S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2735
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 22, 2025
                                ___________
 
 Introduced by M. of A. STIRPE -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the social services law, in relation to the licensure of
   fiscal  intermediaries,  and  to repeal certain provisions of such law
   relating thereto
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (i)  of paragraph (a) of subdivision 4-a of
 section 365-f of the social services law, as amended  by  section  1  of
 part  HH  of  chapter  57  of  the  laws  of 2024, is amended to read as
 follows:
   (i) "[Statewide fiscal] FISCAL  intermediary"  means  an  entity  that
 provides  fiscal  intermediary services and has a contract for providing
 such services with [the]:
   (A) A LOCAL department of SOCIAL SERVICES;
   (B) A health [and is selected through] MAINTENANCE ORGANIZATION CERTI-
 FIED  PURSUANT  TO  ARTICLE  FORTY-FOUR  OF  the  [procurement   process
 described in paragraph (b)] PUBLIC HEALTH LAW; OR
   (C)  AN  ACCOUNTABLE  CARE  ORGANIZATION CERTIFIED PURSUANT TO ARTICLE
 TWENTY-NINE-E of [this subdivision] THE PUBLIC HEALTH LAW, OR  AN  INTE-
 GRATED DELIVERY SYSTEM THAT IS COMPOSED PRIMARILY OF HEALTH CARE PROVID-
 ERS  AND  RECOGNIZED  BY  THE DEPARTMENT AS A PERFORMING PROVIDER SYSTEM
 UNDER THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT PROGRAM.
   § 2. Subparagraphs (ii-a), (ii-b), and (ii-c)  of  paragraph  (a)  and
 paragraph (b) of subdivision 4-a of section 365-f of the social services
 law are REPEALED.
   §  3.  Paragraph (c) of subdivision 4-a of section 365-f of the social
 services law, as added by section 1-a of part K of  chapter  57  of  the
 laws  of 2018 and relettered by section 2 of part G of chapter 57 of the
 laws of 2019, subparagraph (i) as amended by section  5  of  part  G  of
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04005-01-5
 A. 2735                             2
              

 
 chapter  57 of the laws of 2019, is relettered paragraph (b) and amended
 and two new paragraphs (c) and (d) are added to read as follows:
   (b)  (i)  The commissioner shall require [a] EACH fiscal intermediary,
 INCLUDING BUT NOT LIMITED TO FISCAL INTERMEDIARIES THAT CONTRACT WITH  A
 MANAGED CARE PROGRAM, AS DEFINED BY  PARAGRAPH (C) OF SUBDIVISION ONE OF
 SECTION  THREE  HUNDRED  SIXTY-FOUR-J OF THIS ARTICLE, OR AN ACCOUNTABLE
 CARE ORGANIZATION CERTIFIED PURSUANT TO  ARTICLE  TWENTY-NINE-E  OF  THE
 PUBLIC HEALTH LAW, to report annually on:
   (A)  the  direct  care and administrative costs of personal assistance
 services as accounted for by the fiscal intermediary;
   (B) THE NUMBER OF MEMBERS SERVICED;
   (C) THE FISCAL INTERMEDIARY'S SERVICE AREA;
   (D) THE NUMBER OF PERSONAL ASSISTANTS EMPLOYED BY CONSUMERS, INCLUDING
 THE NUMBER OF HOURS WORKED BY EACH SUCH PERSONAL ASSISTANT,  AND  PERIOD
 OF EMPLOYMENT IN PERSONAL CARE OF EACH SUCH PERSONAL ASSISTANT, AND EACH
 SUCH PERSONAL ASSISTANT'S RELATIONSHIP WITH THE CONSUMER;
   (E) THE NUMBER OF AUTHORIZED HOURS PER CONSUMER SERVICED;
   (F) THE NUMBER OF HOURS OF SERVICE BILLED PER CONSUMER;
   (G) THE SELF-DIRECTING STATUS OF THE CONSUMER; AND
   (H) ANY OTHER INFORMATION, AS DETERMINED BY THE COMMISSIONER.
