Senate Bill S9562

2025-2026 Legislative Session

Relates to contracts and dispute resolution process for billing under contracts for home care services with managed care plans

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Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 25, 2026	referred to health

2025-S9562 (ACTIVE) - Details

See Assembly Version of this Bill:: A9607
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §3614-f, Pub Health L

2025-S9562 (ACTIVE) - Summary

Requires review and approval by the commissioner of health of 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; directs the commissioner of health to establish a dispute resolution process independent dispute resolution relating to billing under a contract for home care services.

2025-S9562 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9562

SPONSOR: CLEARE
 
TITLE OF BILL:

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

 
PURPOSE:

To provide Licensed Home Care Services Agencies (LHCSAs)the following:
a required and timely review and approval process from managed care
organizations or MLTCs; a dispute resolution process for billing and
contracts with managed care organizations or MLTCs; and Directed
Payments for state mandated minimum wage payments by Managed Care organ-
izations or MLTCs if approved by the federal Centers for Medicare and
Medicaid.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 would add five new subdivisions new subdivisions(5,6,7,8 and

9)to section 3614-f of the public health law.

The first new subdivision five would require the timely review and
approval of contracts between licensed home care services agencies and a
MCO( managed care organization) or MLTC (Managed Long Term Care plan) at
least three ,months prior to any modification to a 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 or other wage or benefit provisions of state
law.

Subdivision six, seven, eight, nine and ten would establish a dispute
resolution process for disputes regarding bills or contracts for home
care services provided by licensed home care services agencies with a
MCO or MLTC. Subdivision seven establishes criteria for determining a
reasonable contract with factors including: direct care related
payments; base hourly wages; overtime costs; employee benefits; FICA;
Unemployment insurance; workers compensation; operational expenses;
administrative and general operating costs; and other appropriate
factors. Subdivision eight outlines how a LHCSA may submit a dispute:
the timing by a dispute resolution entity; and the binding requirements
of a determination by the dispute resolution entity on the LHSCA, MCO or
MLTC.

Subdivision nine outlines payment for dispute resolution entities.
Subdivision ten prohibits retaliation by MCOs or MTLCs against a LHCSA
as a result of the.submission of any dispute to an independent dispute
resolution entity.

Subdivision eleven provides for Directed Payments for state mandated
minimum wage payments by Managed Care organizations or MLTCs to LHCSAs
if approved by the federal Centers for Medicare and Medicaid for any
minimum wage increases or other provisions of the labor law required on
licensed home care services agencies.

Section 2. Provides for a severability clause Section 3. Effective Date.

 
JUSTIFICATION:

Contracting to deliver home care services with Managed Care Organiza-
tions is not a level playing field. Licensed Home Care Service Agencies
(LHCSAs) are unable to have fair negotiations for rate adequacy with
MCOs and/or MLTCs. For years, LHCSAs have been increasingly offered
unilateral rate amendments-take it or leave it rate packages. Addi-
tionally, MLTCs and MOOS, do not transparently pass through Medicaid
rate increases that are targeted for LHCSA services (1% Across the Board
mandated by the State Budget) and do not consistently pass on state
funding for wage mandates or compensate for increased costs for over-
time, nursing services, scheduling, or overall A&G costs for providers.
In the last 6 months alone, insurers have unilaterally reduced LHCSA
contract rates despite mandatory state wage increases in 2025 for which
funding was allocated. These contracting challenges are anticipated to
worsen in 2026.

This legislation seeks to provide a level playing field for LHCSAs
during their contract and rate negotiations with MLTCs and MCOs. It
would require: a timely review and approval process for LHCSAs in
contracting with MLTCs and MCO; the establishment of a dispute resol-
ution process for billing and contracts with managed care organizations
or MLTCs; non-retaliation provisions for LHCSAs that choose to dispute
their contracts; Directed Payments for state mandated minimum wage
payments by Managed Care organizations or MLTCs if approved by the
federal centers for Medicare and Medicaid.

 
LEGISLATIVE HISTORY:;

None

 
FISCAL IMPLICATIONS:

None noted.

 
EFFECTIVE DATE:
This act shall take effect immediately after it shall become law.

2025-S9562 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9562
 
                             I N  S E N A T E
 
                              March 25, 2026
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed 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
 S. 9562                             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
 S. 9562                             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.

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Senate Bill S9562

Sponsored By

Current Bill Status - In Senate Committee Health Committee

Actions

2025-S9562 (ACTIVE) - Details

2025-S9562 (ACTIVE) - Summary

2025-S9562 (ACTIVE) - Sponsor Memo

2025-S9562 (ACTIVE) - Bill Text download pdf

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Sponsored By

Cordell Cleare

Current Bill Status - In Senate Committee Health Committee

Actions

2025-S9562 (ACTIVE) - Details

2025-S9562 (ACTIVE) - Summary

2025-S9562 (ACTIVE) - Sponsor Memo

2025-S9562 (ACTIVE) - Bill Text download pdf

Comments