Assembly Bill A464B

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    464
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  M.  of  A.  STECK,  SHIMSKY, SEAWRIGHT, JONES, LUNSFORD,
   BENDETT, RA, REYES -- Multi-Sponsored by -- M. of  A.  WALSH  --  read
   once and referred to the Committee on Health
 
 AN  ACT  relating  to complex care assistants and home care services and
   supplementing

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  As  used  in this act: (a) "family member" means a child,
 parent, parent-in-law, sibling, grandparent, grandchild, spouse,  domes-
 tic  partner, or one partner in a civil union couple, or any other indi-
 vidual related by blood, and any other individual with a  close  associ-
 ation that is the equivalent of a family relationship; and
   (b) "complex care assistant" means a family member who is certified by
 the  department  of  health after passing an in-person examination which
 tests the proficiency and competence of performing the tasks required to
 care for a medically fragile child which can include, but is not limited
 to, medication administration, airway clearance therapies,  tracheostomy
 care,  intravenous  line  care,  ventilator care, enteral care and other
 tasks approved by the board of nursing for an individual under 21  years
 of age.
   §  2.  (a) No later than one year after the effective date of this act
 and receipt of federal approval for the program established pursuant  to
 this  act,  the  state Medicaid director within the department of health
 shall establish a program under which a family member of an enrollee  in
 Medicaid may be certified as a complex care assistant and, after receiv-
 ing  such  certification may, under the direction of a registered nurse,
 provide complex care  assistant  services  to  the  enrollee  through  a
 private  duty  nursing  agency under the reimbursement rates established
 under subdivision (d) of this section, provided that the enrollee  is  a
 medically  fragile child as defined in section 4401 of the public health

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00675-01-5
 A. 464                              2
 
 law and qualifies for private duty nursing services under Medicaid. Such
 program shall operate as a New York Medicaid private duty nursing  bene-
 fit. The department shall develop an assessment tool that will allow the
 division to identify enrollees who meet these eligibility criteria read-
 ily.
   (b)  The  program  established  under  this act shall require a family
 member to complete all training, testing, and other qualification crite-
 ria required under state and federal law for certification as a  complex
 care  assistant.  The  private  duty nursing agency that will employ the
 family member to provide complex care assistant services to the enrollee
 shall pay all costs for the family  member  to  become  certified  as  a
 complex  care  assistant  and to receive certification as a complex care
 assistant from the department of health, before providing services under
 the program established pursuant to this act. In no case shall a  family
 member who becomes a complex care assistant under the provisions of this
 section  be  required  to  repay  or  reimburse  the  licensed home care
 services and certified private duty nursing agencies for  the  costs  of
 the  family  member becoming certified as a complex care assistant under
 the program.
   (c) An individual certified to practice as a  complex  care  assistant
 must complete a training program and shall pass an in-person examination
 approved  by the department that demonstrates the applicant's competence
 and proficiency. Such training  program  shall  include  the  following:
 medication  administration,  airway  clearance  therapies,  tracheostomy
 care, intravenous line care, ventilator care,  enteral  care  and  other
 tasks  approved by the board of nursing for an individual under 21 years
 of age.
   (d) Complex care assistant services provided by a family member  of  a
 Medicaid  enrollee  who  becomes  certified  as a complex care assistant
 under the program established pursuant to this act shall  be  reimbursed
 to  a  private  duty nursing agency at a rate of no less than thirty-six
 dollars for complex care assistant services downstate  and  thirty-three
 dollars  upstate. For care assistant high tech services it shall be at a
 rate no less than forty-two dollars downstate and  thirty-seven  dollars
 upstate.   Cost of living adjustments to such rates shall be reviewed by
 the department bi-annually and such  rates  adjusted  accordingly  based
 upon  any  increases  to  the  United  States bureau of labor statistics
 consumer price index.
   (e) The state Medicaid director, no later than three years  after  the
 date the program is established under this act, shall prepare and submit
 a report to the governor and the legislature concerning the viability of
 such program and the director's recommendations concerning such program.
   §  3. The state Medicaid director shall adopt rules and regulations as
 necessary to implement the provisions of this act.
   § 4. The state Medicaid director  shall  apply  for  such  state  plan
 amendments or waivers as may be necessary to implement the provisions of
 this  act  and secure federal financial participation for state Medicaid
 expenditures under the federal Medicaid program.
   § 5. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  464--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  M.  of  A.  STECK,  SHIMSKY, SEAWRIGHT, JONES, LUNSFORD,
   BENDETT, RA, REYES -- Multi-Sponsored by -- M. of  A.  WALSH  --  read
   once  and referred to the Committee on Health -- committee discharged,
   bill amended, ordered reprinted as amended  and  recommitted  to  said
   committee
 
