S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6965--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 9, 2023
                                ___________
 
 Introduced  by  M.  of  A.  SEAWRIGHT  --  read once and referred to the
   Committee on Mental Health -- recommitted to the Committee  on  Mental
   Health  in  accordance  with  Assembly  Rule  3,  sec.  2 -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee

 AN ACT to amend the mental hygiene law, in relation to reimbursement for
   residential habilitation services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph (ii) of subdivision (c) of section 43.02 of the
 mental hygiene law, as amended by section 3 of part OO of chapter 58  of
 the  laws of 2015, is amended and a new subdivision (d) is added to read
 as follows:
   (ii) methodologies used in the establishment of the schedules of rates
 or fees pursuant to this section provided, however, that  IN  ACCORDANCE
 WITH  SUBDIVISION  (D) OF THIS SECTION, the commissioner of health shall
 adopt rules and regulations including methodologies developed by [him or
 her] SUCH COMMISSIONER for services provided by any facility or  program
 licensed,  operated  or  approved by the office for people with develop-
 mental disabilities; provided, however, that such rules and  regulations
 shall  be subject to the approval of the office for people with develop-
 mental disabilities and shall take into account the policies  and  goals
 of such office.
   (D)  (I)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL
 HAVE THE FOLLOWING MEANINGS:
   (1) "RETAINER DAYS" ARE DAYS OF MEDICAL LEAVE  OR  AN  ASSOCIATED  DAY
 WHERE  ANY OTHER INSTITUTIONAL OR IN-PATIENT MEDICAL PAYMENT IS MADE FOR
 PROVIDING RESIDENTIAL HABILITATION SERVICES TO  A  PERSON  ELIGIBLE  FOR
 MEDICAL  ASSISTANCE  PURSUANT  TO  TITLE  ELEVEN  OF ARTICLE FIVE OF THE
 SOCIAL SERVICES LAW.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04991-04-4
 A. 6965--A                          2
              

