S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1112
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2025
                                ___________
 
 Introduced  by  M.  of  A.  PAULIN,  REYES, WEPRIN, ROSENTHAL, SHRESTHA,
   DINOWITZ, EPSTEIN, HEVESI,  SIMON,  STECK,  ZINERMAN,  GONZALEZ-ROJAS,
   KELLES,  SAYEGH, COLTON, SIMONE, SANTABARBARA, RAGA, STIRPE, BRABENEC,
   LEVENBERG, BROOK-KRASNY, LUCAS, JONES -- read once and referred to the
   Committee on Health

 AN ACT to amend the public health law, in relation to  regional  minimum
   hourly base reimbursement rates for home care aides
 
   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  eight  new  subdivisions 5, 6, 7, 8, 9, 10, 11 and 12 to read as
 follows:
   5. (A) BY THE FIRST OF OCTOBER NEXT SUCCEEDING THE EFFECTIVE  DATE  OF
 THIS  SUBDIVISION,  THE  COMMISSIONER SHALL ESTABLISH A REGIONAL MINIMUM
 HOURLY BASE REIMBURSEMENT  RATE  FOR   ALL PROVIDERS  EMPLOYING  WORKERS
 SUBJECT TO THE MINIMUM WAGE PROVISIONS ESTABLISHED IN SUBDIVISION TWO OF
 THIS    SECTION.    THE  REGIONAL MINIMUM HOURLY BASE REIMBURSEMENT RATE
 SHALL BE BASED ON REGIONS ESTABLISHED BY THE COMMISSIONER, PROVIDED THAT
 FOR AREAS SUBJECT TO SECTION THIRTY-SIX HUNDRED FOURTEEN-C OF THIS ARTI-
 CLE, EACH AREA WITH A DIFFERENT PREVAILING RATE OF  TOTAL  COMPENSATION,
 AS DEFINED IN THAT SECTION, SHALL BE ITS OWN REGION.
   (B)  FOR  THE  PURPOSES OF THIS SECTION, "REGIONAL MINIMUM HOURLY BASE
 REIMBURSEMENT RATE" MEANS A REIMBURSEMENT RATE THAT REFLECTS:
   (1) 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:
   A.    BASE HOURLY WAGE GUARANTEED HOME CARE AIDES PURSUANT TO SUBDIVI-
 SION TWO OF THIS SECTION;
   B.  OVERTIME COSTS;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03863-01-5
 A. 1112                             2
              

