S T A T E   O F   N E W   Y O R K
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                                  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.