Bill Text: NY A01112 | 2025-2026 | General Assembly | Introduced
Bill Title: Requires the commissioner of health to establish regional minimum hourly base reimbursement rates for home care aides.
Spectrum: Partisan Bill (Democrat 23-1)
Status: (Introduced) 2025-01-09 - referred to health [A01112 Detail]
Download: New_York-2025-A01112-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1112 2025-2026 Regular Sessions IN ASSEMBLY January 9, 2025 ___________ Introduced by M. of A. PAULIN, REYES, WEPRIN, ROSENTHAL, SHRESTHA, DINOWITZ, EPSTEIN, HEVESI, SIMON, STECK, ZINERMAN, GONZALEZ-ROJAS, KELLES, SAYEGH, COLTON, SIMONE, SANTABARBARA, RAGA, STIRPE, BRABENEC, LEVENBERG, BROOK-KRASNY, LUCAS, JONES -- read once and referred 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: 1 Section 1. Section 3614-f of the public health law is amended by 2 adding eight new subdivisions 5, 6, 7, 8, 9, 10, 11 and 12 to read as 3 follows: 4 5. (a) By the first of October next succeeding the effective date of 5 this subdivision, the commissioner shall establish a regional minimum 6 hourly base reimbursement rate for all providers employing workers 7 subject to the minimum wage provisions established in subdivision two of 8 this section. The regional minimum hourly base reimbursement rate 9 shall be based on regions established by the commissioner, provided that 10 for areas subject to section thirty-six hundred fourteen-c of this arti- 11 cle, each area with a different prevailing rate of total compensation, 12 as defined in that section, shall be its own region. 13 (b) For the purposes of this section, "regional minimum hourly base 14 reimbursement rate" means a reimbursement rate that reflects: 15 (1) a direct care related payment which shall reflect the total direct 16 care related costs for home care aides and other direct care related 17 staff necessary to comply with federal and state statutory and regulato- 18 ry requirements for such providers, and which shall include: 19 A. base hourly wage guaranteed home care aides pursuant to subdivi- 20 sion two of this section; 21 B. overtime costs; EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD03863-01-5A. 1112 2 1 C. employee benefits, including both paid time off and supplemental 2 benefits or benefits as determined by collective bargaining agreements; 3 D. federal insurance contributions act; 4 E. Medicare; 5 F. federal unemployment tax act; 6 G. worker wage parity as provided by section thirty-six hundred four- 7 teen-c of this article, as applicable; 8 H. other payroll taxes; 9 I. fair labor standards act compliance; 10 J. New York state labor law compliance; 11 K. COVID-19 sick pay; 12 L. state unemployment insurance; 13 M. disability insurance; 14 N. workers' compensation; 15 O. travel time and travel reimbursement; 16 P. the metropolitan transportation authority tax; and 17 Q. related increases tied to base wages; 18 (2) a component to reflect operational expenses necessary to comply 19 with federal and state statutory and regulatory requirements for such 20 providers, and which shall include: 21 A. operational supervision and support, including but not limited to 22 nursing staff, home health aide supervision and team support; and 23 B. other operational support, including but not limited to quality 24 assurance and improvement programs, education and recruitment; and 25 (3) a component to reflect administrative and general operating 26 expenses which shall include rent and facilities management and business 27 support, including but not limited to information technology, human 28 resources, legal, compliance, finance, management, margin and communi- 29 cations. 30 (c) The regional minimum hourly base rate cannot be less than the most 31 current average fee for service county rates for level two personal care 32 service for each region as posted by the department for personal care 33 agencies or other providers delivering like services through other Medi- 34 caid programs. 35 (d) Once a regional minimum hourly base reimbursement rate has 36 been established under this section, the commissioner shall thereaft- 37 er annually adjust the regional hourly base reimbursement rate for 38 each region by a trend factor to reflect and accommodate any additional 39 labor law increases, changes or mandates. 40 6. For mainstream managed care and fully capitated Medicaid managed 41 care products for those dually eligible for both Medicaid and Medicare, 42 the commissioner shall submit any and all necessary applications for 43 approvals and/or waivers to the federal centers for Medicare and Medi- 44 caid services to secure approval to establish regional minimum hourly 45 base reimbursement rates and make state-directed payments through to 46 providers for the purposes of supporting wage increases. 