NY State Senate Bill 2025-S3599

Current Bill Status - In Senate Committee Health 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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 28, 2025	referred to health

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2025-S3599 (ACTIVE) - Details

See Assembly Version of this Bill:: A1112
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §3614-f, Pub Health L
Versions Introduced in 2023-2024 Legislative Session:: S6963, A7335

2025-S3599 (ACTIVE) - Summary

Requires the commissioner of health to establish regional minimum hourly base reimbursement rates for home care aides.

2025-S3599 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3599

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law, in relation to regional minimum
hourly base reimbursement rates for home care aides

 
PURPOSE:

To establish a reliable and predictable mechanism to ensure that home
care providers receive adequate reimbursement from managed care organ-
izations for the purpose of paying their employees mandated wages and
benefits and to cover other costs of the employer.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 would add new subdivisions 5-12 to section 3614-f of the
Public Health Law as it relates to the home care minimum wage increase.

The bill would require the Commissioner of Health to establish a
regional minimum hourly base reimbursement rate for providers employing

home care and personal care aides. The legislation would also identify
specific elements of the rate that must be included in its development,
including direct care-related payments, components to reflect opera-
tional expenses necessary to comply with state and federal mandates, and
administrative and general expenses components.  The legislation would
require the rates to reflect regional variation and not be less than the
established fee for service county rates.  The legislation would also
require the rates to be adjusted annually by a trend factor.

Requires the Department of Health (DOH) to apply for federal approval
for a state-directed payment for fully capitated Medicaid managed care
plans to support the regional minimum hourly base reimbursement rate.

Requires for partially capitated managed long-term care plans, and where
federal approval is not secured for state-directed payment, that plans
justify contracts offering deviations from the regional minimum hourly
base reimbursement rate. Providers would have an opportunity to respond.

Ensure that the DOH provides managed care organizations with sufficient
capitation payments to ensure rate adequacy to comply with the require-
ments of regional minimum hourly base reimbursement rates.

Require the DOH to amend the Medicaid managed care model contract rates
to comply with the requirements of the bill. Require the DOH to publicly
post the regional minimum hourly base reimbursement rates.  Require the
DOH to publicly post cost report data of plans and providers In a simple
and understandable manner.

Grant the comptroller the authority to review contracts to ensure rate
adequacy. Section 2 establishes a severability clause. Section 3
provides an effective date.

 
JUSTIFICATION:

The need for a reliable and predictable mechanism to ensure that home
care providers receive adequate reimbursement from managed care organ-
izations to pay their employees was made clear in October 2022, when the
$2 per hour wage increase went into effect for home care workers. There
was overall confusion about what the expectations were concerning rate
sufficiency, timing, and process. Legislation to set clear standards for
the plans, providers, and the State is required.

Currently, there is no common understanding of what constitutes an
adequate rate to cover a worker's wages and benefits. This legislation
would require the DOH to set a minimum hourly base reimbursement rate,
including the elements that are articulated by statute and determined by
the DOH. This will help establish an objective standard against which to
measure negotiated rates. By articulating the elements of the rate that
must be accounted for by the DOH, this legislation would drive the rate
to a formula and bring clarity and predictability to the current proc-
ess. It would set objective expectations for providers, plans, and the
State regulators.  The regional minimum hourly base reimbursement rate
development process should be informed by provider cost reports and
Medicaid Managed Care Operating Reports. This information should be
available broadly and in a searchable format.

The regional minimum hourly base reimbursement rate would set expecta-
tions based on agreed-upon standards. The legislation would propose two
mechanisms to ensure that the minimum hourly base reimbursement rate
reaches the provider. For fully-capitated plans (mainstream managed
care, PACE, MAP), the State would apply to the U.S. Centers for Medicare
& Medicaid Services (CMS) for a state-directed payment of minimum fee
schedules for home care agencies and fiscal intermediaries. Where there
is no approved state-directed payment and for Managed Long Term Care
(MLTC) plans, which are not fully capitated, the legislation would
establish a reporting mechanism for plans where they are paying less
than the minimum hourly base reimbursement rate. The plan's report must
include a rationale for paying under the minimum hourly base reimburse-
ment rate; the impacted provider would also have the opportunity to
address the report in writing. This approach would be paired with DOH
collecting and publicly reporting this data on a regular basis. Imple-
menting these processes would bring visibility as to whether there are
patterns of unjustified and/or unfair behavior.  The bill would make
exceptions, however, where the provider and a plan mutually agree to
enter into a value-based contract.

Finally, the bill would authorize the Comptroller to review contracts
between plans and providers to ensure compliance with regional minimum
hourly base reimbursement rates.

 
LEGISLATIVE HISTORY:;

2023-2024: S6963-A1A7335-A Paulin

 
FISCAL IMPLICATIONS:

None noted.

 
EFFECTIVE DATE:z
This act shall take effect immediately.

2025-S3599 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3599
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 28, 2025
                                ___________
 
 Introduced  by Sens. RIVERA, MAY, CLEARE, COMRIE, GONZALEZ, MAYER, PARK-
   ER, SALAZAR, SKOUFIS, WEBB -- read twice and ordered printed, and when
   printed to be committed 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;
   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;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD03863-01-5
 S. 3599                             2
 
   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
 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
 S. 3599                             3
 
 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
 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.

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Senate Bill S3599

Sponsored By

Current Bill Status - In Senate Committee Health Committee

co-Sponsors

2025-S3599 (ACTIVE) - Details

2025-S3599 (ACTIVE) - Summary

2025-S3599 (ACTIVE) - Sponsor Memo

2025-S3599 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S3599

Share this bill

Sponsored By

Current Bill Status - In Senate Committee Health Committee

co-Sponsors

2025-S3599 (ACTIVE) - Details

2025-S3599 (ACTIVE) - Summary

2025-S3599 (ACTIVE) - Sponsor Memo

2025-S3599 (ACTIVE) - Bill Text download pdf

Comments