Assembly Bill A9607

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9607
 
                           I N  A S S E M B L Y
 
                             January 21, 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 minimum wage
   increases for home care aides and independent dispute  resolution  for
   disputing billing or contracts
 
   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  seven  new  subdivisions  5,  6,  7,  8, 9, 10 and 11 to read as
 follows:
   5. THE COMMISSIONER SHALL REQUIRE FOR REVIEW  AND  APPROVAL  CONTRACTS
 FOR  HOME CARE SERVICES PROVIDED TO A LICENSED HOME CARE SERVICES AGENCY
 FROM A MANAGED CARE ORGANIZATION OR A MANAGED LONG  TERM  CARE  PLAN  AT
 LEAST  THREE  MONTHS  PRIOR  TO  ANY MODIFICATION TO CONTRACT RELATED TO
 BILLING, RATES OR SERVICES, THE EXPIRATION  OF  ANY  CONTRACT,  CONTRACT
 AMENDMENT,  MODIFICATION  OF  ANY CONTRACT, OR RELATED TO AN INCREASE IN
 THE MINIMUM WAGE REQUIREMENTS ESTABLISHED IN  SUBDIVISION  TWO  OF  THIS
 SECTION OR ANY WAGE OR BENEFIT PROVISIONS OF THE LABOR LAW.
   6.  THE  COMMISSIONER  SHALL ESTABLISH A DISPUTE RESOLUTION PROCESS BY
 WHICH A DISPUTE FOR A BILL OR CONTRACT FOR HOME CARE  SERVICES  PROVIDED
 BY A LICENSED HOME CARE SERVICES AGENCY WITH A MANAGED CARE ORGANIZATION
 OR A MANAGED LONG TERM CARE PLAN MAY BE RESOLVED. THE COMMISSIONER SHALL
 HAVE THE POWER TO GRANT AND REVOKE CERTIFICATIONS OF INDEPENDENT DISPUTE
 RESOLUTION  ENTITIES  TO  CONDUCT  THE  DISPUTE  RESOLUTION PROCESS. THE
 COMMISSIONER SHALL PROMULGATE REGULATIONS ESTABLISHING STANDARDS FOR THE
 DISPUTE RESOLUTION PROCESS,  INCLUDING  A  PROCESS  FOR  CERTIFYING  AND
 SELECTING  INDEPENDENT  DISPUTE  RESOLUTION  ENTITIES. DISPUTES SHALL BE
 SUBMITTED TO AN INDEPENDENT DISPUTE RESOLUTION ENTITY WITHIN NINETY DAYS
 OF THE DATE THE MANAGED  CARE  PLAN  OR  MANAGED  LONG  TERM  CARE  PLAN
 PROPOSED  BILLING  OR  CONTRACTUAL  AMENDMENTS  TO  A LICENSED HOME CARE
 SERVICES AGENCY.
   7. IN DETERMINING THE APPROPRIATE AMOUNT TO PAY UNDER A  CONTRACT  FOR
 HOME  CARE  SERVICES,  AN  INDEPENDENT  DISPUTE  RESOLUTION ENTITY SHALL
 CONSIDER ALL RELEVANT FACTORS INCLUDING, BUT NOT LIMITED TO:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14412-02-6
 A. 9607                             2
 
