S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5229
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 19, 2025
                                ___________
 
 Introduced  by  Sens. RIVERA, ASHBY, BORRELLO, GALLIVAN, HELMING, MARTI-
   NEZ, MARTINS, MATTERA, MURRAY, PALUMBO, RHOADS, STEC, WEBER,  WEIK  --
   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 residential health
   care facility rates

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.    Paragraphs  (a), (b), (c) and (d) of subdivision 2-c of
 section 2808 of the public health law, paragraphs (a), (b)  and  (c)  as
 added  by  section 95 of part H of chapter 59 of the laws of 2011, para-
 graph (d) as amended by section 2 of part M of chapter 57 of the laws of
 2022, are amended and a new paragraph (b-1) is added to read as follows:
   (a) Notwithstanding any inconsistent provision of this section or  any
 other  contrary  provision  of  law  and  subject to the availability of
 federal financial participation, the non-capital component of  rates  of
 payment  by  governmental  agencies  for  inpatient services provided by
 residential health care facilities on or after October first, two  thou-
 sand eleven, but no later than January first, two thousand twelve, shall
 reflect a direct statewide price component, and indirect statewide price
 component,  and  a facility specific non-comparable component, utilizing
 allowable operating costs for a base year as determined by  the  commis-
 sioner by regulation. Such rate components shall be periodically updated
 to  reflect  changes in operating costs, PROVIDED HOWEVER THAT SUCH RATE
 COMPONENTS SHALL BE UPDATED NO LATER  THAN  APRIL  FIRST,  TWO  THOUSAND
 TWENTY-SIX  AND  AT  LEAST  EVERY  FIVE YEARS THEREAFTER, USING THE MOST
 CURRENTLY AVAILABLE COST REPORT DATA, WHICH UPDATES  SHALL  INCLUDE  BUT
 NOT  BE  LIMITED  TO AN UPDATE OF RATE COMPONENTS TO REFLECT ACTUAL BASE
 YEAR COSTS.
   (b) The direct  and  indirect  statewide  price  components  shall  be
 adjusted  by a wage equalization factor and such other factors as deter-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09020-01-5
              

