NY State Senate Bill 2021-S7513

Senate Bill S7513

2021-2022 Legislative Session

Provides increased rates for private duty nursing services that are provided to medically fragile adults

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Archive: Last Bill Status - In Senate Committee Finance 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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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 15, 2022	reported and committed to finance
Jan 05, 2022	referred to health
Nov 08, 2021	referred to rules

Votes

- Mar 15, 2022 - Health Committee Vote
  S7513
  
  15
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Mar 15, 2022
      
      aye (15)
      
      Biaggi
      
      Boyle
      
      Brouk
      
      Cleare
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      May
      
      Oberacker
      
      Rath III
      
      Rivera
      
      Ryan
      
      Salazar
      
      Stec
      
      Thomas

co-Sponsors

2021-S7513 (ACTIVE) - Details

See Assembly Version of this Bill:: A8671
Current Committee:: Senate Finance
Law Section:: Social Services Law
Laws Affected:: Amd §367-r, Soc Serv L; amd §3614, Pub Health L

2021-S7513 (ACTIVE) - Summary

Provides increased rates for private duty nursing services that are provided to medically fragile adults to ensure adequate access to such services; applies to private duty nursing services provided to medically fragile adults by fee-for-service private duty nursing services providers who enroll and participate in the applicable provider directory.

2021-S7513 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7513

SPONSOR: MAYER
 
TITLE OF BILL:

An act to amend the social services law and the public health law, in
relation to providing increased rates for private duty nursing services
that are provided to medically fragile adults

 
PURPOSE OR GENERAL IDEA OF BILL:

To eliminate the private duty nursing services reimbursement cliff for
medically fragile adults once they age out of the medically fragile
child category.

 
SUMMARY OF PROVISIONS:

Section 1 matches the medically fragile adult reimbursement rates for
private duty nursing services to the rates paid with respect to
medically fragile children. Medically fragile adult is defined the same
as a medically fragile child except for the age limitation.

Section 2 sets the effective date.

 
JUSTIFICATION:

Medically fragile children who receive care at home are typically served
by private duty nurses, who are reimbursed at enhanced Medicaid rates
structured to properly account for the nature of the care provided.
However, when these medically fragile individuals attain the age of 21,
they no longer qualify as "medically fragile children" and reimbursement
rates for their private duty nurses drop significantly. This reimburse-
ment cliff means that nurses face significant financial loss if they
stay with those patients, forcing many to leave for higher-paying jobs.
As a consequence, finding care for medically fragile adults - whose
needs have not lessened by virtue of growing older is a significant
challenge.

This bill rights this arbitrary wrong by raising the private duty nurse
reimbursement rate for medically fragile adults to the same reimburse-
ment rate as that set for medically fragile children.  Eliminating the
reimbursement cliff that results when these individuals age out is a
matter of basic equity - there is no compelling reason why the
reimbursement rates should be lower simply because a medically fragile
child reaches the age of 21. The federal American Rescue Plan Act
provided for a temporary increase in rates for patients aged 23 and
older, from November 1, 2021 until March 31, 2022. This bill would
implement a permanent fix of the disparity in these reimbursement rates
to lessen the burden on medically fragile adults and their families.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

TBD.

 
EFFECTIVE DATE:
The provisions of the bill shall take effect immediately after becoming
law.

2021-S7513 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7513
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             November 8, 2021
                                ___________
 
 Introduced  by  Sen.  MAYER  -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation  to  providing  increased  rates  for  private  duty  nursing
   services that are provided to medically fragile adults

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subdivisions  2  and  3  of  section  367-r of the social
 services law, subdivision 2 as amended and subdivision  3  as  added  by
 section  2  of part PP of chapter 56 of the laws of 2020, are amended to
 read as follows:
   2. Medically fragile children  AND  ADULTS.    (a)  In  addition,  the
 commissioner  shall  further  increase  rates  for  private duty nursing
 services that are provided to medically fragile children to  ensure  the
 availability  of  such  services to such children. FURTHERMORE, NO LATER
 THAN SIXTY DAYS AFTER THE CHAPTER OF THE LAWS OF TWO THOUSAND TWENTY-TWO
 THAT AMENDED THIS SUBDIVISION TAKES EFFECT,  INCREASED  RATES  SHALL  BE
 EXTENDED FOR PRIVATE DUTY NURSING SERVICES PROVIDED TO MEDICALLY FRAGILE
 ADULTS.  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  AND
 ADULTS  in  a  non-institutional setting as compared to an institutional
 setting. Medically fragile children 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.   FOR PURPOSES  OF
 THIS  SUBDIVISION,  "MEDICALLY  FRAGILE  ADULT"  SHALL BE DEFINED AS ANY
 INDIVIDUAL WHO PREVIOUSLY QUALIFIED AS A MEDICALLY FRAGILE CHILD BUT  NO
 LONGER  MEETS  THE  AGE  REQUIREMENT.  Such increased rates for services
 rendered to such children AND ADULTS 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13224-03-1

