Senate Bill S9404

                                 
BILL NUMBER: S9404

SPONSOR: FAHY
 
TITLE OF BILL:

An act to amend the public health law, in relation to establishing
prescribed pediatric extended care centers; and providing for the repeal
of such provisions upon expiration thereof

 
PURPOSE OR GENERAL IDEA OF BILL:

To authorize and regulate prescribed extended pediatric care (PPEC)
centers in New York State to provide coordinated, comprehensive, nonres-
idential nursing and therapeutic services to medically fragile and
medically complex children who require continual skilled care, while
allowing them to remain living at home with their families.

 
SUMMARY OF PROVISIONS:

Section 1 amends the Public Health Law to add a new Article 44-E, estab-
lishing a statutory framework for prescribed pediatric extended care
centers.
              

*§ 4408-e sets forth the legislative intent, recognizing that many
medically fragile children require continual skilled nursing and thera-
peutic services that cannot be adequately provided through home or
school-based services alone.

*§ 4408-f authorizes the Department of Health to establish and adminis-
ter a certification and oversight program for PPEC centers and permits
approval of up to two centers statewide, with at least one located in
New York City. It defines PPEC centers as nonresidential facilities
providing specialized nursing, therapeutic, and supportive services.

*§ 4408-g establishes eligibility and funding criteria, limiting opera-
tors to pediatric skilled nursing facilities with demonstrated experi-
ence caring for medically fragile children. It authorizes the Department
to award funds without a competitive bid process, subject to oversight
by the Division of the Budget and performance-based milestones.

*§ 4408-h grants the Commissioner of Health authority to promulgate
regulations governing certification, staffing, safety, quality assur-
ance, and enforcement.

*§ 4408-i requires the Commissioner to report to the Governor and Legis-
lature by September 30, 2030, on the clinical and cost-effectiveness of
the program.

*§ 4408-j provides for expiration and repeal of the article on March 31,
2031.

Section 2 provides that the act shall take effect immediately.

 
JUSTIFICATION:

Medically fragile children represent a growing, high-need population in
New York State. A New York State population needs assessment identified
approximately 24,000 individuals under age 35 with medical fragility
enrolled in Medicaid, and national data indicate this population is
increasing by approximately five percent annually.  These children often
rely on ventilators, feeding tubes, tracheostomies, and other life-sus-
taining medical technologies and require continuous skilled nursing
oversight.

Historically, Medicaid private duty nursing (PDN) and waiver programs
enabled medically fragile children to live at home rather than in hospi-
tals or long-term care facilities. However, severe workforce shortages
and chronically low Medicaid reimbursement rates have made it increas-
ingly difficult for families to secure reliable home nursing coverage.

Prescribed pediatric extended care centers offer a proven, community-
based alternative. PPEC centers provide up to twelve hours per day of
skilled nursing care, developmental therapies, and supportive services
in a medically supervised, nonresidential setting. These centers allow
children to remain at home while ensuring access to consistent, high-
quality care, socialization, and early intervention services. For fami-
lies, PPEC centers reduce caregiver burnout, improve family stability,
and mitigate lost income caused by inadequate home nursing coverage.
Other states have implemented PPEC programs, which have proved to be
cost-effective and clinically appropriate. By substituting a portion of
private duty nursing hours with center-based care, PPEC programs reduce
per-day care costs, lower hospitalization and emergency department
utilization, and facilitate earlier discharge from hospitals and pedia-
tric long-term care facilities.

New York currently lacks a comprehensive statutory framework for PPEC
centers. This bill fills that gap by authorizing a limited demonstration
program under Department of Health oversight, allowing the State to
evaluate clinical outcomes and fiscal impacts before considering broader
expansion.

 
PRIOR LEGISLATIVE HISTORY:

None.

 
FISCAL. IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

BD. While there would be initial implementation costs are associated
with operating a limited demonstration program of up to two PPEC
centers, there would be net recurring Medicaid savings as a result of
reducing private duty nursing expenditures, avoidable hospitalizations,
and pediatric long-term care placements.

 
EFFECTIVE DATE:
This act shall take effect immediately.