 
   (2) "SERVICE DAYS" ARE DAYS WHEN RESIDENTIAL HABILITATION SERVICES ARE
 PROVIDED IN A COMMUNITY RESIDENCE UNDER  THE  HOME  AND  COMMUNITY-BASED
 WAIVER OPERATED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
 AND  PURSUANT  TO  REGULATIONS  PROMULGATED  BY  THE COMMISSIONER OF THE
 OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL DISABILITIES TO A PERSON WHO IS
 EITHER PRESENT IN THE COMMUNITY RESIDENCE OR IS ABSENT FROM THE COMMUNI-
 TY RESIDENCE AND RESIDENTIAL  HABILITATION  SERVICES  ARE  PERFORMED  BY
 STAFF.  SUCH  SERVICES  SHALL  INCLUDE HABILITATION SERVICES, PROTECTIVE
 OVERSIGHT SERVICES, SUPERVISION SERVICES, NURSING SUPERVISION OF  DIRECT
 CARE STAFF AND COORDINATION OF A PERSON'S HEALTH CARE NEEDS, THE COORDI-
 NATION OF NECESSARY MEDICAL APPOINTMENTS, FOLLOW-UP REPORTS FROM MEDICAL
 APPOINTMENTS,  FOLLOW-UP  AND  INTERFACE  WITH  HOSPITAL STAFF REGARDING
 EMERGENCY ROOM VISITS AND OTHER HOSPITALIZATIONS, SERVICES AND  SUPPLIES
 RELATED  TO  PROGRAM-RELATED TRANSPORTATION, NUTRITION SERVICES DIRECTLY
 RELATED TO HABILITATION SERVICES AND PSYCHOLOGY SERVICES THAT SUPPORT  A
 PERSON'S NEED FOR BEHAVIORAL SUPPORTS IN A SERVICE SETTING.
   (3) "THERAPY DAYS" ARE DAYS WHEN A PERSON ELIGIBLE FOR MEDICAL ASSIST-
 ANCE PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW
 IS  AWAY  FROM  A  SUPERVISED  COMMUNITY  RESIDENCE AND IS NOT OTHERWISE
 RECEIVING SERVICES FROM PAID  RESIDENTIAL  HABILITATION  STAFF  AND  THE
 ABSENCE  IS  FOR  THE  PURPOSE  OF VISITING WITH FAMILY OR FRIENDS, OR A
 VACATION. THE THERAPY DAY MUST BE DESCRIBED IN THE PERSON'S PLAN OF CARE
 TO BE ELIGIBLE FOR PAYMENT AND THE PERSON MAY NOT RECEIVE ANOTHER  MEDI-
 CAID-FUNDED RESIDENTIAL OR IN-PATIENT SERVICE ON THAT DAY.
   (4)  "OCCUPANCY  ADJUSTMENT"  IS AN ADJUSTMENT TO THE CALCULATED DAILY
 RATE OF AN AGENCY WHICH PROVIDES RESIDENTIAL HABILITATION SERVICES IN  A
 SUPERVISED COMMUNITY RESIDENCE TO ACCOUNT FOR VACANCY DAYS.
   (5)  "VACANCY  DAYS" ARE DAYS FOR WHICH THE PROVIDER IS UNABLE TO BILL
 FOR MEDICAID DUE TO A PERSON RESIDING IN A  COMMUNITY  RESIDENCE  HAVING
 MOVED  FROM  ONE RESIDENTIAL SITE TO ANOTHER, OR DUE TO THE DEATH OF THE
 INDIVIDUAL.
   (II) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF  THIS  SECTION,  OR
 ANY  OTHER  LAW  OR REGULATION TO THE CONTRARY AND SUBJECT TO THE AVAIL-
 ABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR  ANY  REIMBURSEMENT  FOR
 RESIDENTIAL  HABILITATION  SERVICES  PROVIDED  IN A SUPERVISED COMMUNITY
 RESIDENCE ACCORDING TO A DAILY UNIT OF SERVICE  AS  PROMULGATED  BY  THE
 COMMISSIONER OF HEALTH:
   (1) RETAINER DAYS SHALL BE REIMBURSED AT ONE HUNDRED PERCENT THE DAILY
 RATE  AS  DETERMINED  PURSUANT TO REGULATIONS PROMULGATED BY THE COMMIS-
 SIONER OF HEALTH, PROVIDED, HOWEVER A PROVIDER IS LIMITED TO BEING  PAID
 FOURTEEN RETAINER DAYS PER RATE YEAR, MULTIPLIED BY CERTIFIED CAPACITY;
   (2)  THERAPY DAYS SHALL BE REIMBURSED AT ONE HUNDRED PERCENT THE DAILY
 RATE AS DETERMINED PURSUANT TO REGULATIONS PROMULGATED  BY  THE  COMMIS-
 SIONER OF HEALTH, PROVIDED, HOWEVER, A PROVIDER IS LIMITED TO BEING PAID
 NINETY-SIX THERAPY DAYS PER RATE YEAR PER PERSON; AND
   (3)  FOR  THE  RATE PERIODS BEGINNING JULY FIRST, TWO THOUSAND TWENTY-
 TWO, PROVIDERS SHALL RECEIVE AN OCCUPANCY ADJUSTMENT  TO  THE  OPERATING
 COMPONENT  OF  THEIR  RATE,  AS THE OPERATING COMPONENT OF THEIR RATE IS
 DETERMINED PURSUANT TO REGULATIONS PROMULGATED BY  THE  COMMISSIONER  OF
 HEALTH,  FOR  VACANCY DAYS. THE OCCUPANCY ADJUSTMENT PERCENTAGE SHALL BE
 CALCULATED BY DIVIDING THE SUM OF  A  PROVIDER'S  RATE  PERIOD  REPORTED
 RETAINER  DAYS,  SERVICE DAYS AND THERAPY DAYS BY ONE HUNDRED PERCENT OF
 THE PROVIDER'S CERTIFIED CAPACITY. THE CERTIFIED CAPACITY OF THE PROVID-
 ER IS CALCULATED BY TAKING INTO ACCOUNT CAPACITY CHANGES THROUGHOUT  THE
 YEAR,  MULTIPLIED BY ONE HUNDRED PERCENT OF THE YEAR'S DAYS. THE ADJUST-
 MENT WILL BEGIN ON JULY FIRST, TWO  THOUSAND  TWENTY-TWO  AND  SHALL  BE
 A. 6965--A                          3

 RECALCULATED  ON  AN ANNUAL BASIS BASED ON THE MOST CURRENT AND COMPLETE
 TWELVE MONTHS OF EXPERIENCE.  THE OCCUPANCY ADJUSTMENT WILL BE THE LOWER
 OF  THE  PROVIDER'S  ACTUAL  OCCUPANCY  ADJUSTMENT  PERCENTAGE  OR  FIVE
 PERCENT.
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2025.