   (II)  The  department shall specify the format of such reports, deter-
 mine the type and amount of information to be submitted, and require the
 submission of supporting  documentation,  provided,  however,  that  the
 department  shall  provide  no  less  than  ninety calendar days' notice
 before such reports are due.
   [(ii)] (III) If the  department  determines  that  the  [cost]  report
 submitted  by  a  provider  is  inaccurate or incomplete, the department
 shall notify the provider in writing and  advise  the  provider  of  the
 correction  or additional information that the provider must submit. The
 provider must submit the  corrected  or  additional  information  within
 thirty calendar days from the date the provider receives the notice.
   [(iii)] (IV) The department shall grant a provider an additional thir-
 ty  calendar days to submit the original, corrected or additional [cost]
 report when the provider, prior to the date the report is due, submits a
 written request to the department for an extension  and  establishes  to
 the department's satisfaction that the provider cannot submit the report
 by the date due for reasons beyond the provider's control.
   [(iv)] (V) All reports shall be certified by the owner, administrator,
 chief  executive  officer, or public official responsible for the opera-
 tion of the provider. The [cost] report [form] shall include  a  certif-
 ication form, which shall specify who must certify the report.
   (C) (I) ON AND AFTER APRIL FIRST, TWO THOUSAND TWENTY-SEVEN, NO ENTITY
 SHALL   PROVIDE,  DIRECTLY  OR  THROUGH  CONTRACT,  FISCAL  INTERMEDIARY
 SERVICES WITHOUT A LICENSE  AS  A  FISCAL  INTERMEDIARY  ISSUED  BY  THE
 COMMISSIONER  IN ACCORDANCE WITH THIS SUBDIVISION.  THE COMMISSIONER MAY
 GRANT AN ENTITY THAT HAS FILED FOR LICENSURE PRIOR TO SUCH  DATE  TEMPO-
 RARY  AUTHORITY  TO  CONTINUE OPERATING AS A FISCAL INTERMEDIARY PENDING
 SUCH ENTITY'S APPLICATION  REVIEW  AND  A  FINAL  DETERMINATION  BY  THE
 COMMISSIONER. THE COMMISSIONER SHALL MAKE REGULATIONS AND ISSUE GUIDANCE
 TO  ENSURE THE ORDERLY TRANSITION OF CONSUMERS AND PERSONAL CARE ASSIST-
 ANTS THAT ARE RECEIVING  FISCAL  INTERMEDIARY  SERVICES  FROM  A  FISCAL
 INTERMEDIARY  THAT  WILL NOT BE LICENSED ON OR AFTER APRIL 1, 2027. SUCH
 REGULATIONS AND GUIDANCE MAY, AT THE COMMISSIONER'S DISCRETION,  INCLUDE
 AUTHORIZATION FOR A FISCAL INTERMEDIARY THAT IS NOT LICENSED TO CONTINUE
 OPERATING ON A TEMPORARY BASIS AS CONSUMERS AND PERSONAL CARE ASSISTANTS
 TRANSITION TO A LICENSED FISCAL INTERMEDIARY.
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   (II)  AN  APPLICATION FOR LICENSURE AS A FISCAL INTERMEDIARY, AND SUCH
 OTHER FORMS AND INFORMATION AS PRESCRIBED BY THE COMMISSIONER, SHALL  BE
 FILED  WITH  THE  COMMISSIONER.  THE  COMMISSIONER  SHALL NOT APPROVE AN
 APPLICATION FOR LICENSURE UNLESS SUCH COMMISSIONER IS SATISFIED  REGARD-
 ING  THE  CHARACTER,  COMPETENCE,  AND  STANDING IN THE COMMUNITY OF THE
 APPLICANT'S INCORPORATORS, DIRECTORS, SPONSORS, STOCKHOLDERS, OR  OPERA-
 TORS  AND  FINDS THAT THE PERSONNEL, RULES, CONSUMER CONTRACTS OR AGREE-
 MENTS, AND FISCAL INTERMEDIARY SERVICES ARE FIT AND ADEQUATE.
