S T A T E O F N E W Y O R K
________________________________________________________________________
1112
2025-2026 Regular Sessions
I N A S S E M B L Y
January 9, 2025
___________
Introduced by M. of A. PAULIN, REYES, WEPRIN, ROSENTHAL, SHRESTHA,
DINOWITZ, EPSTEIN, HEVESI, SIMON, STECK, ZINERMAN, GONZALEZ-ROJAS,
KELLES, SAYEGH, COLTON, SIMONE, SANTABARBARA, RAGA, STIRPE, BRABENEC,
LEVENBERG, BROOK-KRASNY, LUCAS, JONES -- 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 eight new subdivisions 5, 6, 7, 8, 9, 10, 11 and 12 to read as
follows:
5. (A) BY THE FIRST OF OCTOBER NEXT SUCCEEDING THE EFFECTIVE DATE OF
THIS SUBDIVISION, THE COMMISSIONER SHALL ESTABLISH A REGIONAL MINIMUM
HOURLY BASE REIMBURSEMENT RATE FOR ALL PROVIDERS EMPLOYING WORKERS
SUBJECT TO THE MINIMUM WAGE PROVISIONS ESTABLISHED IN SUBDIVISION TWO OF
THIS SECTION. THE REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATE
SHALL BE BASED ON REGIONS ESTABLISHED BY THE COMMISSIONER, PROVIDED THAT
FOR AREAS SUBJECT TO SECTION THIRTY-SIX HUNDRED FOURTEEN-C OF THIS ARTI-
CLE, EACH AREA WITH A DIFFERENT PREVAILING RATE OF TOTAL COMPENSATION,
AS DEFINED IN THAT SECTION, SHALL BE ITS OWN REGION.
(B) FOR THE PURPOSES OF THIS SECTION, "REGIONAL MINIMUM HOURLY BASE
REIMBURSEMENT RATE" MEANS A REIMBURSEMENT RATE THAT REFLECTS:
(1) A DIRECT CARE RELATED PAYMENT WHICH SHALL REFLECT 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 REGULATO-
RY REQUIREMENTS FOR SUCH PROVIDERS, AND WHICH SHALL INCLUDE:
A. BASE HOURLY WAGE GUARANTEED HOME CARE AIDES PURSUANT TO SUBDIVI-
SION TWO OF THIS SECTION;
B. OVERTIME COSTS;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03863-01-5
A. 1112 2
C. EMPLOYEE BENEFITS, INCLUDING BOTH PAID TIME OFF AND SUPPLEMENTAL
BENEFITS OR BENEFITS AS DETERMINED BY COLLECTIVE BARGAINING AGREEMENTS;
D. FEDERAL INSURANCE CONTRIBUTIONS ACT;
E. MEDICARE;
F. FEDERAL UNEMPLOYMENT TAX ACT;
G. WORKER WAGE PARITY AS PROVIDED BY SECTION THIRTY-SIX HUNDRED FOUR-
TEEN-C OF THIS ARTICLE, AS APPLICABLE;
H. OTHER PAYROLL TAXES;
I. FAIR LABOR STANDARDS ACT COMPLIANCE;
J. NEW YORK STATE LABOR LAW COMPLIANCE;
K. COVID-19 SICK PAY;
L. STATE UNEMPLOYMENT INSURANCE;
M. DISABILITY INSURANCE;
N. WORKERS' COMPENSATION;
O. TRAVEL TIME AND TRAVEL REIMBURSEMENT;
P. THE METROPOLITAN TRANSPORTATION AUTHORITY TAX; AND
Q. RELATED INCREASES TIED TO BASE WAGES;
(2) A COMPONENT TO REFLECT OPERATIONAL EXPENSES NECESSARY TO COMPLY
WITH FEDERAL AND STATE STATUTORY AND REGULATORY REQUIREMENTS FOR SUCH
PROVIDERS, AND WHICH SHALL INCLUDE:
A. OPERATIONAL SUPERVISION AND SUPPORT, INCLUDING BUT NOT LIMITED TO
NURSING STAFF, HOME HEALTH AIDE SUPERVISION AND TEAM SUPPORT; AND
B. OTHER OPERATIONAL SUPPORT, INCLUDING BUT NOT LIMITED TO QUALITY
ASSURANCE AND IMPROVEMENT PROGRAMS, EDUCATION AND RECRUITMENT; AND
(3) A COMPONENT TO REFLECT ADMINISTRATIVE AND GENERAL OPERATING
EXPENSES WHICH SHALL INCLUDE RENT AND FACILITIES MANAGEMENT AND BUSINESS
SUPPORT, INCLUDING BUT NOT LIMITED TO INFORMATION TECHNOLOGY, HUMAN
RESOURCES, LEGAL, COMPLIANCE, FINANCE, MANAGEMENT, MARGIN AND COMMUNI-
CATIONS.
(C) THE REGIONAL MINIMUM HOURLY BASE RATE CANNOT BE 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.
(D) ONCE A REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATE HAS
BEEN ESTABLISHED UNDER THIS SECTION, THE COMMISSIONER SHALL THEREAFT-
ER ANNUALLY ADJUST THE REGIONAL HOURLY BASE REIMBURSEMENT RATE FOR
EACH REGION BY A TREND FACTOR TO REFLECT AND ACCOMMODATE ANY ADDITIONAL
LABOR LAW INCREASES, CHANGES OR MANDATES.