   (A) 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:
   (I)  BASE  HOURLY WAGE GUARANTEED HOME CARE AIDES PURSUANT TO SUBDIVI-
 SION TWO OF THIS SECTION OR ANY WAGE OR BENEFIT PROVISIONS OF THE  LABOR
 LAW;
   (II) OVERTIME COSTS;
   (III) EMPLOYEE BENEFITS, INCLUDING BOTH PAID TIME OFF AND SUPPLEMENTAL
 BENEFITS OR BENEFITS AS DETERMINED BY COLLECTIVE BARGAINING AGREEMENTS;
   (IV) FEDERAL INSURANCE CONTRIBUTIONS ACT;
   (V) MEDICARE;
   (VI) FEDERAL UNEMPLOYMENT TAX ACT;
   (VII)  WORKER  WAGE  PARITY  AS PROVIDED BY SECTION THIRTY-SIX HUNDRED
 FOURTEEN-C OF THIS ARTICLE, AS APPLICABLE;
   (VIII) OTHER PAYROLL TAXES;
   (IX) FAIR LABOR STANDARDS ACT COMPLIANCE;
   (X) NEW YORK STATE LABOR LAW COMPLIANCE;
   (XI) STATE UNEMPLOYMENT INSURANCE;
   (XII) DISABILITY INSURANCE;
   (XIII) WORKERS' COMPENSATION;
   (XIV) TRAVEL TIME AND TRAVEL REIMBURSEMENT;
   (XV) THE METROPOLITAN TRANSPORTATION AUTHORITY TAX, IF APPLICABLE;
   (XVI) RELATED INCREASES TIED TO BASE WAGES; AND
   (XVII) WORKERS SHORTAGES;
   (B) A COMPONENT TO REFLECT OPERATIONAL EXPENSES  NECESSARY  TO  COMPLY
 WITH  FEDERAL  AND  STATE STATUTORY AND REGULATORY REQUIREMENTS FOR SUCH
 PROVIDERS, AND WHICH SHALL INCLUDE:
   (I) OPERATIONAL SUPERVISION AND SUPPORT, INCLUDING BUT NOT LIMITED  TO
 NURSING STAFF, HOME HEALTH AIDE SUPERVISION AND TEAM SUPPORT; AND
   (II)  OTHER  OPERATIONAL SUPPORT, INCLUDING BUT NOT LIMITED TO QUALITY
 ASSURANCE AND IMPROVEMENT PROGRAMS, EDUCATION AND RECRUITMENT; AND
   (C) 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, OPERATING MARGINS AND
 COMMUNICATIONS.
   8. A LICENSED HOME CARE SERVICES AGENCY MAY SUBMIT A DISPUTE REGARDING
 A BILL OR CONTRACT FOR HOME CARE SERVICES FOR REVIEW TO  AN  INDEPENDENT
 DISPUTE  RESOLUTION  ENTITY.  THE  INDEPENDENT DISPUTE RESOLUTION ENTITY
 SHALL DETERMINE IF A BILL OR CONTRACT ADDRESSES THE CRITERIA AND FACTORS
 FOR REASONABLE CONTRACT SET FORTH IN SUBDIVISION SEVEN OF  THIS  SECTION
 FOR  HOME CARE SERVICES BETWEEN A LICENSED HOME CARE SERVICES AGENCY AND
 MANAGED CARE ORGANIZATION OR A MANAGED LONG TERM CARE  PLAN.  THE  INDE-
 PENDENT  DISPUTE  RESOLUTION  ENTITY  SHALL  MAKE A DETERMINATION WITHIN
 THIRTY BUSINESS DAYS OF RECEIPT OF THE DISPUTE FOR REVIEW. THE  DETERMI-
 NATION  SHALL  BE BINDING ON BOTH THE LICENSED HOME CARE SERVICES AGENCY
 AND MANAGED CARE ORGANIZATION OR A MANAGED LONG TERM  CARE  PLAN.    ANY
 CONTRACT  OR  BILL  SUBJECT  TO  THE DISPUTE SHALL BE AMENDED AND A COPY
 FILED WITH THE COMMISSIONER OF HEALTH WITHIN THIRTY DAYS.
   9. A REASONABLE PAYMENT FOR  DISPUTE  RESOLUTION  TO  THE  INDEPENDENT
 DISPUTE RESOLUTION ENTITY SHALL BE PAID BY THE MANAGED CARE ORGANIZATION
 OR  A  MANAGED  LONG TERM CARE PLAN PARTY TO ANY DISPUTE SUBMITTED TO AN
 INDEPENDENT DISPUTE RESOLUTION ENTITY.
   10. A MANAGED CARE ORGANIZATION OR A MANAGED LONG TERM CARE PLAN PARTY
 TO ANY DISPUTE SUBMITTED TO AN INDEPENDENT DISPUTE RESOLUTION ENTITY  BY
 A. 9607                             3
 
 LICENSED  HOME  CARE  SERVICES  AGENCY  REGARDING  A  CONTRACT WITH SUCH
 MANAGED CARE ORGANIZATION OR MANAGED LONG TERM CARE PLAN MANAGED  AGENCY
 MAY  NOT  RETALIATE  OR  TAKE ANY ACTION WHICH WOULD DISCRIMINATE IN ANY
 BUSINESS  ACTIVITY  AGAINST  SUCH  LICENSED HOME CARE SERVICES AGENCY IN
 CONTRACTS, BILLING OR OTHER ACTIONS AS A RESULT  OF  THE  LICENSED  HOME
 CARE  AGENCY  SEEKING  A  DISPUTE  RESOLUTION  FOR  A CONTRACT WITH SUCH
 MANAGED CARE ORGANIZATION OR A MANAGED LONG TERM CARE PLAN.
   11. IF APPROVED BY THE  FEDERAL  CENTERS  FOR  MEDICARE  AND  MEDICAID
 SERVICES,  DIRECTED PAYMENTS SHALL BE MADE TO SUCH PROVIDERS OF MEDICAID
 SERVICES FOR ANY INCREASES IN THE MINIMUM WAGE ESTABLISHED  IN  SUBDIVI-
 SION  TWO OF THIS SECTION OR ANY MINIMUM WAGE OR OTHER PROVISIONS OF THE
 LABOR LAW, THROUGH CONTRACTS WITH MANAGED  CARE  ORGANIZATIONS  PROVIDED
 THAT THE COMMISSIONER ENSURES THAT SUCH DIRECTED PAYMENTS ARE IN ACCORD-
 ANCE WITH THE TERMS 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.