Assembly Bill A10506

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10506
 
                           I N  A S S E M B L Y
 
                               March 6, 2026
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 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:

   Section  1.  Section  3614-f  of  the  public health law is amended by
 adding six new subdivisions 5, 6, 7, 8, 9 and 10 to read as follows:
   5. (A) NO MEDICAID MANAGED CARE ORGANIZATION SHALL REIMBURSE PROVIDERS
 EMPLOYING WORKERS SUBJECT TO THE MINIMUM WAGE PROVISIONS ESTABLISHED  IN
 SUBDIVISION  TWO OF THIS SECTION IN AN AMOUNT THAT IS LESS THAN THE MOST
 CURRENT AVERAGE FEE FOR SERVICE COUNTY RATES FOR LEVEL TWO PERSONAL CARE
 SERVICE FOR EACH REGION AS POSTED BY THE DEPARTMENT  FOR  PERSONAL  CARE
 AGENCIES OR OTHER PROVIDERS DELIVERING LIKE SERVICES THROUGH OTHER MEDI-
 CAID PROGRAMS.
   (B)  ALTERNATIVELY, THE COMMISSIONER MAY REQUIRE MEDICAID MANAGED CARE
 ORGANIZATIONS TO PAY A REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT  RATE,
 WHICH  THE  COMMISSIONER  WILL  DEVELOP  BASED  ON THE TOTAL DIRECT CARE
 RELATED COSTS FOR HOME CARE AIDES AND OTHER DIRECT  CARE  RELATED  STAFF
 NECESSARY  TO  COMPLY  WITH  FEDERAL  AND STATE STATUTORY AND REGULATORY
 REQUIREMENTS FOR SUCH PROVIDERS AND INFORMED BY  PROVIDER  COST  REPORTS
 FILED WITH THE DEPARTMENT, PROVIDED THAT SUCH RESULTING RATE IS NOT LESS
 THAN  THE FEE FOR SERVICE RATE IN PARAGRAPH (A) OF THIS SUBDIVISION.  IF
 THE COMMISSIONER CHOOSES TO EXERCISE THIS OPTION, THE MINIMUM RATE IDEN-
 TIFIED IN PARAGRAPH (A)  OF  THIS  SUBDIVISION  SHALL  APPLY  UNTIL  THE
 REGIONAL  MINIMUM HOURLY BASE REIMBURSEMENT RATE IS DEVELOPED AND IMPLE-
 MENTED.
   6. FOR MAINSTREAM MANAGED CARE AND FULLY  CAPITATED  MEDICAID  MANAGED
 CARE  PRODUCTS FOR THOSE DUALLY ELIGIBLE FOR BOTH MEDICAID AND MEDICARE,
 THE COMMISSIONER SHALL SUBMIT ANY AND  ALL  NECESSARY  APPLICATIONS  FOR
 APPROVALS  AND/OR  WAIVERS TO THE FEDERAL CENTERS FOR MEDICARE AND MEDI-
 CAID SERVICES TO SECURE APPROVAL, IF NECESSARY, UNDER  SUBDIVISION  FIVE
 OF THIS SECTION.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15106-01-6
              

 A. 10506                            2
 
   (A)  IF  APPROVED  BY  THE  FEDERAL  CENTERS FOR MEDICARE AND MEDICAID
 SERVICES, DIRECTED PAYMENTS SHALL BE MADE TO SUCH PROVIDERS OF  MEDICAID
 SERVICES  THROUGH CONTRACTS WITH MANAGED CARE ORGANIZATIONS WHERE APPLI-
 CABLE,  PROVIDED  THAT  THE  COMMISSIONER  ENSURES  THAT  SUCH  DIRECTED
 PAYMENTS ARE IN ACCORDANCE WITH THE TERMS OF THIS SECTION.
   (B)  IF  THE STATE DIRECTED PAYMENT IS NOT APPROVED, THE PROVISIONS OF
 SUBDIVISION SEVEN OF THIS SECTION SHALL APPLY.
   7. FOR PARTIALLY CAPITATED MANAGED LONG  TERM  CARE  PLANS,  OR  WHERE
 STATE DIRECTED PAYMENTS PURSUANT TO SUBDIVISION SIX OF THIS SECTION HAVE
 NOT  BEEN  APPROVED,  THE  DEPARTMENT  SHALL  REQUIRE  PLANS  TO JUSTIFY
 CONTRACTS OFFERING DEVIATIONS FROM THE REIMBURSEMENT RATE SET IN  SUBDI-
 VISION  FIVE  OF THIS SECTION IN A REPORT TO THE DEPARTMENT. SUCH REPORT
 SHALL BE SENT TO THE DEPARTMENT, WITH A COPY TO THE  PROVIDER  PRIOR  TO
 THE  FINALIZING  OF  ANY  CONTRACT,  UNLESS  OTHERWISE PERMITTED BY THIS
 SECTION, WITHIN FIVE WORKING DAYS OF THE CONTRACT  BEING  OFFERED  TO  A
 PROVIDER  WITH RATE DEVIATIONS. ANY REPORT SHALL INCLUDE A RATIONALE FOR
 PAYING BELOW THE REIMBURSEMENT RATE SET  IN  SUBDIVISION  FIVE  OF  THIS
 SECTION, AND THE IMPACTED PROVIDER SHALL HAVE THE OPPORTUNITY TO RESPOND
 TO  THE  REPORT  WITHIN  THIRTY  DAYS OF FILING WITH THE DEPARTMENT. THE
 DEPARTMENT SHALL COMPILE SUCH REPORTS AND PUBLISH AND POST A SUMMARY  OF
 THEM SEMI-ANNUALLY.
   8.  THE COMMISSIONER SHALL TAKE ACTION TO ENSURE RATE RANGES FOR MEDI-
 CAID MANAGED CARE ORGANIZATIONS ARE ACTUARIALLY SOUND IN ORDER TO COMPLY
 WITH THIS SECTION.
   9. NOTHING IN THIS SECTION SHALL  PRECLUDE  PROVIDERS  EMPLOYING  HOME
 HEALTH  AIDES  COVERED  UNDER  THIS  SECTION  OR  PAYERS  FROM PAYING OR
 CONTRACTING FOR SERVICES AT RATES HIGHER THAN  THOSE  ESTABLISHED  UNDER
 SUBDIVISION  FIVE  OF THIS SECTION IF THE PARTIES MUTUALLY AGREE TO SUCH
 TERMS.  NOTWITHSTANDING SUBDIVISION SEVEN OF  THIS  SECTION,  PLANS  AND
 PROVIDERS CAN ALSO MUTUALLY AGREE TO ENTER INTO VALUE-BASED CONTRACTS AT
 A RATE LESS THAN THAT ESTABLISHED IN SUBDIVISION FIVE OF THIS SECTION.
   10.  THE  COMMISSIONER SHALL AMEND THE MODEL MANAGED CARE CONTRACTS TO
 REFLECT THE REQUIREMENTS OF THIS SECTION.
   § 2. Severability. If any provision of this act, or any application of
 any provision of this act, is held to be invalid, or to  violate  or  be
 inconsistent with any federal law or regulation, that shall  not  affect
 the validity or effectiveness of any other provision of this act, or any
 other application of any provision of this act which can be given effect
 without  that  provision or application; and to that end, the provisions
 and applications of this act are severable.
   § 3. This act shall take effect immediately.