to  establish  uniform  reporting   and   accounting principles  designed  to enable certified home health agencies to fairly and accurately determine and report the costs of bad  debt  and  charity care.  In  order  to  be  eligible  for  an  allowance  pursuant to this subdivision, a certified home health agency must be in  compliance  with bad debt and charity care reporting requirements.  (h)  Community  service  plans.  (i) The governing body of a certified home health agency  shall  issue  an  organizational  mission  statement identifying  at  a minimum the populations and communities served by the agency and the agency's commitment to meeting the home care needs of the community.  The  commissioner  shall   take   into   consideration   the limitations  of  agency  size  and  resources,  and allow flexibility in complying with the provisions of this section.  (ii) The governing body of the certified home health agency  shall  at least once every three years:  (A) review and amend as necessary the agency's mission statement;  (B)  solicit the views of the communities served by the agency on such issues as the agency's performance and service priorities;  (C) demonstrate the agency's operational and financial  commitment  to meeting  community  home care needs, to provide charity care service and to improve access to home care services by the underserved; and  (D) prepare and make available to the public a statement  showing  the provision  of free, reduced charge and/or other services of a charitable or community nature.  (iii) The governing body of the certified  home  health  agency  shall annually  make  available  to  the  public  a  review  of  the  agency's performance in meeting the home care needs of the  community,  providing charity care services, and improving access to home care services by the underserved.  (iv) The governing body of the certified home health agency shall file with  the  commissioner  its  mission  statement, its annual performance review, and at least every three years a report detailing amendments  to the  statement  reflecting  changes  in  the  agency's  operational  and financial commitment to meeting the home care needs  of  the  community, providing  charity  care  services,  and  improving  access to home care services by the underserved.  (v) The  commissioner  shall  promulgate  regulations  establishing  a revised percentage for the charity care requirement.  (i)  This  subdivision  shall be effective if, and as long as, federal financial  participation  is  available  for   expenditures   made   for beneficiaries  eligible  for  medical  assistance under title XIX of the federal social security act based  upon  the  allowances  determined  in accordance with this subdivision.   * NB Expires June 30, 2023    6.  (a)  The  commissioner shall, subject to the approval of the state director of  the  budget,  establish  capitated  rates  of  payment  for services  provided  by  assisted living programs as defined by paragraph (a) of subdivision one of section four hundred sixty-one-l of the social services  law.  Such rates of payment shall be related to costs incurred by residential health care facilities. The rates shall reflect the  wage equalization  factor  established  by  the  commissioner for residential health care facilities in  the  region  in  which  the  assisted  living program  is  provided  and  real  property  capital  construction  costs associated with the construction  of  a  free-standing  assisted  living program  such rate shall include a payment equal to the cost of interest owed and depreciation costs of such construction. The rates  shall  also reflect the efficient provision of a quality and quantity of services to patients   in  such  residential  health  care  facilities,  with  needs comparable to the needs of residents  served  in  such  assisted  living programs.  Such  rates of payment shall be equal to fifty percent of the amounts which otherwise would have been expended, based  upon  the  mean prices  for  the  first  of July, nineteen hundred ninety-two (utilizing nineteen hundred eighty-three costs)  for  freestanding,  low  intensity residential  health  care  facilities with less than three hundred beds, and for years subsequent to nineteen hundred  ninety-two,  adjusted  for inflation  in  accordance  with  the  provisions  of  subdivision ten of section twenty-eight hundred seven-c of this  chapter,  to  provide  the appropriate  level of care for such residents in residential health care facilities in the applicable wage equalization factor  regions  plus  an amount   equal   to  capital  construction  costs  associated  with  the construction of an assisted living program facility as provided  for  in this  subdivision.   The commissioner shall also promulgate regulations, and may promulgate emergency regulations, to provide  for  reimbursement of  the  cost of preadmission assessments conducted directly by assisted living programs.  (b)  For  purposes  of  this  subdivision,   real   property   capital construction  costs  shall  only  be  included  in  rates of payment for assisted living programs if: the facility  houses  exclusively  assisted living  program beds authorized pursuant to paragraph (j) of subdivision three of section four hundred sixty-one-l of the social services law  or (i)  the  facility is operated by a not-for-profit corporation; (ii) the facility commenced operation after nineteen hundred ninety-eight and  at least ninety-five percent of the certified approved beds are provided to residents  who are subject to the assisted living program; and (iii) the assisted living program is in a county with a population of no less than two hundred eighty thousand persons. The methodology used  to  calculate the  rate  for  such  capital  construction  costs  shall  be  the  same methodology  used  to  calculate  the  capital  construction  costs   at residential  health  care  facilities  for such costs, provided that the commissioner may adopt rules and regulations which establish  a  cap  on real property capital construction costs for those facilities that house exclusively   assisted   living  program  beds  authorized  pursuant  to paragraph (j) of subdivision three of section four  hundred  sixty-one-l of the social services law.  (c)  The  department shall conduct a study of the use of resident data collected from a uniform assessment tool identified by the  commissioner with  respect  to its effectiveness in evaluation and adjusting rates of payment for assisted living programs. On or  before  July  thirty-first, two  thousand  eleven,  the commissioner shall provide the governor, the speaker of the assembly, the temporary president of the senate, and  the chairpersons  of the assembly and senate health committees with a report setting forth the conclusions of such study.    7. * Notwithstanding any inconsistent provision of law or  regulation, for  purposes  of establishing rates of payment by governmental agencies for certified home health agencies for the period April first,  nineteen hundred  ninety-five  through  December  thirty-first,  nineteen hundred ninety-five  and  for  rate periods beginning on or after January first, nineteen hundred ninety-six, the reimbursable base  year  administrative and  general  costs  of  a  provider  of  services  shall not exceed the statewide average of total reimbursable  base  year  administrative  and general  costs  of  such  providers  of  services.  The  amount  of such reduction in certified home health agency rates of payments made  during the  period  April  first,  nineteen  hundred  ninety-five through March thirty-first, nineteen hundred  ninety-six  shall  be  adjusted  in  the nineteen  hundred  ninety-six  rate period on a pro-rata basis, if it is determined upon post-audit review by June  fifteenth,  nineteen  hundred ninety-six  and  reconciliation  that  the  savings for the state share, excluding the federal and local government shares, of medical assistance payments pursuant to title eleven of article five of the social services law based on the limitation of such payment pursuant to this subdivision is in excess of one million five hundred thousand  dollars  or  is  less than  one  million five hundred thousand dollars for payments made on or before March thirty-first, nineteen hundred ninety-six  to  reflect  the amount  by which such savings are in excess of or lower than one million five hundred thousand dollars. For rate periods  on  and  after  January first,  two  thousand  five  through December thirty-first, two thousand six, there shall be no such reconciliation of the amount of  savings  in excess of or lower than one million five hundred thousand dollars.   * NB Effective until March 31, 2023   * Notwithstanding  any  inconsistent provision of law or regulation to the  contrary,  for  purposes  of  establishing  rates  of  payment   by governmental  agencies  for certified home health agencies and long term home health care programs for rate period beginning on or after  January first, nineteen hundred ninety-five, the department of health may not by rule  or  regulation limit the reimbursable base year administrative and general costs of a provider of services to a percentage which  is  other than thirty percent of total reimbursable base year operational costs of such provider of services.   * NB Effective March 31, 2023   No such limit shall be applied to a provider of services reimbursed on an  initial  budget  basis,  or  a  new  provider,  excluding changes in ownership or changes in name, who begins operations in the year prior to the year which is used as a base year in determining rates of payment.   For  the  purposes  of  this  subdivision,  reimbursable   base   year operational costs shall mean those base year operational costs remaining after  application of all other efficiency standards, including, but not limited to, peer group cost ceilings or guidelines.   The  limitation  on  reimbursement  for  provider  administrative  and general  expenses  provided  by this subdivision shall be expressed as a percentage reduction for the rate promulgated  by  the  commissioner  to each certified home health agency and long term home health care program provider.   7-a.  