S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7583
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               April 1, 2025
                                ___________
 
 Introduced  by M. of A. ALVAREZ -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the social services  law,  in  relation  to  authorizing
   Medicaid coverage for complex care assistant services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The social services law is amended by adding a new  section
 365-q to read as follows:
   §  365-Q.  COMPLEX CARE ASSISTANT SERVICES PROGRAM. 1. AS USED IN THIS
 SECTION:
   (A) "FAMILY MEMBER" MEANS A PARENT, SIBLING, GRANDPARENT, LEGAL GUARD-
 IAN OR ANY OTHER INDIVIDUAL RELATED BY BLOOD; AND
   (B) "COMPLEX CARE ASSISTANT" MEANS A FAMILY MEMBER WHO IS CERTIFIED BY
 THE DEPARTMENT AFTER PASSING AN IN-PERSON EXAMINATION  WHICH  TESTS  THE
 PROFICIENCY  AND COMPETENCE OF PERFORMING THE TASKS REQUIRED TO CARE FOR
 A CHILD  OR  YOUNG  ADULT  WITH  DEVELOPMENTAL  DISABILITIES  WHICH  CAN
 INCLUDE,  BUT  IS NOT LIMITED TO, ALL ADAPTIVE LIVING SKILLS (ADL'S) AND
 INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL'S), AND PROVIDING ACADEMIC
 ASSISTANCE IN ACCORDANCE TO SUCH CHILD OR YOUNG ADULT'S LEVEL OF NEED.
   2. (A) NO LATER THAN ONE YEAR AFTER THIS SECTION SHALL HAVE  BECOME  A
 LAW AND RECEIPT OF FEDERAL APPROVAL FOR THE PROGRAM ESTABLISHED PURSUANT
 TO  THIS  SECTION, THE STATE MEDICAID DIRECTOR SHALL ESTABLISH A PROGRAM
 UNDER WHICH A FAMILY MEMBER OF AN ENROLLEE IN MEDICAID MAY BE  CERTIFIED
 AS A COMPLEX CARE ASSISTANT AND, AFTER RECEIVING SUCH CERTIFICATION MAY,
 UNDER  THE  DIRECTION  OF  A  CERTIFIED  COMPLEX CARE ASSISTANT, PROVIDE
 COMPLEX CARE ASSISTANT SERVICES TO THE ENROLLEE THROUGH A  COMPLEX  CARE
 AGENCY  UNDER THE REIMBURSEMENT RATES ESTABLISHED UNDER PARAGRAPH (F) OF
 THIS SUBDIVISION, PROVIDED THAT THE ENROLLEE IS A CHILD OR  YOUNG  ADULT
 WITH  DEVELOPMENTAL DISABILITIES AS DEFINED IN SUBDIVISION TWENTY-TWO OF
 SECTION 1.03 OF THE MENTAL HYGIENE LAW AND QUALIFIES FOR SERVICES  UNDER
 MEDICAID. SUCH PROGRAM SHALL OPERATE AS A NEW YORK MEDICAID PRIVATE DUTY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11246-01-5
              

 A. 7583                             2
 
 NURSING  BENEFIT.  THE  DEPARTMENT SHALL DEVELOP AN ASSESSMENT TOOL THAT
 WILL ALLOW THE DIVISION TO IDENTIFY ENROLLEES WHO MEET THESE ELIGIBILITY
 CRITERIA READILY.
