Bill Text: NY A07335 | 2023-2024 | General Assembly | Amended
Bill Title: Requires the commissioner of health to establish regional minimum hourly base reimbursement rates for home care aides.
Spectrum: Partisan Bill (Democrat 25-1)
Status: (Introduced) 2024-03-06 - print number 7335a [A07335 Detail]
Download: New_York-2023-A07335-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 7335--A 2023-2024 Regular Sessions IN ASSEMBLY May 17, 2023 ___________ Introduced by M. of A. PAULIN, REYES, WEPRIN, L. ROSENTHAL, SHRESTHA, DINOWITZ, EPSTEIN, HEVESI, SIMON, STECK, ZINERMAN, GONZALEZ-ROJAS, GUNTHER, KELLES, SAYEGH, COLTON, McDONALD, SIMONE, SANTABARBARA, RAGA, STIRPE, BRABENEC, LEVENBERG, BROOK-KRASNY, LUCAS -- read once and referred to the Committee on Health -- recommitted to the Committee on Ways and Means in accordance with Assembly Rule 3, sec. 2 -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to regional minimum hourly base reimbursement rates for home care aides The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 3614-f of the public health law is amended by 2 adding eight new subdivisions 5, 6, 7, 8, 9, 10, 11 and 12 to read as 3 follows: 4 5. (a) By the first of October next succeeding the effective date of 5 this subdivision, the commissioner shall establish a regional minimum 6 hourly base reimbursement rate for all providers employing workers 7 subject to the minimum wage provisions established in subdivision two of 8 this section. The regional minimum hourly base reimbursement rate 9 shall be based on regions established by the commissioner, provided that 10 for areas subject to section thirty-six hundred fourteen-c of this arti- 11 cle, each area with a different prevailing rate of total compensation, 12 as defined in that section, shall be its own region. 13 (b) For the purposes of this section, "regional minimum hourly base 14 reimbursement rate" means a reimbursement rate that reflects: 15 (1) a direct care related payment which shall reflect the total direct 16 care related costs for home care aides and other direct care related 17 staff necessary to comply with federal and state statutory and regulato- 18 ry requirements for such providers, and which shall include: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10383-06-4A. 7335--A 2 1 A. base hourly wage guaranteed home care aides pursuant to subdivi- 2 sion two of this section; 3 B. overtime costs; 4 C. employee benefits, including both paid time off and supplemental 5 benefits or benefits as determined by collective bargaining agreements; 6 D. federal insurance contributions act; 7 E. Medicare; 8 F. federal unemployment tax act; 9 G. worker wage parity as provided by section thirty-six hundred four- 10 teen-c of this article, as applicable; 11 H. other payroll taxes; 12 I. fair labor standards act compliance; 13 J. New York state labor law compliance; 14 K. COVID-19 sick pay; 15 L. state unemployment insurance; 16 M. disability insurance; 17 N. workers' compensation; 18 O. travel time and travel reimbursement; 19 P. the metropolitan transportation authority tax; and 20 Q. related increases tied to base wages; 21 (2) a component to reflect operational expenses necessary to comply 22 with federal and state statutory and regulatory requirements for such 23 providers, and which shall include: 24 A. operational supervision and support, including but not limited to 25 nursing staff, home health aide supervision and team support; and 26 B. other operational support, including but not limited to quality 27 assurance and improvement programs, education and recruitment; and 28 (3) a component to reflect administrative and general operating 29 expenses which shall include rent and facilities management and business 30 support, including but not limited to information technology, human 31 resources, legal, compliance, finance, management, margin and communi- 32 cations. 33 (c) The regional minimum hourly base rate cannot be less than the most 34 current average fee for service county rates for level two personal care 35 service for each region as posted by the department for personal care 36 agencies or other providers delivering like services through other Medi- 37 caid programs. 38 (d) Once a regional minimum hourly base reimbursement rate has 39 been established under this section, the commissioner shall thereaft- 40 er annually adjust the regional hourly base reimbursement rate for 41 each region by a trend factor to reflect and accommodate any additional 42 labor law increases, changes or mandates. 43 6. For mainstream managed care and fully capitated Medicaid managed 44 care products for those dually eligible for both Medicaid and Medicare, 45 the commissioner shall submit any and all necessary applications for 46 approvals and/or waivers to the federal centers for Medicare and Medi- 47 caid services to secure approval to establish regional minimum hourly 48 base reimbursement rates and make state-directed payments through to 49 providers for the purposes of supporting wage increases. 