Notwithstanding any inconsistent provision of law or regulation, for the purposes  of  establishing  rates  of  payment  by  governmental agencies  for  long  term home health care programs for the period April first, two thousand five, through December  thirty-first,  two  thousand five,  and  for the period January first, two thousand six through March thirty-first, two thousand seven, and on  and  after  April  first,  two thousand seven through March thirty-first, two thousand nine, and on and after  April  first,  two  thousand nine through March thirty-first, two  thousand eleven, and on and  after  April  first,  two  thousand  eleven through March thirty-first, two thousand thirteen and on and after April first,  two  thousand  thirteen through March thirty-first, two thousand fifteen,  and on and after April 1st, two thousand fifteen through March thirty-first,  two  thousand  seventeen  the  reimbursable   base   year administrative  and  general  costs  of a provider of services shall not exceed  the  statewide  average  of   total   reimbursable   base   year administrative and general costs of such providers of services.   No such limit shall be applied to a provider of services reimbursed on an  initial  budget  basis,  or  a  new  provider,  excluding changes in ownership or changes in name, who begins operations in the year prior to the year which is used as a base year in determining rates of payment.   For  the  purposes  of  this  subdivision,  reimbursable   base   year operational costs shall mean those base year operational costs remaining after  application of all other efficiency standards, including, but not limited to, cost guidelines.   The  limitation  on  reimbursement  for  provider  administrative  and general  expenses  provided  by this subdivision shall be expressed as a percentage reduction for the rate promulgated  by  the  commissioner  to each long term home health care program provider.   8.  (a)  Notwithstanding  any  inconsistent  provision of law, rule or regulation and subject to  the  provisions  of  paragraph  (b)  of  this subdivision  and to the availability of federal financial participation, the commissioner shall adjust medical assistance rates  of  payment  for services  provided  by  certified home health agencies for such services provided to children under  eighteen  years  of  age  and  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, long term home health care programs and AIDS  home  care  programs  in  accordance  with  this paragraph  and  paragraph  (b)  of  this  subdivision  for  purposes  of improving  recruitment  and  retention  of  non-supervisory  home   care services  workers  or any worker with direct patient care responsibility in the following amounts for services provided  on  and  after  December first, two thousand two.  (i)  rates  of  payment  by  governmental  agencies for certified home health agency services for such  services  provided  to  children  under eighteen  years  of  age  and  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  (including services provided through contracts with licensed home care  services  agencies)  shall  be  increased  by  three percent;  (ii)  rates  of  payment  by  governmental agencies for long term home health  care  program  services  (including  services  provided  through contracts  with licensed home care services agencies) shall be increased by three percent; and  (iii) rates of payment by governmental agencies  for  AIDS  home  care programs  (including  services  provided through contracts with licensed home care services agencies) shall be increased by three percent.  (b) (i) Providers which have their rates  adjusted  pursuant  to  this subdivision  shall use such funds solely for the purposes of recruitment and retention of non-supervisory  home  care  services  workers  or  any worker  with  direct  patient  care  responsibility. Such purposes shall include the recruitment  and  retention  of  non-supervisory  home  care services  workers  or any worker with direct patient care responsibility employed in licensed home care services  agencies  under  contract  with  such  providers.  Providers are prohibited from using such funds for any other purpose.  (ii)  Each  such  provider  shall  submit,  at  a time and in a manner determined by the commissioner, a written certification  attesting  that such  funds  will  be  used  solely  for  the purpose of recruitment and retention of non-supervisory home care services workers  or  any  worker with  direct patient care responsibility. The commissioner is authorized to audit each such  provider  to  ensure  compliance  with  the  written certification  required  by  this subdivision and shall recoup any funds determined to have been used for purposes  other  than  recruitment  and retention  of  non-supervisory  home care services workers or any worker with direct patient care responsibility. Such  recoupment  shall  be  in addition to any other penalties provided by law.  (iii)  In  the  case  of  services  provided by such providers through contracts with licensed home  care  services  agencies,  rate  increases received  by  such  providers  pursuant  to  this  subdivision  shall be reflected, consistent with the purposes  of  subparagraph  (i)  of  this paragraph,  in  either  the  fees  paid  or  benefits  or other supports provided to non-supervisory home care services  workers  or  any  worker with direct patient care responsibility of such contracted licensed home care  services  agencies and such fees, benefits or other supports shall be proportionate to the contracted volume of  services  attributable  to each  contracted  agency.  