 
   C.  EMPLOYEE BENEFITS, INCLUDING BOTH PAID TIME OFF  AND  SUPPLEMENTAL
 BENEFITS OR BENEFITS AS DETERMINED BY COLLECTIVE BARGAINING AGREEMENTS;
   D.  FEDERAL INSURANCE CONTRIBUTIONS ACT;
   E.  MEDICARE;
   F.  FEDERAL UNEMPLOYMENT TAX ACT;
   G.  WORKER WAGE PARITY AS PROVIDED BY SECTION THIRTY-SIX HUNDRED FOUR-
 TEEN-C OF THIS ARTICLE, AS APPLICABLE;
   H.  OTHER PAYROLL TAXES;
   I.  FAIR LABOR STANDARDS ACT COMPLIANCE;
   J.  NEW YORK STATE LABOR LAW COMPLIANCE;
   K.  COVID-19 SICK PAY;
   L.  STATE UNEMPLOYMENT INSURANCE;
   M.  DISABILITY  INSURANCE;
   N.  WORKERS' COMPENSATION;
   O.  TRAVEL TIME AND TRAVEL REIMBURSEMENT;
   P.  THE METROPOLITAN TRANSPORTATION AUTHORITY TAX; AND
   Q.  RELATED INCREASES  TIED  TO  BASE  WAGES;
   (2)    A COMPONENT TO REFLECT OPERATIONAL EXPENSES NECESSARY TO COMPLY
 WITH FEDERAL AND STATE STATUTORY AND REGULATORY  REQUIREMENTS  FOR  SUCH
 PROVIDERS, AND WHICH SHALL INCLUDE:
   A.   OPERATIONAL SUPERVISION AND SUPPORT, INCLUDING BUT NOT LIMITED TO
 NURSING STAFF, HOME HEALTH AIDE SUPERVISION AND TEAM SUPPORT; AND
   B.  OTHER OPERATIONAL SUPPORT, INCLUDING BUT NOT  LIMITED  TO  QUALITY
 ASSURANCE AND IMPROVEMENT PROGRAMS, EDUCATION AND RECRUITMENT; AND
   (3)  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, MARGIN AND COMMUNI-
 CATIONS.
   (C) THE REGIONAL MINIMUM HOURLY BASE RATE CANNOT BE LESS THAN THE MOST
 CURRENT AVERAGE FEE FOR SERVICE COUNTY RATES FOR LEVEL TWO PERSONAL CARE
 SERVICE FOR EACH REGION AS POSTED BY THE DEPARTMENT  FOR  PERSONAL  CARE
 AGENCIES OR OTHER PROVIDERS DELIVERING LIKE SERVICES THROUGH OTHER MEDI-
 CAID PROGRAMS.
   (D)  ONCE  A REGIONAL   MINIMUM  HOURLY  BASE REIMBURSEMENT  RATE  HAS
 BEEN ESTABLISHED  UNDER  THIS  SECTION, THE COMMISSIONER SHALL THEREAFT-
 ER ANNUALLY ADJUST THE REGIONAL HOURLY BASE   REIMBURSEMENT   RATE   FOR
 EACH REGION  BY A TREND FACTOR TO REFLECT AND ACCOMMODATE ANY ADDITIONAL
 LABOR LAW INCREASES, CHANGES OR MANDATES.
   6.  FOR  MAINSTREAM  MANAGED CARE AND FULLY CAPITATED MEDICAID MANAGED
 CARE PRODUCTS FOR THOSE DUALLY ELIGIBLE FOR BOTH MEDICAID AND  MEDICARE,
 THE  COMMISSIONER  SHALL  SUBMIT  ANY AND ALL NECESSARY APPLICATIONS FOR
 APPROVALS AND/OR WAIVERS TO THE FEDERAL CENTERS FOR MEDICARE  AND  MEDI-
 CAID  SERVICES  TO  SECURE APPROVAL TO ESTABLISH REGIONAL MINIMUM HOURLY
 BASE REIMBURSEMENT RATES AND MAKE STATE-DIRECTED PAYMENTS    THROUGH  TO
 PROVIDERS  FOR THE PURPOSES OF SUPPORTING WAGE INCREASES.
   (A)  IF  APPROVED  BY  THE  FEDERAL  CENTERS FOR MEDICARE AND MEDICAID
 SERVICES, DIRECTED  PAYMENTS  SHALL  BE  MADE TO SUCH PROVIDERS OF MEDI-
 CAID SERVICES THROUGH CONTRACTS WITH MANAGED  CARE  ORGANIZATIONS  WHERE
 APPLICABLE,  PROVIDED  THAT  THE COMMISSIONER ENSURES THAT SUCH DIRECTED
 PAYMENTS ARE IN ACCORDANCE WITH THE TERMS OF THIS SECTION.
   (B) IF THE STATE DIRECTED PAYMENT IS NOT APPROVED, THE  PROVISIONS  OF
 SUBDIVISION SEVEN OF THIS SECTION SHALL APPLY.
   7.  FOR  PARTIALLY  CAPITATED  MANAGED  LONG TERM CARE PLANS, OR WHERE
 STATE DIRECTED PAYMENTS PURSUANT TO SUBDIVISION SIX OF THIS SECTION HAVE
 NOT BEEN  APPROVED,  THE  DEPARTMENT  SHALL  REQUIRE  PLANS  TO  JUSTIFY
 A. 1112                             3
 