50 (a) If approved by the federal centers for Medicare and Medicaid 51 services, directed payments shall be made to such providers of Medi- 52 caid services through contracts with managed care organizations where 53 applicable, provided that the commissioner ensures that such directed 54 payments are in accordance with the terms of this section. 55 (b) If the state directed payment is not approved, the provisions of 56 subdivision seven of this section shall apply.A. 7335--A 3 1 7. For partially capitated managed long term care plans, or where 2 state directed payments pursuant to subdivision six of this section have 3 not been approved, the department shall require plans to justify 4 contracts offering deviations from the regional minimum hourly base 5 reimbursement rates in a report to the department. This report shall be 6 sent to the department, with a copy to the provider prior to the final- 7 izing of any contract, unless otherwise permitted by this section, with- 8 in five working days of the contract being offered to a provider with 9 rate deviations. Any report shall include a rationale for paying below 10 the regional minimum hourly base reimbursement rate, and the impacted 11 provider shall have the opportunity to respond to the report within 12 thirty days of filing with the department. The department shall compile 13 such reports and publish and post a summary of them semi-annually. 14 8. The commissioner shall establish actuarially sound regional 15 reimbursement rate ranges for Medicaid managed care organizations in 16 order to comply with this section. These ranges will reflect managed 17 care adjustments including but not limited to: (a) managed care plan 18 variations in utilizations from the regional utilization average; (b) 19 the impact of risk adjustment; and (c) premium withholds. Rate ranges 20 shall also account for quality incentives, volume, costs associated with 21 value-based arrangements, and reimbursement for individuals with hard to 22 serve needs. 23 9. Nothing in this section shall preclude providers employing home 24 health aides covered under this section or payers from paying or 25 contracting for services at rates higher than the regional mini- 26 mum hourly base reimbursement rate if the parties mutually agree to such 27 terms. Notwithstanding subdivision seven of this section, plans and 28 providers can also mutually agree to enter into value-based contracts at 29 a rate less than the regional minimum hourly base reimbursement rate. 30 10. The commissioner shall amend the model managed care contracts to 31 reflect the requirements of this section. In addition, the commissioner 32 shall post the managed care, certified and licensed home care services 33 agencies and fiscal intermediaries cost report data in a simple under- 34 standable manner on the department's website by the fifteenth of Febru- 35 ary second succeeding the effective date of this subdivision and annual- 36 ly thereafter. 37 11. The commissioner shall publish and post regional minimum hourly 38 base reimbursement rates annually, and shall take all necessary steps 39 to advise commercial and government programs payers of home care 40 services of the regional minimum hourly base reimbursement rates. 41 12. To ensure compliance with minimum wage increases, the comptroller 42 shall have the authority to review the contracts entered into between a 43 managed care organization and a licensed home care services agency, 44 fiscal intermediary, or any agency subject to the provisions of this 45 section to ensure that rates being offered are adequate and meet the 46 department's actuarial standards. The comptroller, in consultation with 47 the Medicaid inspector general, shall develop and promulgate a process 48 to ensure such audits comply with state and federal law to protect 49 proprietary information and contracts. In the event that the comptroller 50 finds evidence that managed care organizations are not paying sufficient 51 adequate rates, they will refer such instances to the department and the 52 Medicaid fraud control unit for enforcement. If the department or the 53 Medicaid fraud control unit chooses not to pursue action related to this 54 referral, it shall inform, in writing, the comptroller's office as to 55 the reasoning. Such reports, and the department's responses, shall be 56 public information and made available on the comptroller's website.A. 7335--A 4 1 § 2. Severability. If any provision of this act, or any application of 2 any provision of this act, is held to be invalid, or to violate or be 3 inconsistent with any federal law or regulation, that shall not affect 4 the validity or effectiveness of any other provision of this act, or any 5 other application of any provision of this act which can be given effect 6 without that provision or application; and to that end, the provisions 7 and applications of this act are severable. 8 § 3. This act shall take effect immediately.
