S T A T E O F N E W Y O R K
________________________________________________________________________
1191
2009-2010 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2009
___________
Introduced by M. of A. CAHILL, ENGLEBRIGHT, JOHN, EDDINGTON -- Multi-
Sponsored by -- M. of A. BRENNAN, CANESTRARI, COOK, GLICK, GREENE,
HOOPER, JACOBS, McENENY, PRETLOW, J. RIVERA, ROBINSON, TOWNS, WEISEN-
BERG -- read once and referred to the Committee on Ways and Means
AN ACT to amend chapter 53 of the laws of 1990 constituting the aid to
localities budget, in relation to the personal care trend language
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Legislative intent and declaration. The legislature hereby
finds and declares that a medicaid rate setting methodology for personal
care services, entitled "Personal Care Trend Language", was incorporated
in chapter 53 of the laws of 1990. The legislature further declares that
its intention in adopting the subject provisions of chapter 53 of the
laws of 1990 was to correct inadequacies and inconsistencies in the
amount of medicaid reimbursement paid to personal care providers across
the state by mandating a more consistent and equitable medicaid
reimbursement rate, ensuring thereby that personal care providers would
be able and available to provide services to medically indigent elderly,
disabled, ill and infirm individuals.
The legislature further finds that, since their adoption, medicaid
personal care rate setting provisions of chapter 53 of the laws of 1990
have from time to time been construed by public officials and agencies,
and in courts, in a manner inconsistent with the legislature's intent in
respect of those provisions, the public policy of the state, the finan-
cial viability of the personal care program and access by the public to
personal care services upon which thousands of the state's citizenry
rely. Therefore, the legislature hereby finds and declares that it is
necessary to amend the subject provisions of chapter 53 of the laws of
1990 to clarify the legislature's intent in adopting the same.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00650-01-9
A. 1191 2
S 2. That part of section 1 of chapter 53 of the laws of 1990 consti-
tuting the aid to localities budget making an appropriation to the
department of social services for the medical assistance program is
amended to read as follows:
DEPARTMENT OF SOCIAL SERVICES
SCHEDULE
MEDICAL ASSISTANCE PROGRAM
General Fund - Local Assistance Account
PERSONAL CARE TREND LANGUAGE
Notwithstanding any inconsistent provision
of law or regulation to the contrary, for
services provided by personal care provid-
ers for the rate or contract year begin-
ning on or after July 1, 1990, payments
will be based upon reimbursement rate in
effect for rate or contract years begin-
ning prior to July 1, 1990 and adjusted by
a trend factor. This trend factor, subject
to approval by the director of the budget,
shall be developed in accordance with
regulations promulgated by the department
of social services and shall reflect
appropriate external price indicators for
three major components which comprise the
cost of personal care: aide wage and bene-
fit; administrative and operating; and
clinical; provided however that the
department of social services shall
provide public notice of the criteria
utilized in calculating the trend factor;
and provided further, however, that the
department of social services and the
director of the budget shall, within two
months of receipt of a rate request,
review and approve rates which are based
on the trend factor determinants and
established at or below the mandatory
trend factor; and provided further, howev-
er, that exceptions to the trend factor
shall be considered and acted upon by the
department of social services and the
division of the budget within four months
from receipt, for extraordinary circum-
stances, such as the inability to provide
adequate personal care services, a diminu-
tion in the quality of services and such
other factors as defined by the department
in consultation with personal care provid-
ers and local districts. Additionally,
the department of social services, in
A. 1191 3
consultation with personal care providers,
local departments of social services and
the panel of independent economists which
advises the department of health concern-
ing trend factor for hospitals, shall no
later than January 1, 1991, summit to the
legislature and governor a plan containing
the criteria for the establishment of a
rate setting methodology for personal care
which shall at a minimum consider: (a)
changes in the cost of living; (b) appli-
cable minimum wage laws; (c) any changes
in federal department of labor, bureau of
labor statistics; (d) administration,
operation and clinical factors; (e) the
cost of training personal care workers;
[and] (f) the development of a rate year
consistent with article 36 home health
care providers; AND (G) THE RATES CHARGED
BY PERSONAL CARE PROVIDERS TO UNINSURED
PERSONS TO WHOM SUCH SERVICES ARE
PROVIDED; PROVIDED HOWEVER, THAT IN NO
EVENT SHALL A RATE OR RATES CHARGED TO
UNINSURED RECIPIENTS OF PERSONAL CARE
SERVICES OR ANY AVERAGE OF OR OTHER CALCU-
LATION BASED UPON SUCH RATE OR RATES BE
DEEMED TO BE A MINIMUM OR MAXIMUM RATE FOR
PURPOSES OF ESTABLISHING PROVIDER
REIMBURSEMENT RATES FOR PERSONAL CARE
SERVICES RENDERED TO PERSONS ELIGIBLE FOR
MEDICAL ASSISTANCE. Such plan shall also
consider a method, developed by the
department of health in consultation with
the department of social services and
representatives of the home care industry,
by which the methodology used by the
department of health to establish rates
for certified home health agencies, long
term home health care programs and the
AIDS home care programs shall consider in
the establishment of such rates, rates
approved by the department of social
services and the division of the budget
for personal care in order to assure
adequate reimbursement for aide services
provided by certified home health agen-
cies, long term home health care programs
and AIDS home care programs -- less ....... (10,000,000)
S 3. This act shall take effect immediately.