 CONTRACTS  OFFERING  DEVIATIONS  FROM  THE  REGIONAL MINIMUM HOURLY BASE
 REIMBURSEMENT RATES IN A REPORT TO THE DEPARTMENT. THIS REPORT SHALL  BE
 SENT  TO THE DEPARTMENT, WITH A COPY TO THE PROVIDER PRIOR TO THE FINAL-
 IZING OF ANY CONTRACT, UNLESS OTHERWISE PERMITTED BY THIS SECTION, WITH-
 IN  FIVE  WORKING  DAYS OF THE CONTRACT BEING OFFERED TO A PROVIDER WITH
 RATE DEVIATIONS.  ANY REPORT SHALL INCLUDE A RATIONALE FOR PAYING  BELOW
 THE  REGIONAL MINIMUM  HOURLY  BASE REIMBURSEMENT RATE, AND THE IMPACTED
 PROVIDER SHALL HAVE THE OPPORTUNITY TO  RESPOND  TO  THE  REPORT  WITHIN
 THIRTY DAYS OF FILING WITH THE DEPARTMENT.  THE DEPARTMENT SHALL COMPILE
 SUCH REPORTS AND PUBLISH AND POST A SUMMARY OF THEM SEMI-ANNUALLY.
   8.   THE  COMMISSIONER  SHALL  ESTABLISH  ACTUARIALLY  SOUND  REGIONAL
 REIMBURSEMENT RATE RANGES FOR MEDICAID  MANAGED  CARE  ORGANIZATIONS  IN
 ORDER  TO  COMPLY  WITH THIS SECTION.  THESE RANGES WILL REFLECT MANAGED
 CARE ADJUSTMENTS INCLUDING BUT NOT LIMITED TO:  (A)  MANAGED  CARE  PLAN
 VARIATIONS  IN  UTILIZATIONS  FROM THE REGIONAL UTILIZATION AVERAGE; (B)
 THE IMPACT OF RISK ADJUSTMENT;  AND (C) PREMIUM WITHHOLDS.  RATE  RANGES
 SHALL ALSO ACCOUNT FOR QUALITY INCENTIVES, VOLUME, COSTS ASSOCIATED WITH
 VALUE-BASED ARRANGEMENTS, AND REIMBURSEMENT FOR INDIVIDUALS WITH HARD TO
 SERVE NEEDS.
   9. NOTHING IN THIS SECTION SHALL  PRECLUDE  PROVIDERS  EMPLOYING  HOME
 HEALTH  AIDES    COVERED   UNDER   THIS SECTION OR PAYERS FROM PAYING OR
 CONTRACTING FOR SERVICES  AT  RATES  HIGHER  THAN  THE  REGIONAL   MINI-
 MUM HOURLY BASE REIMBURSEMENT RATE IF THE PARTIES MUTUALLY AGREE TO SUCH
 TERMS.  NOTWITHSTANDING  SUBDIVISION  SEVEN  OF  THIS SECTION, PLANS AND
 PROVIDERS CAN ALSO MUTUALLY AGREE TO ENTER INTO VALUE-BASED CONTRACTS AT
 A RATE LESS THAN THE REGIONAL  MINIMUM  HOURLY BASE REIMBURSEMENT RATE.
   10.  THE COMMISSIONER SHALL AMEND THE MODEL MANAGED CARE CONTRACTS  TO
 REFLECT  THE REQUIREMENTS OF THIS SECTION. IN ADDITION, THE COMMISSIONER
 SHALL POST THE MANAGED CARE, CERTIFIED AND LICENSED HOME  CARE  SERVICES
 AGENCIES   AND FISCAL INTERMEDIARIES COST REPORT DATA IN A SIMPLE UNDER-
 STANDABLE MANNER ON THE DEPARTMENT'S WEBSITE BY THE FIFTEENTH OF  FEBRU-
 ARY SECOND SUCCEEDING THE EFFECTIVE DATE OF THIS SUBDIVISION AND ANNUAL-
 LY THEREAFTER.
   11.  THE  COMMISSIONER  SHALL PUBLISH AND POST REGIONAL MINIMUM HOURLY
 BASE REIMBURSEMENT RATES ANNUALLY, AND SHALL TAKE  ALL  NECESSARY  STEPS
 TO  ADVISE  COMMERCIAL    AND  GOVERNMENT  PROGRAMS  PAYERS OF HOME CARE
 SERVICES OF THE REGIONAL MINIMUM HOURLY  BASE  REIMBURSEMENT  RATES.
   12. TO ENSURE COMPLIANCE WITH  MINIMUM WAGE INCREASES, THE COMPTROLLER
 SHALL HAVE THE AUTHORITY TO REVIEW THE CONTRACTS ENTERED INTO BETWEEN  A
 MANAGED  CARE  ORGANIZATION  AND  A  LICENSED HOME CARE SERVICES AGENCY,
 FISCAL INTERMEDIARY, OR ANY AGENCY SUBJECT TO  THE  PROVISIONS  OF  THIS
 SECTION  TO  ENSURE  THAT  RATES BEING OFFERED ARE ADEQUATE AND MEET THE
 DEPARTMENT'S ACTUARIAL STANDARDS. THE COMPTROLLER, IN CONSULTATION  WITH
 THE  MEDICAID  INSPECTOR GENERAL, SHALL DEVELOP AND PROMULGATE A PROCESS
 TO ENSURE SUCH AUDITS COMPLY WITH  STATE  AND  FEDERAL  LAW  TO  PROTECT
 PROPRIETARY INFORMATION AND CONTRACTS. IN THE EVENT THAT THE COMPTROLLER
 FINDS EVIDENCE THAT MANAGED CARE ORGANIZATIONS ARE NOT PAYING SUFFICIENT
 ADEQUATE RATES, THEY WILL REFER SUCH INSTANCES TO THE DEPARTMENT AND THE
 MEDICAID  FRAUD  CONTROL  UNIT FOR ENFORCEMENT. IF THE DEPARTMENT OR THE
 MEDICAID FRAUD CONTROL UNIT CHOOSES NOT TO PURSUE ACTION RELATED TO THIS
 REFERRAL, IT SHALL INFORM, IN WRITING, THE COMPTROLLER'S  OFFICE  AS  TO
 THE  REASONING.  SUCH  REPORTS, AND THE DEPARTMENT'S RESPONSES, SHALL BE
 PUBLIC INFORMATION AND MADE AVAILABLE ON THE COMPTROLLER'S WEBSITE.
   § 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
 A. 1112                             4
 
 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.