S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4162--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 31, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation to rates of reimbursement for private duty nursing

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 11 of section 3614 of the public health law  is
 amended by adding a new paragraph (d) to read as follows:
   (D)  FOR  ENROLLEES COVERED BY MEDICAID AS OF JANUARY FIRST, TWO THOU-
 SAND TWENTY-SIX UNDER A PAYMENT RATE  METHODOLOGY  AGREEMENT  NEGOTIATED
 WITH  A  LICENSED HOME CARE SERVICES PROVIDER, INCLUDING BUT NOT LIMITED
 TO SERVICES PROVIDED  THROUGH  LICENSED  HOME  CARE  SERVICES  AGENCIES,
 PAYMENTS FOR ALL HOURLY HOME CARE SERVICES PROVIDED THROUGH PRIVATE DUTY
 NURSING,  INCLUDING  BUT  NOT  LIMITED  TO NURSING SERVICES, PROVIDED TO
 PATIENTS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT  TO  TITLE  ELEVEN  OF
 ARTICLE  FIVE OF THE SOCIAL SERVICES LAW MADE BY ORGANIZATIONS OPERATING
 IN ACCORDANCE WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF THIS  CHAPTER
 OR  BY  HEALTH  MAINTENANCE  ORGANIZATIONS  ORGANIZED  AND  OPERATING IN
 ACCORDANCE WITH ARTICLE FORTY-THREE OF THE INSURANCE  LAW  SHALL,  AT  A
 MINIMUM,  BE AT A BENCHMARK RATE WHICH IS TO BE THE FEE-FOR-SERVICE RATE
 CALCULATED PURSUANT TO THIS CHAPTER AND AS IN EFFECT AT  THE  TIME  SUCH
 SERVICES WERE PROVIDED.
   §  2.  Section 364-j of the social services law is amended by adding a
 new subdivision 40 to read as follows:
   40. FOR ENROLLEES COVERED BY MEDICAID AS OF JANUARY FIRST,  TWO  THOU-
 SAND  TWENTY-SIX  UNDER  A PAYMENT RATE METHODOLOGY AGREEMENT NEGOTIATED
 WITH A LICENSED HOME CARE SERVICES PROVIDER, INCLUDING BUT  NOT  LIMITED
 TO  SERVICES  PROVIDED  THROUGH  LICENSED  HOME  CARE SERVICES AGENCIES,
 PAYMENTS FOR ALL HOURLY HOME CARE SERVICES PROVIDED THROUGH PRIVATE DUTY
 NURSING, INCLUDING BUT NOT LIMITED  TO  NURSING  SERVICES,  PROVIDED  TO
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03865-04-5
              

 A. 4162--A                          2
 
 PATIENTS ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS TITLE MADE BY ORGAN-
 IZATIONS  OPERATING  IN ACCORDANCE WITH THE PROVISIONS OF ARTICLE FORTY-
 FOUR OF THE PUBLIC HEALTH LAW OR  BY  HEALTH  MAINTENANCE  ORGANIZATIONS
 ORGANIZED  AND  OPERATING  IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE
 INSURANCE LAW SHALL, AT A MINIMUM, BE THE RATES OF PAYMENT THAT WOULD BE
 PAID FOR SUCH PATIENTS PURSUANT TO SUBDIVISION ELEVEN OF  SECTION  THIR-
 TY-SIX HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW.
   §  3.  Effective  July  1,  2026,  payments  for  private duty nursing
 services shall be  no  less  than  eighty  percent  of  the  appropriate
 CHAMPUS/TRICARE maximum allowable charge based on the New York locality.
 For  purposes of implementation, the appropriate CHAMPUS/TRICARE maximum
 allowable charge shall be the CHAMPUS/TRICARE maximum  allowable  charge
 in  effect  as of April 1 of the state fiscal year in which the services
 are rendered. The department of health shall publish a private duty rate
 schedule at least thirty days prior to  the  effective  date  of    such
 increase and annually thereafter.
   §  4.  This act shall take effect immediately; provided, however, that
 the amendments to section 364-j of  the  social  services  law  made  by
 section  two of this act shall not affect the repeal of such section and
 shall be deemed repealed therewith.