S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  3209

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 23, 2009
                               ___________

Introduced  by  M. of A. CHRISTENSEN, GREENE, COOK, MILLMAN, WEISENBERG,
  FIELDS, ABBATE, MAISEL, REILLY -- Multi-Sponsored by -- M. of A. ALFA-
  NO, CAHILL, DelMONTE, KOON, MARKEY, McENENY, PEOPLES, PHEFFER,  ROSEN-
  THAL, SCHIMEL, SEMINERIO -- read once and referred to the Committee on
  Health

AN  ACT  to  amend the public health law and the social services law, in
  relation to rates of  payment  for  continuous  nursing  services  for
  medically fragile persons

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subdivision 3-a of section 3614 of the public  health  law,
as amended by section 9 of part C of chapter 109 of the laws of 2006, is
amended to read as follows:
  3-a.  Medically  fragile  [children]  PERSONS.    Rates of payment for
continuous nursing services for  medically  fragile  [children]  PERSONS
provided  by  a  certified  home  health  agency,  a  licensed home care
services agency or a long term home health care program shall be  estab-
lished  to ensure the availability of such services, whether provided by
registered nurses or licensed practical nurses who are  employed  by  or
under  contract with such agencies or programs, and shall be established
at a rate that is at least equal to rates of payment for  such  services
rendered  to  patients  eligible  for AIDS home care programs; provided,
however, that a certified home  health  agency,  a  licensed  home  care
services  agency  or  a long term home health care program that receives
such enhanced rates for continuous nursing services for medically  frag-
ile  [children]  PERSONS  shall  use  such  enhanced  rates  to increase
payments to registered nurses and licensed practical nurses who  provide
such services. In the case of services provided by certified home health
agencies  and long term home health care programs through contracts with
licensed home care services agencies, rate increases  received  by  such
certified  home  health agencies and long term home health care programs

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02132-01-9
              

A. 3209                             2

pursuant to this subdivision shall be reflected in payments made to  the
registered nurses or licensed practical nurses employed by such licensed
home  care  services  agencies  to  render  services to these [children]
PERSONS.  In  establishing  rates of payment under this subdivision, the
commissioner shall consider the cost neutrality of such rates as related
to the cost effectiveness of caring  for  medically  fragile  [children]
PERSONS  in  a non-institutional setting as compared to an institutional
setting. For the purposes  of  this  subdivision,  a  medically  fragile
[child]  PERSON shall mean a [child] PERSON who is at risk of hospitali-
zation or institutionalization, including but not limited to  [children]
PERSONS  who are technologically-dependent for life or health-sustaining
functions, require complex medication regimen or  medical  interventions
to  maintain or to improve their health status or are in need of ongoing
assessment or intervention to prevent  serious  deterioration  of  their
health  status or medical complications that place their life, health or
development at risk, but who are capable of being cared for at  home  if
provided  with appropriate home care services, including but not limited
to case management services and continuous nursing services. The commis-
sioner shall promulgate regulations  to  implement  provisions  of  this
subdivision and may also direct the providers specified in this subdivi-
sion  to  provide  such  additional  information and in such form as the
commissioner shall determine is reasonably necessary  to  implement  the
provisions of this subdivision.
  S  2.  Subdivisions  1-a and 2 of section 367-r of the social services
law, subdivision 1-a as amended by section 10 of part C of  chapter  109
of  the  laws  of  2006, and subdivision 2 as amended by section 58-a of
part A of chapter 57 of the  laws  of  2006,  are  amended  to  read  as
follows:
  1-a.  Medically  fragile  [children] PERSONS. In addition, the commis-
sioner shall further increase rates for private  duty  nursing  services
that  are provided to medically fragile [children] PERSONS to ensure the
availability of such services to such [children] PERSONS.  In establish-
ing rates of payment under  this  subdivision,  the  commissioner  shall
consider the cost neutrality of such rates as related to the cost effec-
tiveness of caring for medically fragile [children] PERSONS in a non-in-
stitutional  setting  as compared to an institutional setting. Medically
fragile [children] PERSONS shall, for the purposes of this  subdivision,
have  the  same  meaning as in subdivision three-a of section thirty-six
hundred fourteen of the public health law.   Such  increased  rates  for
services rendered to such [children] PERSONS may take into consideration
the elements of cost, geographical differentials in the elements of cost
considered, economic factors in the area in which the private duty nurs-
ing  service is provided, costs associated with the provision of private
duty nursing services to medically fragile [children] PERSONS,  and  the
need for incentives to improve services and institute economies and such
increased  rates  shall be payable only to those private duty nurses who
can demonstrate, to the satisfaction of the department of health, satis-
factory training and experience to provide services to  such  [children]
PERSONS.   Such increased rates shall be determined based on application
of the case mix adjustment factor for AIDS home  care  program  services
rates as determined pursuant to applicable regulations of the department
of  health. The commissioner may promulgate regulations to implement the
provisions of this subdivision.
  2. Private duty nursing services  providers  which  have  their  rates
adjusted  pursuant  to  this section shall use such funds solely for the
purposes of recruitment and retention  of  private  duty  nurses  or  to

A. 3209                             3

ensure  the delivery of private duty nursing services to medically frag-
ile [children] PERSONS and are prohibited from using such funds for  any
other  purpose.  Funds  provided  under this section are not intended to
supplant  support  provided  by  a local government. Each such provider,
with the exception of self-employed private duty nurses,  shall  submit,
at  a  time  and  in  a  manner  to be determined by the commissioner of
health, a written certification attesting that such funds will  be  used
solely  for  the  purpose  of  recruitment and retention of private duty
nurses or to ensure the delivery of private  duty  nursing  services  to
medically  fragile  [children]  PERSONS.   The commissioner of health is
authorized to audit each such provider to  ensure  compliance  with  the
written  certification required by this subdivision and shall recoup all
funds determined to have been used for purposes other  than  recruitment
and  retention  of  private  duty nurses or the delivery of private duty
nursing services to medically fragile [children] PERSONS.  Such  recoup-
ment shall be in addition to any other penalties provided by law.
  S  3.  This  act shall take effect on the thirtieth day after it shall
have become a law, provided that:
  1. the amendments to subdivision 3-a of section  3614  of  the  public
health  law made by section one of this act shall not affect the expira-
tion and repeal of such subdivision  and  shall  expire  and  be  deemed
repealed therewith; and
  2.  the amendments to section 367-r of the social services law made by
section two of this act shall not affect the expiration of such  section
and shall be deemed to expire therewith.