   (III) IN DETERMINING CHARACTER AND COMPETENCE PURSUANT TO SUBPARAGRAPH
 (II) OF THIS PARAGRAPH, THE COMMISSIONER SHALL CONSIDER, BUT  SHALL  NOT
 BE LIMITED TO, THE FOLLOWING FACTORS:
   (A) HISTORICAL COMPLIANCE WITH SUBMISSION OF COST REPORTS;
   (B)  DEMONSTRATED  CULTURAL  AND LANGUAGE COMPETENCIES SPECIFIC TO THE
 POPULATION OF CONSUMERS AND THOSE OF THE AVAILABLE WORKFORCE;
   (C) DEMONSTRATED ABILITY TO COMPLY WITH ELECTRONIC VISIT  VERIFICATION
 REQUIREMENTS; AND
   (D) DEMONSTRATED COMPLIANCE WITH ALL APPLICABLE FEDERAL AND STATE LAWS
 AND REGULATIONS.
   (IV) AS A CONDITION OF PARTICIPATION IN THE STATE'S MEDICAL ASSISTANCE
 PROGRAM  AND LICENSURE, NO FISCAL INTERMEDIARY SHALL ENGAGE IN ADVERTIS-
 ING UNLESS IN ACCORDANCE WITH REGULATIONS PROMULGATED BY THE COMMISSION-
 ER.  FOR THE PURPOSES OF THIS SUBPARAGRAPH, "ADVERTISEMENT"  SHALL  MEAN
 ANY  MATERIAL  PRODUCED IN ANY MEDIUM THAT CAN REASONABLY BE INTERPRETED
 AS INTENDED TO  MARKET  A  FISCAL  INTERMEDIARY'S  SERVICES  TO  MEDICAL
 ASSISTANCE RECIPIENTS.
   (V)  FISCAL  INTERMEDIARIES  GRANTED  LICENSURE UNDER THIS SUBDIVISION
 SHALL COMPLY WITH ALL  RULES  AND  REGULATIONS,  AS  DETERMINED  BY  THE
 COMMISSIONER.    FAILURE TO COMPLY WITH THIS SECTION SHALL RESULT IN THE
 IMPOSITION OF PENALTIES, REDUCTION OF RATES, OR  ACTIONS  INVOLVING  THE
 LICENSE, AS THE COMMISSIONER DEEMS APPROPRIATE.
   (VI)  THE  COMMISSIONER  SHALL  CHARGE  APPLICANTS  FOR LICENSURE AS A
 FISCAL INTERMEDIARY A ONE-TIME APPLICATION FEE OF TEN THOUSAND DOLLARS.
   (D) (I) THE DEPARTMENT SHALL ESTABLISH AND MAINTAIN A PERSONAL ASSIST-
 ANT REGISTRY FOR PERSONAL ASSISTANTS EMPLOYED BY EACH CONSUMER UNDER THE
 PROGRAM. THE DEPARTMENT SHALL DETERMINE THE METHOD OF  REGISTRATION  AND
 THE  DOCUMENTATION  REQUIRED TO REGISTER. THE DEPARTMENT SHALL ASSESS NO
 FEE OR CHARGE FOR SUCH REGISTRATION.
   (II) IT SHALL BE THE RESPONSIBILITY OF EACH FISCAL  INTERMEDIARY  THAT
 IS GRANTED LICENSURE UNDER THIS SUBDIVISION TO REGISTER WITH THE DEPART-
 MENT EACH PERSONAL ASSISTANT THAT IS EMPLOYED BY EACH CONSUMER UNDER THE
 PROGRAM.
   (III) SUCH REGISTRY SHALL BE KEPT CONFIDENTIAL AND SHALL NOT BE AVAIL-
 ABLE TO THE PUBLIC. THE DEPARTMENT SHALL UTILIZE SUCH REGISTRY TO AID IN
 THE OVERSIGHT OF THE PROGRAM AND FRAUD AND ABUSE INVESTIGATIONS.
   §  4. Subdivision 4-a-1 of section 365-f of the social services law is
 REPEALED.