 AN  ACT  to  amend  the  social services law, in relation to authorizing
   Medicaid coverage for complex care assistant services
 
   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. COMPLEX CARE ASSISTANT SERVICES PROGRAM. 1. AS USED  IN  THIS
 SECTION:
   (A)  "FAMILY  MEMBER"  MEANS  A CHILD, PARENT, PARENT-IN-LAW, SIBLING,
 GRANDPARENT, GRANDCHILD, SPOUSE, DOMESTIC PARTNER, OR ONE PARTNER  IN  A
 CIVIL UNION COUPLE, OR ANY OTHER INDIVIDUAL RELATED BY BLOOD; AND
   (B) "COMPLEX CARE ASSISTANT" MEANS A FAMILY MEMBER WHO IS CERTIFIED BY
 THE  DEPARTMENT  AFTER  PASSING AN IN-PERSON EXAMINATION WHICH TESTS THE
 PROFICIENCY AND COMPETENCE OF PERFORMING THE TASKS REQUIRED TO CARE  FOR
 A  MEDICALLY  FRAGILE  CHILD AND MEDICALLY FRAGILE YOUNG ADULT WHICH CAN
 INCLUDE, BUT IS NOT LIMITED TO, ALL ADAPTIVE LIVING SKILLS  (ADL'S)  AND
 INSTRUMENTAL  ACTIVITIES  OF  DAILY LIVING (IADL'S), AND ALLOWABLE TASKS
 FOR A HOME HEALTH AIDE AS DEFINED IN SECTION 700.2 (C)(15) OF  TITLE  10
 OF  THE  NEW YORK CODES, RULES AND REGULATIONS, AS WELL AS, ANY ENHANCED
 TASK AS DEFINED BY THE BOARD OF NURSING. ANY MEDICAL  NECESSARY  SKILLED
 NURSING  TASK,  INCLUDING  BUT NOT LIMITED TO TRACHEOSTOMY CARE, CENTRAL
 LINE CARE, MECHANICAL VENTILATION, ENTERAL  CARE  (G-TUBE,  GJ-TUBE,  NG
 TUBE)  NOT  OTHERWISE  INCLUDED IN ELIGIBLE COMPLEX CARE ASSISTANT TASKS
 MAY BE PERFORMED SIMULTANEOUSLY IN THE ROLE OF COMPETENT FAMILY CAREGIV-
 ER IN ABSENCE OF AN AVAILABLE PRIVATE DUTY NURSE.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00675-02-5
 A. 464--A                           2
 