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 TO ESTABLISH REGIONAL MINIMUM HOURLY
BASE REIMBURSEMENT RATES AND MAKE STATE-DIRECTED PAYMENTS THROUGH TO
PROVIDERS FOR THE PURPOSES OF SUPPORTING WAGE INCREASES.
(A) IF APPROVED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID
SERVICES, DIRECTED PAYMENTS SHALL BE MADE TO SUCH PROVIDERS OF MEDI-
CAID SERVICES THROUGH CONTRACTS WITH MANAGED CARE ORGANIZATIONS WHERE
APPLICABLE, 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
A. 1112 3
CONTRACTS OFFERING DEVIATIONS FROM THE REGIONAL MINIMUM HOURLY BASE
REIMBURSEMENT RATES IN A REPORT TO THE DEPARTMENT. THIS REPORT SHALL BE
SENT TO THE DEPARTMENT, WITH A COPY TO THE PROVIDER PRIOR TO THE FINAL-
IZING OF ANY CONTRACT, UNLESS OTHERWISE PERMITTED BY THIS SECTION, WITH-
IN FIVE WORKING DAYS OF THE CONTRACT BEING OFFERED TO A PROVIDER WITH
RATE DEVIATIONS. ANY REPORT SHALL INCLUDE A RATIONALE FOR PAYING BELOW
THE REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATE, 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 ESTABLISH ACTUARIALLY SOUND REGIONAL
REIMBURSEMENT RATE RANGES FOR MEDICAID MANAGED CARE ORGANIZATIONS IN
ORDER TO COMPLY WITH THIS SECTION. THESE RANGES WILL REFLECT MANAGED
CARE ADJUSTMENTS INCLUDING BUT NOT LIMITED TO: (A) MANAGED CARE PLAN
VARIATIONS IN UTILIZATIONS FROM THE REGIONAL UTILIZATION AVERAGE; (B)
THE IMPACT OF RISK ADJUSTMENT; AND (C) PREMIUM WITHHOLDS. RATE RANGES
SHALL ALSO ACCOUNT FOR QUALITY INCENTIVES, VOLUME, COSTS ASSOCIATED WITH
VALUE-BASED ARRANGEMENTS, AND REIMBURSEMENT FOR INDIVIDUALS WITH HARD TO
SERVE NEEDS.
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 THE REGIONAL MINI-
MUM HOURLY BASE REIMBURSEMENT RATE 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 THE REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATE.
10. THE COMMISSIONER SHALL AMEND THE MODEL MANAGED CARE CONTRACTS TO
REFLECT THE REQUIREMENTS OF THIS SECTION. IN ADDITION, THE COMMISSIONER
SHALL POST THE MANAGED CARE, CERTIFIED AND LICENSED HOME CARE SERVICES
AGENCIES AND FISCAL INTERMEDIARIES COST REPORT DATA IN A SIMPLE UNDER-
STANDABLE MANNER ON THE DEPARTMENT'S WEBSITE BY THE FIFTEENTH OF FEBRU-
ARY SECOND SUCCEEDING THE EFFECTIVE DATE OF THIS SUBDIVISION AND ANNUAL-
LY THEREAFTER.
11. THE COMMISSIONER SHALL PUBLISH AND POST REGIONAL MINIMUM HOURLY
BASE REIMBURSEMENT RATES ANNUALLY, AND SHALL TAKE ALL NECESSARY STEPS
TO ADVISE COMMERCIAL AND GOVERNMENT PROGRAMS PAYERS OF HOME CARE
SERVICES OF THE REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATES.
12. TO ENSURE COMPLIANCE WITH MINIMUM WAGE INCREASES, THE COMPTROLLER
SHALL HAVE THE AUTHORITY TO REVIEW THE CONTRACTS ENTERED INTO BETWEEN A
MANAGED CARE ORGANIZATION AND A LICENSED HOME CARE SERVICES AGENCY,
FISCAL INTERMEDIARY, OR ANY AGENCY SUBJECT TO THE PROVISIONS OF THIS
SECTION TO ENSURE THAT RATES BEING OFFERED ARE ADEQUATE AND MEET THE
DEPARTMENT'S ACTUARIAL STANDARDS. THE COMPTROLLER, IN CONSULTATION WITH
THE MEDICAID INSPECTOR GENERAL, SHALL DEVELOP AND PROMULGATE A PROCESS
TO ENSURE SUCH AUDITS COMPLY WITH STATE AND FEDERAL LAW TO PROTECT
PROPRIETARY INFORMATION AND CONTRACTS. IN THE EVENT THAT THE COMPTROLLER
FINDS EVIDENCE THAT MANAGED CARE ORGANIZATIONS ARE NOT PAYING SUFFICIENT
ADEQUATE RATES, THEY WILL REFER SUCH INSTANCES TO THE DEPARTMENT AND THE
MEDICAID FRAUD CONTROL UNIT FOR ENFORCEMENT. IF THE DEPARTMENT OR THE
MEDICAID FRAUD CONTROL UNIT CHOOSES NOT TO PURSUE ACTION RELATED TO THIS
REFERRAL, IT SHALL INFORM, IN WRITING, THE COMPTROLLER'S OFFICE AS TO
THE REASONING. SUCH REPORTS, AND THE DEPARTMENT'S RESPONSES, SHALL BE
PUBLIC INFORMATION AND MADE AVAILABLE ON THE COMPTROLLER'S WEBSITE.
§ 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
A. 1112 4
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.