   § 5. Subdivision 4-b of section 365-f of the social services  law,  as
 amended  by  section  5 of part HH of chapter 57 of the laws of 2024, is
 amended to read as follows:
   4-b. Actions involving the [registration] LICENSURE of a fiscal inter-
 mediary.
   (a) A fiscal intermediary's [registration]  LICENSE  may  be  revoked,
 suspended,  limited,  or annulled by the commissioner upon [thirty days'
 written notice to the fiscal intermediary, if] the [commissioner  finds]
 COMMISSIONER'S  RECEIPT OF PROOF that the fiscal intermediary has failed
 A. 2735                             4
 
 to comply with the provisions of SUBDIVISION FOUR-A OF this  section  or
 regulations promulgated hereunder.
   (b)  [The  commissioner]  NO SUCH LICENSE SHALL BE REVOKED, SUSPENDED,
 LIMITED, ANNULLED, OR DENIED PURSUANT TO PARAGRAPH (A) OF THIS  SUBDIVI-
 SION  WITHOUT A HEARING. HOWEVER, A LICENSE may [issue orders] BE TEMPO-
 RARILY SUSPENDED OR LIMITED WITHOUT A HEARING FOR A PERIOD NOT IN EXCESS
 OF FORTY-FIVE DAYS  UPON  WRITTEN  NOTICE  TO  THE  FISCAL  INTERMEDIARY
 FOLLOWING  A  FINDING BY THE DEPARTMENT THAT THE PUBLIC HEALTH OR SAFETY
 IS IN IMMINENT DANGER. SUCH PERIOD MAY BE RENEWED FOR UP  TO  TWO  ADDI-
 TIONAL  PERIODS  NOT  EXCEEDING  THIRTY DAYS, RESPECTIVELY, UPON WRITTEN
 NOTICE, INCLUDING AN OPPORTUNITY TO  SUBMIT  EVIDENCE  and  [take  other
 actions as necessary] WRITTEN ARGUMENT IN OPPOSITION TO THE RENEWAL, and
 [appropriate]  A CONTINUED FINDING PURSUANT to [prohibit and prevent the
 provision of fiscal intermediary services  by  an  unregistered  entity]
 THIS PARAGRAPH.
   (c)  THE  COMMISSIONER  SHALL FIX A TIME AND PLACE FOR THE HEARING.  A
 COPY OF THE CHARGES, TOGETHER WITH THE NOTICE OF THE TIME AND  PLACE  OF
 THE HEARING, SHALL BE SERVED IN PERSON OR MAILED BY REGISTERED OR CERTI-
 FIED  MAIL  TO THE FISCAL INTERMEDIARY AT LEAST TWENTY-ONE DAYS PRIOR TO
 THE DATE FIXED FOR THE HEARING. THE FISCAL INTERMEDIARY SHALL FILE  WITH
 THE  DEPARTMENT  A WRITTEN ANSWER TO THE CHARGES AT LEAST TEN DAYS PRIOR
 TO THE DATE FIXED FOR THE HEARING.
   (D) All orders or  determinations  under  this  subdivision  shall  be
 subject  to  review  as  provided  in article seventy-eight of the civil
 practice law and rules.
   § 6. Subdivision 4-c of section 365-f of the social services  law,  as
 added  by  section  6  of  part  G of chapter 57 of the laws of 2019, is
 amended to read as follows:
   4-c. (A) The commissioner shall convene and chair a stakeholder  work-
 group  pertaining  to  fiscal  intermediary  services  and  the needs of
 consumers.   The workgroup shall consist of,  at  a  minimum,  represen-
 tatives  of  service  centers  for independent living; statewide associ-
 ations of fiscal intermediaries; representatives of managed  care  enti-
 ties  under article forty-four of the public health law and local social
 service districts; consumers OR REPRESENTATIVES OF SUCH  CONSUMERS;  and
 representatives  of  advocacy  groups representing consumers of services
 under this section. The workgroup shall be established no later than May
 fifteenth, two thousand [nineteen] TWENTY-SIX.