   (B)  THE PROGRAM ESTABLISHED UNDER THIS SECTION SHALL REQUIRE A FAMILY
 MEMBER TO COMPLETE ALL TRAINING, TESTING, AND OTHER QUALIFICATION CRITE-
 RIA REQUIRED UNDER STATE AND FEDERAL LAW FOR CERTIFICATION AS A  COMPLEX
 CARE ASSISTANT. THE AGENCY THAT WILL EMPLOY THE FAMILY MEMBER TO PROVIDE
 COMPLEX  CARE ASSISTANT SERVICES TO THE ENROLLEE SHALL PAY ALL COSTS FOR
 THE FAMILY MEMBER TO BECOME CERTIFIED AS A COMPLEX CARE ASSISTANT AND TO
 RECEIVE CERTIFICATION AS A COMPLEX CARE ASSISTANT FROM THE DEPARTMENT OF
 HEALTH, BEFORE PROVIDING SERVICES UNDER THE PROGRAM ESTABLISHED PURSUANT
 TO THIS SECTION. IN NO CASE SHALL A FAMILY MEMBER WHO BECOMES A  COMPLEX
 CARE ASSISTANT UNDER THE PROVISIONS OF THIS SECTION BE REQUIRED TO REPAY
 OR  REIMBURSE THE LICENSED HOME CARE SERVICES AND CERTIFIED COMPLEX CARE
 AGENCIES FOR THE COSTS OF THE FAMILY  MEMBER  BECOMING  CERTIFIED  AS  A
 COMPLEX CARE ASSISTANT UNDER THE PROGRAM.
   (C)  AN  INDIVIDUAL  CERTIFIED TO PRACTICE AS A COMPLEX CARE ASSISTANT
 MUST COMPLETE A TRAINING PROGRAM AND SHALL PASS AN IN-PERSON EXAMINATION
 APPROVED BY THE DEPARTMENT OF HEALTH THAT DEMONSTRATES  THE  APPLICANT'S
 COMPETENCE  AND  PROFICIENCY.  IF  THE  DEPARTMENT OF HEALTH SELECTS THE
 OPTION OF UTILIZING DESIGNATED HOME CARE PROVIDERS TO PROVIDE THE TRAIN-
 ING, THE DEPARTMENT SHALL ADEQUATELY REIMBURSE SUCH DESIGNATED PROVIDERS
 FOR PROVIDING THE TRAINING TO FAMILY CAREGIVERS OF ELIGIBLE RELATIVES.
   (D) THE SERVICES RECEIVED UNDER THIS PROGRAM  BY  AN  ELIGIBLE  MEMBER
 FROM  A  COMPLEX  CARE  ASSISTANT SHALL NOT EXCEED FORTY HOURS PER WEEK.
 NOTHING IN THIS PARAGRAPH SHALL RESTRICT  UNPAID  SERVICES  PROVIDED  AS
 PART OF THE FAMILY CAREGIVER'S FAMILIAL OR HOUSEHOLD RELATIONSHIP TO THE
 ELIGIBLE RELATIVE.
   (E)  A COMPLEX CARE ASSISTANT SHALL NOT PROVIDE QUALIFIED COMPLEX CARE
 ASSISTANT SERVICES TO AN ELIGIBLE MEMBER UNLESS THE PLAN OF CARE FOR THE
 ELIGIBLE MEMBER IS RECERTIFIED  BY  THE  PROVIDER  AT  LEAST  EVERY  ONE
 HUNDRED  EIGHTY CALENDAR DAYS. REGISTERED NURSE SUPERVISORY VISITS SHALL
 OCCUR REGULARLY TO  ENSURE  SUPPORT  FOR  ALL  COMPLEX  CARE  ASSISTANTS
 ASSIGNED  TO AN ELIGIBLE MEMBER AND THE ABILITY TO COMPLETE ALL TASKS AS
 OUTLINED IN THE MEMBER'S CARE PLAN.
   (F) COMPLEX CARE ASSISTANT SERVICES PROVIDED BY A FAMILY MEMBER  OF  A
 MEDICAID  ENROLLEE  WHO  BECOMES  CERTIFIED  AS A COMPLEX CARE ASSISTANT
 UNDER THE PROGRAM ESTABLISHED PURSUANT TO THIS SECTION  SHALL  BE  REIM-
 BURSED  TO  A  COMPLEX  CARE  AGENCY  AT A RATE THAT IS NO MORE THAN THE
 CURRENT BASE REIMBURSEMENT RATE FOR COMPLEX CARE SERVICES AND  DEPENDENT
 UPON  WHETHER  THE  SERVICES  ARE  PROVIDED  IN  THE DOWNSTATE REGION OR
 UPSTATE REGION, PROVIDED, HOWEVER, THAT SUCH AGENCIES SHALL ENSURE  THAT
 NO  LESS THAN SIXTY-FIVE PERCENT OF SUCH REIMBURSEMENT IS PASSED THROUGH
 TO A COMPLEX CARE ASSISTANT. COST OF LIVING ADJUSTMENTS  TO  SUCH  RATES
 SHALL  BE REVIEWED BY THE DEPARTMENT BI-ANNUALLY AND SUCH RATES ADJUSTED
 ACCORDINGLY BASED UPON ANY INCREASES TO  THE  UNITED  STATES  BUREAU  OF
 LABOR STATISTICS CONSUMER PRICE INDEX.