 S. 7513                             2
 
 ing service is provided, costs associated with the provision of  private
 duty  nursing services to medically fragile children AND ADULTS, 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 AND
 ADULTS.  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.
   (b)  Private  duty  nursing  services providers which have their rates
 adjusted pursuant to paragraph (b) of subdivision one  of  this  section
 and  paragraph  (a)  of this subdivision shall use such funds solely for
 the purposes of recruitment and retention of private duty nurses  or  to
 ensure  the delivery of private duty nursing services to medically frag-
 ile children AND ADULTS and are prohibited from using such funds for any
 other purpose. Funds provided under paragraph (b) of subdivision one  of
 this  section  and paragraph (a) of this subdivision 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 AND ADULTS.   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 AND ADULTS.  Such recoup-
 ment shall be in addition to any other penalties provided by law.
   (c)  The  commissioner  of  health shall, subject to the provisions of
 paragraph (b) of this subdivision, and  the  provisions  of  subdivision
 three of this section, and subject to the availability of federal finan-
 cial  participation,  annually  increase  fees  for  the fee-for-service
 reimbursement of private duty nursing  services  provided  to  medically
 fragile  children  by  fee-for-service  private  duty  nursing  services
 providers who enroll and participate in the provider directory  pursuant
 to  subdivision  three  of  this  section, over a period of three years,
 commencing October first,  two  thousand  twenty,  by  one-third  annual
 increments,  until such fees for reimbursement equal the final benchmark
 payment designed to ensure adequate access to the service. In developing
 such benchmark the commissioner of health may utilize  the  average  two
 thousand  eighteen  Medicaid  managed care payments for reimbursement of
 such private duty nursing  services.  The  commissioner  may  promulgate
 regulations to implement the provisions of this paragraph.
   (D)  THE  COMMISSIONER  OF  HEALTH SHALL, SUBJECT TO THE PROVISIONS OF
 PARAGRAPH (B) OF THIS SUBDIVISION, AND  THE  PROVISIONS  OF  SUBDIVISION
 THREE OF THIS SECTION, AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINAN-
 CIAL  PARTICIPATION, INCREASE FEES FOR THE FEE-FOR-SERVICE REIMBURSEMENT
 OF PRIVATE DUTY NURSING SERVICES PROVIDED TO MEDICALLY FRAGILE ADULTS BY
 FEE-FOR-SERVICE PRIVATE DUTY NURSING SERVICES PROVIDERS WHO  ENROLL  AND
 PARTICIPATE  IN  THE PROVIDER DIRECTORY PURSUANT TO SUBDIVISION THREE OF
 THIS SECTION, NO LATER THAN SIXTY DAYS AFTER THE CHAPTER OF THE LAWS  OF
 TWO  THOUSAND  TWENTY-TWO THAT AMENDED THIS SUBDIVISION TAKES EFFECT, SO
 S. 7513                             3
 
 SUCH FEES FOR REIMBURSEMENT EQUAL  THE  BENCHMARK  PAYMENT  DESIGNED  TO
 ENSURE  ADEQUATE ACCESS TO THE SERVICE. IN DEVELOPING SUCH BENCHMARK THE
 COMMISSIONER OF HEALTH MAY UTILIZE THE AVERAGE TWO THOUSAND TWENTY MEDI-
 CAID  MANAGED CARE PAYMENTS FOR REIMBURSEMENT OF SUCH PRIVATE DUTY NURS-
 ING SERVICES. THE COMMISSIONER MAY PROMULGATE REGULATIONS  TO  IMPLEMENT
 THE PROVISIONS OF THIS PARAGRAPH.
   3.   Provider  directory  for  fee-for-service  private  duty  nursing
 services provided to medically fragile children AND ADULTS.  The commis-
 sioner of health is authorized to establish  a  directory  of  qualified
 providers  for  the  purpose  of promoting the availability and ensuring
 delivery of fee-for-service private duty nursing services  to  medically
 fragile  children [and individuals transitioning out of such category of
 care] AND ADULTS.  Qualified providers enrolling in the directory  shall
 ensure  the availability and delivery of and shall provide such services
 to those individuals as are in need of such services, and shall  receive
 increased  reimbursement  for  such services pursuant to [paragraph (c)]
 PARAGRAPHS (C) AND (D) of subdivision two of this section. The directory
 shall offer enrollment to all private duty nursing services providers to
 promote and ensure the participation in the  directory  of  all  nursing
 services  providers  available  to  serve medically fragile children AND
 ADULTS.
   § 2. 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  AND  ADULTS.  Rates  of  payment  for
 continuous  nursing  services  for medically fragile children AND ADULTS
 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 AND ADULTS  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
 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  AND
 ADULTS.  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  AND
 ADULTS  in  a  non-institutional setting as compared to an institutional
 setting. For the purposes of this subdivision, a medically fragile child
 shall mean a child who is at risk of hospitalization or  institutionali-
 zation,  including  but not limited to children who are technologically-
 dependent for life or health-sustaining functions, require complex medi-
 cation 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  compli-
 S. 7513                             4
 
 cations  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.   FOR THE PURPOSES OF THIS SUBDIVISION, A
 MEDICALLY FRAGILE ADULT SHALL MEAN ANY INDIVIDUAL WHO PREVIOUSLY  QUALI-
 FIED  AS  A MEDICALLY FRAGILE CHILD BUT NO LONGER MEETS THE AGE REQUIRE-
 MENT.  The  commissioner  shall  promulgate  regulations  to   implement
 provisions  of this subdivision and may also direct the providers speci-
 fied in this subdivision to provide such additional information  and  in
 such form as the commissioner shall determine is reasonably necessary to
 implement the provisions of this subdivision.
   § 3. This act shall take effect immediately.

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Senate Bill S7513

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Sponsored By

Shelley B. Mayer