   (B) The workgroup shall:
   (I) identify and develop best practices pertaining to the delivery  of
 fiscal  intermediary  services;  [inform  the  criteria  for  use by the
 department for the selection]
   (II) ANALYZE TRENDS ON AUTHORIZATION of  [entities  under  subdivision
 four-a  of  this section; identify whether] services [differ for certain
 consumers and] under [what circumstances; inform  criteria  in  relation
 to]  the  [development  of quality reporting requirements; and work with
 the department] PROGRAM to [develop transition plans for consumers  that
 may  need]  DETERMINE  WHETHER  AUTHORIZED HOURS ARE CONSISTENT WITH THE
 PLAN OF CARE AND ASSESSMENT;
   (III) ANALYZE KEY INDICES OR METRICS UNDER  THE  PROGRAM  COMPARED  to
 [transition] PERSONAL CARE SERVICES DELIVERED THROUGH LICENSED HOME CARE
 AGENCIES; AND
   (IV) ISSUE RECOMMENDATIONS FOR AREAS OF POTENTIAL IMPROVEMENT OR CHAL-
 LENGES RELATING to [another fiscal intermediary] ACCESS, DELIVERY, QUAL-
 ITY,  OUTCOMES,  ADMINISTRATIVE  COSTS,  EFFICIENCIES, COST SAVINGS, AND
 OTHER IMPACTS ON ENROLLEES THAT MAY RESULT FROM  THE  IMPLEMENTATION  OF
 A. 2735                             5
 
 ANY  SUCH RECOMMENDATIONS, INCLUDING HOW SUCH RECOMMENDATIONS MAY IMPACT
 ENROLLEES' ABILITY TO SELF-DIRECT SUCH ENROLLEES' OWN SERVICES.
   (C) NO LATER THAN DECEMBER FIRST, TWO THOUSAND TWENTY-SIX, AND ANNUAL-
 LY  THEREAFTER, THE WORKGROUP SHALL REPORT ON ITS FINDINGS AND RECOMMEN-
 DATIONS TO THE COMMISSIONER, THE SPEAKER OF THE ASSEMBLY, AND THE TEMPO-
 RARY PRESIDENT OF THE SENATE. THE COMMISSIONER SHALL GATHER AND DISCLOSE
 SUCH DATA CONTAINED IN SUCH ANNUAL REPORTS AS THE WORKGROUP  MEMBERS  OR
 THE  COMMISSIONER  DETERMINES NECESSARY TO FACILITATE THE EFFORTS OF THE
 WORKGROUP.
   § 7. Subdivision 5 of section 365-f  of  the  social  service  law  is
 amended by adding a new paragraph (c) to read as follows:
   (C)  (I)  NOTWITHSTANDING ANY OTHER PROVISION OF LAW, THE COMMISSIONER
 IS AUTHORIZED  TO  PROMULGATE  REGULATIONS  REGARDING  MINIMUM  TRAINING
 REQUIREMENTS  FOR  PERSONAL ASSISTANTS. SUCH TRAINING REQUIREMENTS SHALL
 MEET A CURRICULUM DETERMINED BY THE COMMISSIONER AND SHALL, AT  A  MINI-
 MUM,  PROVIDE  BASIC  CORE KNOWLEDGE AND SKILLS THAT PERSONAL ASSISTANTS
 NEED TO LEARN AND UNDERSTAND TO EFFECTIVELY AND SAFELY PROVIDE  CARE  TO
 CONSUMERS.  SUCH  TRAINING  SHALL  TAKE  INTO  ACCOUNT CERTAIN CRITERIA,
 INCLUDING BUT NOT LIMITED TO THE RELATIONSHIP OF THE PERSONAL  ASSISTANT
 TO  THE CONSUMER, THE LEVEL OF CARE THAT THE CONSUMER NEEDS AND THAT THE
 PERSONAL  ASSISTANT  WILL  PROVIDE,  AND  ANY  CERTIFICATIONS  THAT  THE
 PERSONAL  ASSISTANT  HOLDS.  THE  TRAINING  MAY VARY IN COMPETENCIES AND
 MINIMUM REQUIRED HOURS BASED ON SUCH CRITERIA.
