Senate Bill S7859

                                 
BILL NUMBER: S7859

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to authority for
existing assisted living programs to expand capacity by nine or fewer
beds under an expedited process

 
PURPOSE:

This bill is intended to expand assisted living options for Medicaid
beneficiaries.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1: Authorizes existing assisted living providers licensed on or
before April 1, 2024 to apply to the Department of Health for approval
to add up to 9 additional assisted living program beds that do not
require major renovation or construction. The Department of Health would
begin to accept such applications no later than May 1, 2025 and would
set a deadline for submission.
              

Section 2: Provides an immediate effective date.

 
JUSTIFICATION:

This amendment would allow existing assisted living programs (ALPs) to
add up to 9 beds, provided that they submit an application which is
approved by the Department of Health and the addition of beds does not
require major renovation or construction.

New York State currently lacks the capacity to serve individuals who
require and desire residential care (e.g., 24/7 supervision and assist-
ance with ADLs), but do not necessarily require the skilled nursing care
provided in a nursing home. According to the AARP's 2023 State Score-
card, New York State has the lowest supply of assisted living beds in
the nation. Assisted living capacity is in even shorter supply for indi-
viduals with low incomes.

According to the national data (Nat'l Center for Health Statistics in
NYS there are 34.98 people age 85+ per Medicaid ALP bed and 9.52 people
age 85+ per ACF/AL bed overall (including ALP and other types of
assisted living combined). Although there is no national data comparing
Medicaid assisted living capacity by state, we know that nationally
there are 5.26 people age 85+ per assisted living bed overall. Thus,
despite New York's health equity goals, the supply of Medicaid ALP beds
in New York is particularly low.

This lack of assisted living capacity limits options for individuals
(especially low-income individuals) in need of long-term services and
support. It is impeding their ability to live in the most integrated
setting appropriate to their needs and optimize their quality of life,
as they age and their needs change. We can expect that the need for
these services will only grow in the years to come, given the demograph-
ic trends.

Under existing law (Social Services Law § 461-1(3)(m)), as interpreted
by the Department of Health, no new Medicaid ALP beds may be approved
until a need methodology is developed and implemented, beginning April
1, 2025. This new needs-based application process was originally
intended to be completed by 2023; however, the deadline was extended to
April 1, 2025. Unfortunately, this means that new ALP beds are not like-
ly to be approved and operational through the new process until poten-
tially 2026 or 2027, given the time it will take for the adoption of
regulations and the implementation of an application and review process.

The last opportunity to create new ALP beds was in 2020, when existing
ALPs had the opportunity to expand by 9 or fewer beds through an expe-
dited process. Since that time, there have been significant shifts in
long-term care services with a number of ACFs and ALPs closing. In 2024
alone, one assisted living program (ALP) has closed, and another is in
the process of closing.

As a result, there are currently people in the community who are not
able to access the supports they need. Meanwhile, we have a growing
population of older adults in New York and the need for residential care
is likewise growing. This legislation would create an opportunity to
help address this gap in services on an interim basis while the new
need-based application process becomes operational.

 
PRIOR LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

Would generate Medicaid savings to the extent that low acuity nursing
home residents are served in ALPs at the lower ALP rates. If 1,000 nurs-
ing home residents were to be served for a full year in ALPs rather than
nursing homes, the estimated overall Medicaid savings would be about
$40M (i.e., $20M state share) based on current ALP and nursing home
rates

 
EFFECTIVE DATE:
This act shall take effect immediately.