Assembly Bill A10375

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10375
 
                           I N  A S S E M B L Y
 
                               March 3, 2026
                                ___________
 
 Introduced by M. of A. HEVESI -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend  the  social services law, in relation to authorizing
   Medicaid coverage for family  caregiver  services  for  children  with
   intellectual  or developmental disabilities; and directing the commis-
   sioner of health to submit an application for amendments  and  waivers
   to add family caregivers to state Medicaid coverage
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The social services law is amended by adding a new  section
 365-q to read as follows:
   §  365-Q. FAMILY CAREGIVER SERVICES PROGRAM FOR PERSONS WITH INTELLEC-
 TUAL OR DEVELOPMENTAL DISABILITIES. 1. AS USED IN THIS SECTION:
   (A) "ELIGIBLE PERSON" MEANS AN INDIVIDUAL WHO:
   (I) HAS BEEN DETERMINED BY THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL
 DISABILITIES  TO  HAVE  AN  INTELLECTUAL  OR DEVELOPMENTAL DISABILITY AS
 DEFINED IN SECTION 1.03 OF THE MENTAL HYGIENE LAW;
   (II) RESIDES AT HOME WITH THEIR FAMILY  AND  PARTICIPATES  IN,  OR  IS
 ELIGIBLE  FOR,  A SELF-DIRECTION OR COMPARABLE HOME- AND COMMUNITY-BASED
 SERVICES PROGRAM ADMINISTERED BY THE OFFICE  FOR  PEOPLE  WITH  DEVELOP-
 MENTAL DISABILITIES AND THE DEPARTMENT; AND
   (III)  REQUIRES  ASSISTANCE  WITH  ACTIVITIES OF DAILY LIVING, INSTRU-
 MENTAL ACTIVITIES OF DAILY LIVING, OR OTHER  SUPPORTS  THAT  EXCEED  THE
 TYPE,  FREQUENCY,  OR  INTENSITY  OF  SUPPORT  ORDINARILY  PROVIDED BY A
 PARENT, LEGAL GUARDIAN, OR HOUSEHOLD MEMBER.
   (B) "FAMILY CAREGIVER" MEANS A PARENT, LEGAL GUARDIAN, OR OTHER FAMILY
 MEMBER WHO IS LEGALLY RESPONSIBLE FOR, AN ELIGIBLE PERSON WITH AN INTEL-
 LECTUAL OR DEVELOPMENTAL DISABILITY AND WHO PROVIDES CARE TO SUCH PERSON
 IN THE HOME.
   2. (A) NO LATER THAN ONE YEAR AFTER THE EFFECTIVE DATE OF THIS SECTION
 AND RECEIPT OF FEDERAL APPROVAL FOR THE PROGRAM ESTABLISHED PURSUANT  TO
 THIS SECTION, THE DEPARTMENT, IN CONSULTATION WITH THE OFFICE FOR PEOPLE
 WITH DEVELOPMENTAL DISABILITIES, SHALL ESTABLISH A PROGRAM UNDER WHICH A
 FAMILY CAREGIVER OF AN ELIGIBLE PERSON MAY BE CERTIFIED TO PROVIDE FAMI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14488-01-6
 A. 10375                            2
 