   2. (A) NO LATER THAN ONE YEAR AFTER THIS SECTION SHALL HAVE  BECOME  A
 LAW AND RECEIPT OF FEDERAL APPROVAL FOR THE PROGRAM ESTABLISHED PURSUANT
 TO  THIS  SECTION, THE STATE MEDICAID DIRECTOR SHALL ESTABLISH A PROGRAM
 UNDER WHICH A FAMILY MEMBER OF AN ENROLLEE IN MEDICAID MAY BE  CERTIFIED
 AS A COMPLEX CARE ASSISTANT AND, AFTER RECEIVING SUCH CERTIFICATION MAY,
 UNDER  THE DIRECTION OF A REGISTERED NURSE, PROVIDE COMPLEX CARE ASSIST-
 ANT SERVICES TO THE ENROLLEE THROUGH A PRIVATE DUTY NURSING AGENCY UNDER
 THE REIMBURSEMENT RATES ESTABLISHED UNDER PARAGRAPH (F) OF THIS SUBDIVI-
 SION, PROVIDED THAT THE ENROLLEE IS A MEDICALLY FRAGILE CHILD AS DEFINED
 IN SECTION FORTY-FOUR HUNDRED ONE OF THE PUBLIC HEALTH LAW OR  MEDICALLY
 FRAGILE  YOUNG  ADULT AS DEFINED IN SECTION TWENTY-EIGHT HUNDRED EIGHT-E
 OF THE PUBLIC HEALTH LAW AND QUALIFIES FOR PRIVATE DUTY NURSING SERVICES
 UNDER MEDICAID. SUCH PROGRAM  SHALL  OPERATE  AS  A  NEW  YORK  MEDICAID
 PRIVATE DUTY NURSING BENEFIT. THE DEPARTMENT SHALL DEVELOP AN ASSESSMENT
 TOOL  THAT  WILL ALLOW THE DIVISION TO IDENTIFY ENROLLEES WHO MEET THESE
 ELIGIBILITY CRITERIA READILY.
   (B) THE PROGRAM ESTABLISHED UNDER THIS SECTION SHALL REQUIRE A  FAMILY
 MEMBER TO COMPLETE ALL TRAINING, TESTING, AND OTHER QUALIFICATION CRITE-
 RIA  REQUIRED UNDER STATE AND FEDERAL LAW FOR CERTIFICATION AS A COMPLEX
 CARE ASSISTANT. THE PRIVATE DUTY NURSING AGENCY  THAT  WILL  EMPLOY  THE
 FAMILY MEMBER TO PROVIDE COMPLEX CARE ASSISTANT SERVICES TO THE ENROLLEE
 SHALL  PAY  ALL  COSTS  FOR  THE  FAMILY MEMBER TO BECOME CERTIFIED AS A
 COMPLEX CARE ASSISTANT AND TO RECEIVE CERTIFICATION AS  A  COMPLEX  CARE
 ASSISTANT FROM THE DEPARTMENT OF HEALTH, BEFORE PROVIDING SERVICES UNDER
 THE  PROGRAM  ESTABLISHED  PURSUANT  TO THIS SECTION. IN NO CASE SHALL A
 FAMILY MEMBER WHO BECOMES A COMPLEX CARE ASSISTANT UNDER THE  PROVISIONS
 OF THIS SECTION BE REQUIRED TO REPAY OR REIMBURSE THE LICENSED HOME CARE
 SERVICES  AND  CERTIFIED  PRIVATE DUTY NURSING AGENCIES FOR THE COSTS OF
 THE FAMILY MEMBER BECOMING CERTIFIED AS A COMPLEX CARE  ASSISTANT  UNDER
 THE PROGRAM.
   (C)  AN  INDIVIDUAL  CERTIFIED TO PRACTICE AS A COMPLEX CARE ASSISTANT
 MUST COMPLETE A TRAINING PROGRAM AND SHALL PASS AN IN-PERSON EXAMINATION
 APPROVED BY THE DEPARTMENT OF HEALTH THAT DEMONSTRATES  THE  APPLICANT'S
 COMPETENCE  AND  PROFICIENCY.  IF  THE  DEPARTMENT OF HEALTH SELECTS THE
 OPTION OF UTILIZING DESIGNATED HOME CARE PROVIDERS TO PROVIDE THE TRAIN-
 ING, THE DEPARTMENT SHALL ADEQUATELY REIMBURSE SUCH DESIGNATED PROVIDERS
 FOR PROVIDING THE TRAINING TO FAMILY CAREGIVERS OF ELIGIBLE RELATIVES.
   (D) THE SERVICES RECEIVED UNDER THIS PROGRAM  BY  AN  ELIGIBLE  MEMBER
 FROM  A  COMPLEX  CARE  ASSISTANT SHALL NOT EXCEED FORTY HOURS PER WEEK.
 NOTHING IN THIS PARAGRAPH SHALL RESTRICT  UNPAID  SERVICES  PROVIDED  AS
 PART OF THE FAMILY CAREGIVER'S FAMILIAL OR HOUSEHOLD RELATIONSHIP TO THE
 ELIGIBLE RELATIVE.
   (E)  A COMPLEX CARE ASSISTANT SHALL NOT PROVIDE QUALIFIED COMPLEX CARE
 ASSISTANT SERVICES TO AN ELIGIBLE MEMBER UNLESS THE PLAN OF CARE FOR THE
 ELIGIBLE MEMBER IS RECERTIFIED  BY  THE  PROVIDER  AT  LEAST  EVERY  ONE
 HUNDRED  EIGHTY CALENDAR DAYS. REGISTERED NURSE SUPERVISORY VISITS SHALL
 OCCUR REGULARLY TO  ENSURE  SUPPORT  FOR  ALL  COMPLEX  CARE  ASSISTANTS
 ASSIGNED  TO AN ELIGIBLE MEMBER AND THE ABILITY TO COMPLETE ALL TASKS AS
 OUTLINED IN THE MEMBER'S CARE PLAN.
   (F) COMPLEX CARE ASSISTANT SERVICES PROVIDED BY A FAMILY MEMBER  OF  A
 MEDICAID  ENROLLEE  WHO  BECOMES  CERTIFIED  AS A COMPLEX CARE ASSISTANT
 UNDER THE PROGRAM ESTABLISHED PURSUANT TO THIS SECTION  SHALL  BE  REIM-
 BURSED  TO  A PRIVATE DUTY NURSING AGENCY AT A RATE THAT IS NO MORE THAN
 THE CURRENT BASE REIMBURSEMENT RATE FOR PRIVATE  DUTY  NURSING  SERVICES
 AND  DEPENDENT  UPON  WHETHER THE SERVICES ARE PROVIDED IN THE DOWNSTATE
 REGION OR UPSTATE REGION, PROVIDED, HOWEVER, THAT  SUCH  AGENCIES  SHALL
 A. 464--A                           3