   (II) SUCH TRAINING MAY BE DELIVERED THROUGH AN ORGANIZATION  OR  INDE-
 PENDENT  CONTRACTOR,  FREE  OF  CHARGE  TO  THE  PERSONAL ASSISTANT, AND
 CONDUCTED IN PERSON OR IN A VIRTUAL ENVIRONMENT.  FISCAL  INTERMEDIARIES
 SHALL CERTIFY, IN A MANNER DETERMINED BY THE COMMISSIONER, THAT PERSONAL
 ASSISTANTS  PROVIDING SERVICES TO ENROLLEES HAVE COMPLETED SUCH REQUIRED
 TRAINING.
   (III) THE COMMISSIONER SHALL DEVELOP REGULATIONS TO WAIVE SUCH  TRAIN-
 ING  REQUIREMENTS FOR CERTAIN INDIVIDUALS WHO HAVE ALREADY ATTAINED SUCH
 REQUISITE  TRAINING  THROUGH  APPROPRIATE  LICENSURE,  REGISTRATION,  OR
 CERTIFICATION  IN CONNECTION TO ANOTHER HEALTHCARE, AS DETERMINED BY THE
 COMMISSIONER. SUCH INDIVIDUALS SHALL STILL  BE  REGISTERED  AS  PERSONAL
 CARE  ASSISTANTS  WITH  THE DEPARTMENT PURSUANT TO SUBDIVISION FOUR-A OF
 THIS SECTION.
   § 8. Section 365-f of the social services law is amended by  adding  a
 new subdivision 5-a to read as follows:
   5-A. (A) TO ENSURE COMPLIANCE WITH THIS SECTION, THE COMPTROLLER SHALL
 HAVE  THE  AUTHORITY TO REVIEW CONTRACTS ENTERED INTO BY FISCAL INTERME-
 DIARIES AND ANY ENTITY SUBJECT TO THE  PROVISIONS  OF  THIS  SECTION  TO
 ENSURE  THAT SERVICES AND PAYMENTS UNDER THIS SECTION ARE BEING PROVIDED
 IN COMPLIANCE WITH STATE AND FEDERAL LAW. THE COMPTROLLER, IN  CONSULTA-
 TION  WITH THE MEDICAID FRAUD CONTROL UNIT, MAY DEVELOP AND PROMULGATE A
 PROCESS TO ENSURE SUCH AUDITS COMPLY WITH STATE AND FEDERAL LAW. IN  THE
 EVENT  THAT THE COMPTROLLER FINDS EVIDENCE THAT FISCAL INTERMEDIARIES OR
 ANY ENTITY SUBJECT TO THE PROVISIONS OF THIS SECTION ARE  ACTING  IN  AN
 UNLAWFUL  MANNER,  THE  COMMISSIONER  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, THE DEPARTMENT OR  THE  MEDICAID  FRAUD
 CONTROL  UNIT  SHALL  INFORM THE COMPTROLLER'S OFFICE, IN WRITING, AS TO
 THE REASONS WHY. SUCH REPORTS, AND THE DEPARTMENT'S RESPONSES, SHALL  BE
 MADE PUBLICLY AVAILABLE ON THE COMPTROLLER'S WEBSITE.
   (B)  FISCAL  INTERMEDIARIES  AND  ANY  OTHER  ENTITY  SUBJECT  TO  THE
 PROVISIONS OF THIS SECTION SHALL BE SUBJECT TO THE PROVISIONS OF SECTION
 A. 2735                             6
 
 ONE HUNDRED FORTY-FIVE-B OF THIS CHAPTER, SECTION THREE  HUNDRED  SIXTY-
 SIX-B OF THIS ARTICLE, AND ARTICLE THIRTEEN OF THE STATE FINANCE LAW.
   § 9. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 of part thereof directly involved in the controversy on which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 10. This act shall take effect immediately.