 LY  CAREGIVER  SERVICES  UNDER  MEDICAID  AND  BE  REIMBURSED  FOR  SUCH
 SERVICES.
   (B)  SUCH  SERVICES  SHALL INCLUDE ASSISTANCE WITH ACTIVITIES OF DAILY
 LIVING, INSTRUMENTAL ACTIVITIES OF DAILY LIVING, AND OTHER TASKS AUTHOR-
 IZED UNDER THE ELIGIBLE PERSON'S PERSON-CENTERED PLAN OF CARE,  PROVIDED
 SUCH  TASKS SUBSTITUTE FOR SERVICES THAT WOULD OTHERWISE BE PERFORMED BY
 PAID DIRECT SUPPORT STAFF OR PERSONAL CARE WORKERS  UNDER  THE  MEDICAID
 PROGRAM.
   (C)  THE  DEPARTMENT SHALL ESTABLISH TRAINING, TESTING, AND COMPETENCY
 REQUIREMENTS FOR CERTIFICATION AS A FAMILY CAREGIVER THAT ARE COMPARABLE
 TO THE REQUIREMENTS APPLICABLE TO PERSONAL  CARE  ASSISTANTS  OR  DIRECT
 SUPPORT  PROFESSIONALS  UNDER  STATE LAW AND REGULATION. TRAINING MAY BE
 PROVIDED BY DESIGNATED HOME CARE OR SELF-DIRECTION PROVIDERS, WHO  SHALL
 BE  ADEQUATELY  REIMBURSED BY THE DEPARTMENT FOR THE COST OF SUCH TRAIN-
 ING.
   (D) AN ELIGIBLE FAMILY CAREGIVER WHO  BECOMES  CERTIFIED  PURSUANT  TO
 THIS  SECTION  SHALL BE EMPLOYED THROUGH AN APPROVED FISCAL INTERMEDIARY
 OR SELF-DIRECTION PROVIDER AGENCY PARTICIPATING IN THE MEDICAID PROGRAM.
   3. (A) FAMILY CAREGIVER SERVICES SHALL BE REIMBURSED AT  RATES  ESTAB-
 LISHED  BY  THE  DEPARTMENT CONSISTENT WITH REIMBURSEMENT FOR COMPARABLE
 SELF-DIRECTION OR PERSONAL CARE SERVICES, PROVIDED  THAT  NO  LESS  THAN
 SIXTY-FIVE  PERCENT OF SUCH REIMBURSEMENT SHALL BE PASSED THROUGH TO THE
 CERTIFIED FAMILY CAREGIVER. THE DEPARTMENT SHALL ENSURE THAT A  PERSON'S
 SELF-DIRECTION  BUDGET  OR  COMPARABLE  HOME- AND COMMUNITY-BASED BUDGET
 SHALL NOT BE INCREASED FOR THE PURPOSE OF ENABLING PAYMENT TO A  PARENT,
 LEGAL  GUARDIAN, OR OTHER FAMILY CAREGIVER PURSUANT TO THIS SECTION, AND
 ALL SERVICES MUST BE PROVIDED WITHIN THE INDIVIDUAL'S EXISTING  APPROVED
 BUDGET.
   (B)  NO  FAMILY  CAREGIVER SHALL BE PAID FOR MORE THAN FIFTY HOURS PER
 WEEK.  NOTHING IN THIS PARAGRAPH SHALL RESTRICT UNPAID SERVICES PROVIDED
 AS PART OF THE FAMILY CAREGIVER'S  FAMILIAL  OR  HOUSEHOLD  RESPONSIBIL-
 ITIES.
   (C)  PLANS  OF  CARE  SHALL  BE REVIEWED AND RECERTIFIED AT LEAST ONCE
 EVERY ONE HUNDRED EIGHTY CALENDAR DAYS. SUPERVISORY VISITS  SHALL  OCCUR
 REGULARLY  TO ENSURE THAT ALL TASKS ARE COMPLETED IN ACCORDANCE WITH THE
 MEMBER'S PLAN OF CARE.
   4. THE DEPARTMENT SHALL REQUIRE THE USE OF ELECTRONIC VISIT  VERIFICA-
 TION  OR EQUIVALENT DOCUMENTATION IN ACCORDANCE WITH FEDERAL LAW FOR ALL
 SERVICES PROVIDED PURSUANT TO THIS SECTION.
   5. NO LATER THAN THREE YEARS AFTER THE DATE THE PROGRAM IS ESTABLISHED
 PURSUANT TO THIS SECTION, AND EVERY TWO YEARS  THEREAFTER,  THE  DEPART-
 MENT,  IN  CONSULTATION  WITH  THE  OFFICE FOR PEOPLE WITH DEVELOPMENTAL
 DISABILITIES, SHALL SUBMIT A REPORT TO THE GOVERNOR AND THE  LEGISLATURE
 AND  MAKE  SUCH  REPORT  PUBLICLY AVAILABLE ON THE DEPARTMENT'S WEBSITE.
 SUCH REPORT SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (A) THE NUMBER OF ELIGIBLE PERSONS PARTICIPATING IN THE PROGRAM;
   (B) THE NUMBER OF CERTIFIED FAMILY CAREGIVERS PROVIDING SERVICES;
   (C) THE NUMBER OF HOURS OF CARE PROVIDED; AND
   (D) AN ANALYSIS OF THE PROGRAM'S IMPACT ON HOSPITALIZATION,  EMERGENCY
 ROOM UTILIZATION, AND FAMILY FINANCIAL STABILITY.
   §  2.  The  commissioner of health is directed to apply for such state
 Medicaid plan amendments or waivers as may be necessary to implement the
 provisions of this act  and  include  family  caregivers  as  a  covered
 service  under  the state Medicaid plan, and to secure federal financial
 participation for state  Medicaid  expenditures  for  family  caregivers
 under the federal Medicaid program.
 A. 10375                            3
 
   § 3. This act shall take effect immediately; provided that section one
 of this act shall take effect upon receipt by the commissioner of health
 of approval from the federal Centers for Medicare & Medicaid Services to
 include  family caregivers as a covered service under the state Medicaid
 plan.  The  commissioner  of  health  shall  notify the legislative bill
 drafting commission upon the occurrence of the receipt of such  approval
 in  order that the commission may maintain an accurate and timely effec-
 tive data base of the official text of the laws of the state of New York
 in furtherance of effectuating the  provisions  of  section  44  of  the
 legislative law and section 70-b of the public officers law.