Such  agencies shall submit to providers with which they contract written certifications  attesting  that  such  funds will  be  used  solely  for the purposes of recruitment and retention of non-supervisory home care services workers or  any  worker  with  direct patient   care   responsibility   and  shall  maintain  in  their  files expenditure plans specifying how  such  funds  will  be  used  for  such purposes.  The  commissioner  is  authorized  to  audit such agencies to ensure compliance with such certifications  and  expenditure  plans  and shall  recoup  any funds determined to have been used for purposes other than those set forth in this subdivision. Such  recoupment  will  be  in addition to any other penalties provided by law.  (iv) Funds under this subdivision are not intended to supplant support provided by local government.   9.  Notwithstanding  any  law to the contrary, the commissioner shall, subject to the availability of federal financial  participation,  adjust medical  assistance  rates of payment for certified home health agencies for such services provided to children under eighteen years of  age  and 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,  long  term home  health care programs, AIDS home care programs established pursuant to this article, hospice programs established  under  article  forty  of this  chapter  and for managed long term care plans and approved managed long term care operating demonstrations as defined in section forty-four hundred three-f of this chapter. Such adjustments shall be for  purposes of improving recruitment, training and retention of home health aides or other personnel with direct patient care responsibility in the following aggregate amounts for the following periods:  (a)  for  the  period  June  first,  two thousand six through December thirty-first, two thousand six, fifty million dollars;  (b) for the period January first,  two  thousand  seven  through  June thirtieth, two thousand seven, fifty million dollars;  (c)  for  the  period  July  first,  two  thousand seven through March thirty-first, two thousand eight, up to one hundred million dollars;  (d) for the period April  first,  two  thousand  eight  through  March thirty-first, two thousand nine, up to one hundred million dollars;  (e)  for  the  period  April  first,  two  thousand nine through March thirty-first, two thousand ten, up to one hundred million dollars;  (f)  for  the  period  April  first,  two  thousand  ten through March thirty-first, two thousand eleven, up to one hundred million dollars;  (g) for the period April first,  two  thousand  eleven  through  March thirty-first, two thousand twelve, up to one hundred million dollars;  (h)  for  the  period  April  first, two thousand twelve through March thirty-first, two thousand thirteen, up to one hundred million dollars;  (i) for the period April first, two thousand  thirteen  through  March thirty-first, two thousand fourteen, up to one hundred million dollars;  (j)  for  the  period April first, two thousand fourteen through March thirty-first, two thousand fifteen, up to one hundred million dollars;  (k) for the period April first, two  thousand  fifteen  through  March thirty-first, two thousand sixteen, up to one hundred million dollars;  (l)  for  the  period  April first, two thousand sixteen through March thirty-first, two thousand seventeen, up to one hundred million dollars;  (m) for the period April first, two thousand seventeen  through  March thirty-first, two thousand eighteen, up to one hundred million dollars;  (n)  for  the  period April first, two thousand eighteen through March thirty-first, two thousand nineteen, up to one hundred million dollars;  (o) for the period April first, two thousand  nineteen  through  March thirty-first, two thousand twenty, up to one hundred million dollars;  (p)  for  the  period  April  first, two thousand twenty through March thirty-first,  two  thousand  twenty-one,  up  to  one  hundred  million dollars;  (q)  for the period April first, two thousand twenty-one through March thirty-first,  two  thousand  twenty-two,  up  to  one  hundred  million dollars;  (r)  for the period April first, two thousand twenty-two through March thirty-first, two thousand  twenty-three,  up  to  one  hundred  million dollars.   10.  (a)  Such  adjustments  to  rates  of payments shall be allocated proportionally based on each certified home  health  agency,  long  term home  health  care  program,  AIDS  home care and hospice program's home health aide or other direct care services total annual hours of  service provided  to  medicaid  patients, as reported in each such agency's most recently available cost report as submitted to the department or for the purpose of the managed long term care program a suitable proxy developed by the department in consultation with the interested parties.  Payments made  pursuant  to  this  section  shall  not  be  subject to subsequent adjustment or reconciliation; provided that such adjustments to rates of payments to certified home  health  agencies  shall  only  be  for  that portion of services provided to children under eighteen years of age and 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.  (b)  Programs  which  have  their  rates  adjusted  pursuant  to  this subdivision shall use such funds solely for the purposes of recruitment, training  and retention of non-supervisory home care services workers or other personnel with direct patient care  responsibility.  