 ENSURE  THAT  NO  LESS  THAN SIXTY-FIVE PERCENT OF SUCH REIMBURSEMENT IS
 PASSED THROUGH TO A COMPLEX CARE ASSISTANT. COST OF  LIVING  ADJUSTMENTS
 TO  SUCH  RATES SHALL BE REVIEWED BY THE DEPARTMENT BI-ANNUALLY AND SUCH
 RATES ADJUSTED ACCORDINGLY BASED UPON ANY INCREASES TO THE UNITED STATES
 BUREAU OF LABOR STATISTICS CONSUMER PRICE INDEX.
   (G)  THE  DEPARTMENT  SHALL  REQUIRE COMPLEX CARE ASSISTANTS PROVIDING
 QUALIFIED COMPLEX CARE ASSISTANT SERVICES UNDER THE MEDICAID PROGRAM  TO
 UTILIZE  AN ELECTRONIC VISIT VERIFICATION ESTABLISHED IN ACCORDANCE WITH
 FEDERAL LAW.
   (H) THE NEW YORK STATE MEDICAID DIRECTOR, NO LATER  THAN  THREE  YEARS
 AFTER  THE DATE THE PROGRAM IS ESTABLISHED UNDER THIS SECTION, AND EVERY
 TWO YEARS THEREAFTER, SHALL PREPARE AND SUBMIT A REPORT TO THE  GOVERNOR
 AND MAKE SUCH REPORT PUBLICLY AVAILABLE ON THE DEPARTMENT'S WEBSITE. THE
 REPORT SHALL INCLUDE BUT NOT BE LIMITED TO THE FOLLOWING:
   (1) THE NUMBER OF HOSPITALIZATIONS AND EMERGENCY ROOM VISITS OF ELIGI-
 BLE MEMBERS PARTICIPATING IN THE PROGRAM;
   (2)  THE  NUMBER  OF  AGENCY  PRIVATE DUTY NURSING HOURS EACH ELIGIBLE
 MEMBER PARTICIPATING IN THE PROGRAM HAS  RECEIVED  AND  AN  ANALYSIS  OF
 WHETHER SUCH HOURS HAVE INCREASED OR DECREASED SINCE THEIR PARTICIPATION
 IN THE PROGRAM;
   (3)  THE NUMBER OF QUALIFIED COMPLEX CARE ASSISTANT SERVICES THAT WERE
 PROVIDED BY COMPLEX CARE ASSISTANTS TO EACH ELIGIBLE MEMBER ENROLLED  IN
 THE PROGRAM;
   (4) THE NUMBER OF OVERPAYMENTS MADE TO EACH PROVIDER EMPLOYING COMPLEX
 CARE  ASSISTANTS  AND  OTHER METRICS DETERMINED BY THE STATE THAT MAY BE
 USED TO DETERMINE THE AMOUNT OF FRAUD, WASTE, AND ABUSE IN THE PROGRAM;
   (5) AN ANALYSIS OF WHETHER THE STATE'S WAITLIST FOR PRIVATE DUTY NURS-
 ING SERVICES OR OTHER HOME AND COMMUNITY-BASED SERVICES UNDER THE  MEDI-
 CAID  PROGRAM  HAS  IMPROVED  OR  DECLINED SINCE THE INTRODUCTION OF THE
 PROGRAM; AND
   (6) REPORTING CONCERNING THE VIABILITY OF SUCH PROGRAM AND  THE  MEDI-
 CAID DIRECTOR'S RECOMMENDATIONS CONCERNING SUCH PROGRAM.
   §  2.  The  state  Medicaid  director  shall apply for such state plan
 amendments or waivers as may be necessary to implement the provisions of
 this act and secure federal financial participation for  state  Medicaid
 expenditures under the federal Medicaid program.
   § 3. This act shall take effect immediately. The state Medicaid direc-
 tor  shall  adopt  rules  and  regulations as necessary to implement the
 provisions of this act.