 S. 5229                             2
 
 mined to be appropriate to recognize legitimate cost  differentials  and
 the  direct  statewide  price  component  shall be subject to a case mix
 adjustment utilizing the patients that are eligible for medical  assist-
 ance  pursuant  to  title  eleven of article five of the social services
 law. Such wage equalization factor AND OTHER FACTORS  shall  be  period-
 ically  updated  to  reflect  current labor market AND OTHER conditions,
 PROVIDED HOWEVER THAT SUCH UPDATES SHALL BE IMPLEMENTED  NO  LATER  THAN
 APRIL  FIRST,  TWO  THOUSAND  TWENTY-SIX,  AND AT LEAST EVERY FIVE YEARS
 THEREAFTER, BASED ON THE MOST CURRENTLY AVAILABLE COST REPORT DATA.
   (B-1) FOR PURPOSES OF THE UPDATES REQUIRED BY PARAGRAPHS (A)  AND  (B)
 OF THIS SUBDIVISION AND ASSOCIATED CHANGES IN THE RATE-SETTING METHODOL-
 OGY, THE DEPARTMENT SHALL ESTABLISH AND CONSULT WITH A TECHNICAL ASSIST-
 ANCE  WORKGROUP  THAT INCLUDES EXTERNAL EXPERTS WITH PROFESSIONAL EXPER-
 TISE IN NURSING HOME RATE SETTING.
   (c) The non-capital component of the rates for: (i) AIDS facilities or
 discrete AIDS units within facilities; (ii) discrete units for residents
 receiving care in a long-term inpatient rehabilitation program for trau-
 matic brain injured persons; (iii) discrete units providing  specialized
 programs for residents requiring behavioral interventions; (iv) discrete
 units  for  long-term ventilator dependent residents; and (v) facilities
 or discrete units within  facilities  that  provide  extensive  nursing,
 medical,  psychological  and counseling support services solely to chil-
 dren shall reflect the rates in effect for such  facilities  on  January
 first,  two thousand nine, as adjusted for inflation and rate appeals in
 accordance with applicable statutes, provided, however, that such  rates
 for  facilities  described  in  subparagraph (i) of this paragraph shall
 reflect the application of the provisions of section twelve of part D of
 chapter fifty-eight of the laws  of  two  thousand  nine,  and  provided
 further,  however,  that insofar as such rates reflect trend adjustments
 for trend factors attributable to the two thousand eight and  two  thou-
 sand  nine  calendar  years  the  aggregate  amount of such trend factor
 adjustments shall be subject to the provisions of section two of part  D
 of  chapter  fifty-eight  of  the laws of two thousand nine, as amended.
 NOTWITHSTANDING THE ELIMINATION OF A TREND FACTOR FROM RATES OF  PAYMENT
 PAID TO OTHER RESIDENTIAL HEALTH CARE FACILITIES OR ANY OTHER INCONSIST-
 ENT  PROVISION OF LAW, COMMENCING ON AND AFTER APRIL FIRST, TWO THOUSAND
 TWENTY-SIX, THE NON-CAPITAL COMPONENT OF RATES ESTABLISHED  PURSUANT  TO
 THIS PARAGRAPH SHALL BE ADJUSTED FOR INFLATION.
   (d)  The commissioner shall promulgate regulations, and may promulgate
 emergency regulations, to implement the provisions of this  subdivision,
 INCLUDING  REGULATIONS  TO  IMPLEMENT THE UPDATES TO THE RATE COMPONENTS
 AND ASSOCIATED CHANGES IN THE METHODOLOGY AS SET FORTH IN PARAGRAPHS (A)
 AND (B) OF THIS SUBDIVISION.   Such regulations shall  be  developed  in
 consultation  with  the nursing home industry and advocates for residen-
 tial health care facility residents and, further, the commissioner shall
 provide notification concerning such regulations to the  chairs  of  the
 senate  and  assembly health committees, the chair of the senate finance
 committee and the chair of the assembly ways and means  committee.  Such
 regulations  shall  include  provisions  for rate adjustments or payment
 enhancements to facilitate a minimum four-year transition of  facilities
 to  the rate-setting methodology established by this subdivision and may
 also include, but not be limited to, provisions for facilitating quality
 improvements in residential health  care  facilities,  PROVIDED  HOWEVER
 THAT  REGULATIONS  GOVERNING THE UPDATES SET FORTH IN PARAGRAPHS (A) AND
 (B) OF THIS SUBDIVISION AND ASSOCIATED CHANGES IN  THE  METHODOLOGY  MAY
 INCLUDE A TRANSITION PERIOD AS DETERMINED BY THE COMMISSIONER IN CONSUL-
 S. 5229                             3
 
 TATION  WITH  THE STAKEHOLDERS DESCRIBED IN THIS PARAGRAPH AND THE WORK-
 GROUP SET FORTH IN PARAGRAPH (B-1) OF THIS SUBDIVISION. For purposes  of
 facilitating quality improvements through the establishment of a nursing
 home  quality pool to be funded at the discretion of the commissioner by
 (i) adjustments in medical assistance rates, (ii) funds  made  available
 through  state  appropriations,  or  (iii)  a combination thereof, those
 facilities that contribute to the quality pool, but are deemed  ineligi-
 ble  for  quality  pool  payments  due exclusively to a specific case of
 employee misconduct, shall nevertheless be eligible for a  quality  pool
 payment  if the facility properly reported the incident, did not receive
 a survey citation from the commissioner or the Centers for Medicare  and
 Medicaid Services establishing the facility's culpability with regard to
 such  misconduct  and, but for the specific case of employee misconduct,
 the facility would have otherwise received a quality pool payment. Regu-
 lations pertaining to the facilitation of  quality  improvement  may  be
 made  effective  for  periods  on  and after January first, two thousand
 thirteen.
   § 2. This act shall take effect immediately.