Such  purpose shall include the recruitment, training and retention of non-supervisory home  care  services  workers  or  any  worker  with direct patient care responsibility employed in licensed home care  services  agencies  under contract  with  such  agencies.  Such agencies are prohibited from using such fund for any other purpose. For purposes  of  the  long  term  home health  care  program,  such  payment  shall  be treated as supplemental payments and not effect any current  cost  cap  requirement.  Each  such agency  shall  submit,  at  a  time  and  in  a manner determined by the  commissioner, a written certification attesting that such funds will  be used  solely  for  the purpose of recruitment, training and retention of non-supervisory home health aides or any personnel with  direct  patient care  responsibility.  The commissioner is authorized to audit each such agency or program to ensure compliance with  the  written  certification required  by  this  subdivision and shall recoup any funds determined to have been used for purposes other  than  recruitment  and  retention  of non-supervisory home health aides or other personnel with direct patient care  responsibility.  Such recoupment shall be in addition to any other penalties provided by law.  (c) In the case of services provided  by  such  agencies  or  programs through  contracts  with  licensed  home  care  services  agencies, rate increases received  by  such  agencies  or  programs  pursuant  to  this subdivision  shall  be  reflected,  consistent with the purposes of this subdivision, in either the fees paid  or  benefits  or  other  supports, including training, provided to non-supervisory home health aides or any other   personnel  with  direct  patient  care  responsibility  of  such contracted licensed home care services agencies and such fees,  benefits or  other  supports  shall  be proportionate to the contracted volume of services attributable  to  each  contracted  agency.  Such  agencies  or programs  shall  submit  to  providers  with which they contract written certifications attesting that such funds will be  used  solely  for  the purposes  of recruitment, training and retention of non-supervisory home health aides or other personnel with direct patient care  responsibility and  shall maintain in their files expenditure plans specifying how such funds will be used for such purposes. The commissioner is authorized  to audit   such  agencies  or  programs  to  ensure  compliance  with  such certifications  and  expenditure  plans  and  shall  recoup  any   funds determined  to have been used for purposes other than those set forth in this subdivision. Such recoupment shall be  in  addition  to  any  other penalties provided by law.  (d)  Funds under this subdivision are not intended to supplant support provided by local government.   11. (a) Notwithstanding any inconsistent provision  of  law,  rule  or regulation   and  subject  to  the  availability  of  federal  financial participation, the commissioner is authorized and directed to  implement a  program  whereby  he  or she shall adjust medical assistance rates of payment for services provided by certified home  health  agencies,  long term home health care programs, AIDS home care programs and providers of personal care services and/or providers of private duty nursing services under  the  social  services law in accordance with this subdivision for purposes of  enhancing  the  provision,  accessibility,  quality  and/or efficiency of home care services. Such rate adjustments shall be for the purposes  of  assisting  such  providers,  located  in  social  services districts which do not include a city with  a  population  of  over  one million persons, in meeting the cost of:  (i) Increased use of technology in the delivery of services, including telehealth   and  clinical  and  administrative  management  information system;  (ii) Specialty training of direct service personnel in dementia  care, pediatric  care  and/or the care of other conditions or populations with complex needs;  (iii) Increased auto and travel expenses associated with  rising  fuel prices,  including  the  increased  cost of providing services in remote areas; and/or  (iv) Providing enhanced access to care for high need populations;  (v)  Such  other  purposes  related  to  the  provision  of   quality, accessible home care services as the commissioner may deem appropriate.  (b)  The  commissioner  shall increase the medical assistance rates of payment pursuant to this subdivision in an amount up to an aggregate  of sixteen  million  dollars  for  the  period June first, two thousand six through March thirty-first, two  thousand  seven,  and  sixteen  million dollars  for  the  period  April first, two thousand seven through March thirty-first, two thousand eight, and sixteen million  dollars  for  the period  April  first, two thousand eight through March thirty-first, two thousand nine, provided however that if federal financial  participation is  not available for rate adjustments pursuant to this subdivision such aggregate amount shall not exceed eight million dollars,  and  provided, further,  however,  that  for  purposes  of  long  term home health care programs, such payments provided pursuant to this subdivision  shall  be treated  as  supplemental payments and shall not effect any current cost cap requirement.  (c) Such rate adjustments shall be in the form of a uniform percentage add-on to the rates, as determined  by  the  department,  based  on  the proportion  of  the total allocated adjustment dollars, as determined in paragraph (b) of this subdivision, to the  total  medicaid  expenditures for services provided for certified home health agencies, long-term home health care programs, AIDS nursing, personal care assistants and private duty  nurses  services  in  local social services districts which do not include a city with a population over one million.   12.  (a)  Notwithstanding  any  inconsistent  provision  of   law   or regulation   and  subject  to  the  availability  of  federal  financial participation, effective on and after April first, two  thousand  eleven through  March  thirty-first,  two  thousand twelve, rates of payment by government agencies for  services  provided  by  certified  home  health agencies,  except  for such services provided to children under eighteen years of age and other discrete groups  as  may  be  determined  by  the commissioner  pursuant to regulations, shall reflect ceiling limitations determined in accordance with this subdivision, provided, however,  that at  the  discretion  of  the  commissioner  such  ceilings  may,  as  an alternative, be applied to payments for services provided on  and  after April  first,  two thousand eleven, except for such services provided to children  and  other  discrete  groups  as  may  be  determined  by  the commissioner  pursuant  to  regulations. In determining such payments or rates of payment, agency ceilings shall be  established.  Such  ceilings shall  be  applied  to  payments  or rates of payment for certified home health agency services as  established  pursuant  to  this  section  and applicable  regulations.   Ceilings shall be based on a blend of: (i) an agency's two thousand nine average per patient Medicaid claims, weighted at a percentage as determined by the  commissioner;  and  (ii)  the  two thousand  nine statewide average per patient Medicaid claims adjusted by a regional wage index factor and  an  agency  patient  case  mix  index, weighted  at  a  percentage  as  determined  by  the  commissioner. Such ceilings will be effective April  first,  two  thousand  eleven  through March  thirty-first,  two thousand twelve. An interim payment or rate of payment adjustment effective April first, two thousand eleven, shall  be applied  to agencies with projected average per patient Medicaid claims, as determined by the commissioner,  to  be  over  their  ceilings.  Such agencies  shall  have  their  payments  or  rates  of payment reduced to reflect the amount by which such claims exceed their ceilings.  (b) Ceiling limitations determined pursuant to paragraph (a)  of  this subdivision  shall  be subject to reconciliation. In determining payment or rate of payment adjustments based on  such  reconciliation,  adjusted agency  ceilings  shall  be established. Such adjusted ceilings shall be based on a blend of: (i) an  agency's  two  thousand  nine  average  per patient  Medicaid  claims  adjusted  by  the  percentage  of increase or  decrease in such agency's patient case mix from the  two  thousand  nine calendar  year  to  the  annual  period April first, two thousand eleven through  March  thirty-first,  two  thousand  twelve,  weighted   at   a percentage  as determined by the commissioner; and (ii) the two thousand nine statewide  average  per  patient  Medicaid  claims  adjusted  by  a regional  wage  index factor and the agency's patient case mix index for the annual  period  April  first,  two  thousand  eleven  through  March thirty-first,   two   thousand  twelve,  weighted  at  a  percentage  as determined by the commissioner. Such adjusted agency  ceiling  shall  be compared  to actual Medicaid paid claims for the period April first, two thousand eleven through March  thirty-first,  two  thousand  twelve.  In those  instances when an agency's actual per patient Medicaid claims are determined to exceed the agency's adjusted ceiling, the amount  of  such excess  shall  be  due  from  each  such  agency to the state and may be recouped by the department in a lump sum amount or through reductions in the Medicaid payments due to the agency. In  those  instances  where  an interim  payment  or rate of payment adjustment was applied to an agency in accordance with paragraph (a) of this subdivision, and such  agency's actual  per  patient  Medicaid claims are determined to be less than the agency's adjusted ceiling, the amount by which such Medicaid claims  are less  than  the agency's adjusted ceiling shall be remitted to each such agency by the department in a lump sum amount or through an increase  in the Medicaid payments due to the agency.  (c)  Interim  payment  or rate of payment adjustments pursuant to this subdivision shall be based on Medicaid paid claims, as determined by the commissioner, for services provided by agencies in  the  base  year  two thousand  nine.  Amounts  due from reconciling rate adjustments shall be based on Medicaid paid claims, as determined by  the  commissioner,  for services  provided  by  agencies  in the base year two thousand nine and Medicaid paid claims, as determined by the  commissioner,  for  services provided  by  agencies  in  the  reconciliation  period April first, two thousand eleven through March  thirty-first,  two  thousand  twelve.  