Senate Bill S5337

                                 
BILL NUMBER: S5337

SPONSOR: FAHY
 
TITLE OF BILL:

An act to amend the public health law, in relation to the application of
certain provisions relating to the operating component of rates of
payment made by governmental agencies for certain services

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this legislation is to provide a consistent Medicaid
nursing home reimbursement rate for a specialty nursing home that treats
neurologically impaired children who cannot be appropriately discharged
into the community when they age.

 
SUMMARY OF SPECIFIC PROVISIONS:

This legislation provides that the residential health care facility with
fewer than sixty beds as of July 1, 2007, which provides services prima-
rily to neurologically impaired individuals and is located in a county
with a population between 290,000 - 310,000 as of July 1, 2007, shall
              

receive one Medicaid reimbursement rate, which shall be based solely on
the methodology to establish rates for a specialty children's nursing
home.

 
JUSTIFICATION:

Prior to the enactment of Chapter 414 of the Laws of 2007, the facility
received two different Medicaid rates under the Health Department's rate
setting - one for individuals under 16 and one for individuals 16 and
over, despite the fact that virtually the same services were provided.
Because of the differences in the way the two rates were calculated, the
rate for those 16 and over was considerably less than that for those
under 16. The rate for those over 16 did not cover the cost of care for
these vulnerable individuals. Chapter 414 of the laws of 2007 and chap-
ter 350 of the last of 2010 mandated that the facility receive one rate
of payment based solely on the methodology used to establish rates for
facilities which provide extensive nursing, medical, psychological and
counseling services solely to children.

Chapter 350 of the Laws of 2010 was enacted to accommodate the increase
in bed count for those under 16, ensuring the rational of the laws of
2007 were maintained, that of a single rate for those cared for in a
residential health care facility which provides services primarily to
neurologically impaired individuals, when the facility is located in a
county with a population between 290,000 - 310,000 as of July 1, 2007.

A reading of chapter 59 of the laws of 2011 has resulted in a reversion
to the rate calculation for the residential health care facility which
provides services primarily to neurologically impaired individuals, when
the facility is located in a county with a population between 290,000 -
310,000 as of July 1, 2007, to require two different rates. The number
of beds for the young adult neurologically impaired population age 16
and over, remains at 20; therefore, unchanged in the number of beds the
higher rate applies to. The intent of the laws of 2007 remains as neces-
sary as it was at the time of the change.

 
PRIOR LEGISLATIVE HISTORY:
2023-2024: S9568/A10330

 
FISCAL IMPLICATIONS:

$775,000 for fiscal year 2025-2026

 
EFFECTIVE DATE:
Take effect immediately.