S T A T E O F N E W Y O R K
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7583
2025-2026 Regular Sessions
I N A S S E M B L Y
April 1, 2025
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Introduced by M. of A. ALVAREZ -- read once and referred to the Commit-
tee on Health
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 PARENT, SIBLING, GRANDPARENT, LEGAL GUARD-
IAN 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 CHILD OR YOUNG ADULT WITH DEVELOPMENTAL DISABILITIES WHICH CAN
INCLUDE, BUT IS NOT LIMITED TO, ALL ADAPTIVE LIVING SKILLS (ADL'S) AND
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL'S), AND PROVIDING ACADEMIC
ASSISTANCE IN ACCORDANCE TO SUCH CHILD OR YOUNG ADULT'S LEVEL OF NEED.
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 CERTIFIED COMPLEX CARE ASSISTANT, PROVIDE
COMPLEX CARE ASSISTANT SERVICES TO THE ENROLLEE THROUGH A COMPLEX CARE
AGENCY UNDER THE REIMBURSEMENT RATES ESTABLISHED UNDER PARAGRAPH (F) OF
THIS SUBDIVISION, PROVIDED THAT THE ENROLLEE IS A CHILD OR YOUNG ADULT
WITH DEVELOPMENTAL DISABILITIES AS DEFINED IN SUBDIVISION TWENTY-TWO OF
SECTION 1.03 OF THE MENTAL HYGIENE LAW AND QUALIFIES FOR SERVICES UNDER
MEDICAID. SUCH PROGRAM SHALL OPERATE AS A NEW YORK MEDICAID PRIVATE DUTY
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11246-01-5
A. 7583 2
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 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 COMPLEX CARE
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 COMPLEX CARE AGENCY AT A RATE THAT IS NO MORE THAN THE
CURRENT BASE REIMBURSEMENT RATE FOR COMPLEX CARE SERVICES AND DEPENDENT
UPON WHETHER THE SERVICES ARE PROVIDED IN THE DOWNSTATE REGION OR
UPSTATE REGION, PROVIDED, HOWEVER, THAT SUCH AGENCIES SHALL 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:
A. 7583 3
(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.