In determining  case  mix,  each patient shall be classified using a system based on measures which may include, but not be limited to, clinical and functional measures, as reported on the federal Outcome  and  Assessment Information Set (OASIS), as may be amended.  (d)  The  commissioner  may require agencies to collect and submit any data required to implement  the  provisions  of  this  subdivision.  The commissioner  may  promulgate regulations to implement the provisions of this subdivision.  (e) Payments or rate of payment  adjustments  determined  pursuant  to this  subdivision shall, for the period April first, two thousand eleven through  March  thirty-first,  two  thousand  twelve,  be  retroactively reconciled   utilizing   the   methodology  in  paragraph  (b)  of  this subdivision and utilizing actual paid claims from such period.  (f) Notwithstanding any inconsistent provision  of  this  subdivision, payments   or   rate  of  payment  adjustments  made  pursuant  to  this subdivision shall not result in an aggregate annual decrease in Medicaid payments to providers subject to this subdivision that is in  excess  of two  hundred  million dollars, as determined by the commissioner and not subject to subsequent adjustment, and the commissioner shall  make  such adjustments  to  such  payments  or rates of payment as are necessary to ensure that such aggregate limits on payment decreases are not exceeded.   13.  (a)  Notwithstanding  any  inconsistent  provision  of   law   or regulation   and  subject  to  the  availability  of  federal  financial participation, effective April first, two thousand twelve through  March thirty-first, two thousand twenty-three, payments by government agencies for services provided by certified home health agencies, except for such  services  provided  to  children  under  eighteen years of age and other discreet groups as may be determined by  the  commissioner  pursuant  to regulations,  shall  be based on episodic payments. In establishing such payments, a statewide base price shall be established for each sixty day episode  of  care  and  adjusted  by a regional wage index factor and an individual patient case mix index. Such episodic payments may be further adjusted  for  low  utilization  cases  and  to  reflect  a   percentage limitation  of  the  cost for high-utilization cases that exceed outlier thresholds of such payments.  (b) Initial base year episodic payments shall  be  based  on  Medicaid paid  claims,  as determined and adjusted by the commissioner to achieve savings comparable to the prior state fiscal year, for services provided by all certified home health agencies in  the  base  year  two  thousand nine.  Subsequent  base  year episodic payments may be based on Medicaid paid claims for services provided by all certified home health  agencies in  a  base  year  subsequent to two thousand nine, as determined by the commissioner, provided, however, that such base year adjustment shall be made not less frequently than every three  years.  In  determining  case mix,  each  patient shall be classified using a system based on measures which may include, but not limited to, clinical and functional measures, as reported on  the  federal  Outcome  and  Assessment  Information  Set (OASIS), as may be amended.  (c)  The  commissioner  may require agencies to collect and submit any data required  to  implement  this  subdivision.  The  commissioner  may promulgate regulations to implement the provisions of this subdivision.   14.  (a)  Notwithstanding any contrary provision of law and subject to the availability of federal financial participation, for periods on  and after  March  first, two thousand fourteen the commissioner shall adjust Medicaid rates of payment for services provided by certified home health agencies to address cost increases  stemming  from  the  wage  increases required  by  implementation  of  the  provisions  of section thirty-six hundred fourteen-c of this article. Such rate adjustments shall be based on a comparison, as  determined  by  the  commissioner,  of  the  hourly compensation  levels  for  home  health aides and personal care aides as reflected in the existing  Medicaid  rates  for  certified  home  health agencies  to  the  hourly  compensation  levels  incurred as a result of complying with the provisions of section thirty-six  hundred  fourteen-c of this article.  (b)  Notwithstanding  any contrary provision of law and subject to the availability of federal financial  participation,  for  periods  on  and after  March  first, two thousand fourteen the commissioner shall adjust Medicaid rates of payment for services provided by long term home health care programs to address cost increases stemming from the wage increases required by implementation  of  the  provisions  of  section  thirty-six hundred fourteen-c of this article. Such rate adjustments shall be based on  a  comparison,  as  determined  by  the  commissioner, of the hourly compensation levels for home health aides and  personal  care  aides  as reflected  in the existing Medicaid rates for long term home health care programs to the hourly compensation  levels  incurred  as  a  result  of complying  with  the provisions of section thirty-six hundred fourteen-c of this article.