   (G)  THE  DEPARTMENT  SHALL  REQUIRE COMPLEX CARE ASSISTANTS PROVIDING
 QUALIFIED COMPLEX CARE ASSISTANT SERVICES UNDER THE MEDICAID PROGRAM  TO
 UTILIZE  AN ELECTRONIC VISIT VERIFICATION ESTABLISHED IN ACCORDANCE WITH
 FEDERAL LAW.
   (H) THE NEW YORK STATE MEDICAID DIRECTOR, NO LATER  THAN  THREE  YEARS
 AFTER  THE DATE THE PROGRAM IS ESTABLISHED UNDER THIS SECTION, AND EVERY
 TWO YEARS THEREAFTER, SHALL PREPARE AND SUBMIT A REPORT TO THE  GOVERNOR
 AND MAKE SUCH REPORT PUBLICLY AVAILABLE ON THE DEPARTMENT'S WEBSITE. THE
 REPORT SHALL INCLUDE BUT NOT BE LIMITED TO THE FOLLOWING:
 A. 7583                             3
 
   (1) THE NUMBER OF HOSPITALIZATIONS AND EMERGENCY ROOM VISITS OF ELIGI-
 BLE MEMBERS PARTICIPATING IN THE PROGRAM;
   (2)  THE  NUMBER  OF  AGENCY  PRIVATE DUTY NURSING HOURS EACH ELIGIBLE
 MEMBER PARTICIPATING IN THE PROGRAM HAS  RECEIVED  AND  AN  ANALYSIS  OF
 WHETHER SUCH HOURS HAVE INCREASED OR DECREASED SINCE THEIR PARTICIPATION
 IN THE PROGRAM;
   (3)  THE NUMBER OF QUALIFIED COMPLEX CARE ASSISTANT SERVICES THAT WERE
 PROVIDED BY COMPLEX CARE ASSISTANTS TO EACH ELIGIBLE MEMBER ENROLLED  IN
 THE PROGRAM;
   (4) THE NUMBER OF OVERPAYMENTS MADE TO EACH PROVIDER EMPLOYING COMPLEX
 CARE  ASSISTANTS  AND  OTHER METRICS DETERMINED BY THE STATE THAT MAY BE
 USED TO DETERMINE THE AMOUNT OF FRAUD, WASTE, AND ABUSE IN THE PROGRAM;
   (5) AN ANALYSIS OF WHETHER THE STATE'S WAITLIST FOR PRIVATE DUTY NURS-
 ING SERVICES OR OTHER HOME AND COMMUNITY-BASED SERVICES UNDER THE  MEDI-
 CAID  PROGRAM  HAS  IMPROVED  OR  DECLINED SINCE THE INTRODUCTION OF THE
 PROGRAM; AND
   (6) REPORTING CONCERNING THE VIABILITY OF SUCH PROGRAM AND  THE  MEDI-
 CAID DIRECTOR'S RECOMMENDATIONS CONCERNING SUCH PROGRAM.
   §  2.  The  state  Medicaid  director  shall apply for such state plan
 amendments or waivers as may be necessary to implement the provisions of
 this act and secure federal financial participation for  state  Medicaid
 expenditures under the federal Medicaid program.
   § 3. This act shall take effect immediately. The state Medicaid direc-
 tor  shall  adopt  rules  and  regulations as necessary to implement the
 provisions of this act.