47 (a) If approved by the federal centers for Medicare and Medicaid 48 services, directed payments shall be made to such providers of Medi- 49 caid services through contracts with managed care organizations where 50 applicable, provided that the commissioner ensures that such directed 51 payments are in accordance with the terms of this section. 52 (b) If the state directed payment is not approved, the provisions of 53 subdivision seven of this section shall apply. 54 7. For partially capitated managed long term care plans, or where 55 state directed payments pursuant to subdivision six of this section have 56 not been approved, the department shall require plans to justifyA. 1112 3 1 contracts offering deviations from the regional minimum hourly base 2 reimbursement rates in a report to the department. This report shall be 3 sent to the department, with a copy to the provider prior to the final- 4 izing of any contract, unless otherwise permitted by this section, with- 5 in five working days of the contract being offered to a provider with 6 rate deviations. Any report shall include a rationale for paying below 7 the regional minimum hourly base reimbursement rate, and the impacted 8 provider shall have the opportunity to respond to the report within 9 thirty days of filing with the department. The department shall compile 10 such reports and publish and post a summary of them semi-annually. 11 8. The commissioner shall establish actuarially sound regional 12 reimbursement rate ranges for Medicaid managed care organizations in 13 order to comply with this section. These ranges will reflect managed 14 care adjustments including but not limited to: (a) managed care plan 15 variations in utilizations from the regional utilization average; (b) 16 the impact of risk adjustment; and (c) premium withholds. Rate ranges 17 shall also account for quality incentives, volume, costs associated with 18 value-based arrangements, and reimbursement for individuals with hard to 19 serve needs. 20 9. Nothing in this section shall preclude providers employing home 21 health aides covered under this section or payers from paying or 22 contracting for services at rates higher than the regional mini- 23 mum hourly base reimbursement rate if the parties mutually agree to such 24 terms. Notwithstanding subdivision seven of this section, plans and 25 providers can also mutually agree to enter into value-based contracts at 26 a rate less than the regional minimum hourly base reimbursement rate. 27 10. The commissioner shall amend the model managed care contracts to 28 reflect the requirements of this section. In addition, the commissioner 29 shall post the managed care, certified and licensed home care services 30 agencies and fiscal intermediaries cost report data in a simple under- 31 standable manner on the department's website by the fifteenth of Febru- 32 ary second succeeding the effective date of this subdivision and annual- 33 ly thereafter. 34 11. The commissioner shall publish and post regional minimum hourly 35 base reimbursement rates annually, and shall take all necessary steps 36 to advise commercial and government programs payers of home care 37 services of the regional minimum hourly base reimbursement rates. 38 12. To ensure compliance with minimum wage increases, the comptroller 39 shall have the authority to review the contracts entered into between a 40 managed care organization and a licensed home care services agency, 41 fiscal intermediary, or any agency subject to the provisions of this 42 section to ensure that rates being offered are adequate and meet the 43 department's actuarial standards. The comptroller, in consultation with 44 the Medicaid inspector general, shall develop and promulgate a process 45 to ensure such audits comply with state and federal law to protect 46 proprietary information and contracts. In the event that the comptroller 47 finds evidence that managed care organizations are not paying sufficient 48 adequate rates, they will refer such instances to the department and the 49 Medicaid fraud control unit for enforcement. If the department or the 50 Medicaid fraud control unit chooses not to pursue action related to this 51 referral, it shall inform, in writing, the comptroller's office as to 52 the reasoning. Such reports, and the department's responses, shall be 53 public information and made available on the comptroller's website. 54 § 2. Severability. If any provision of this act, or any application of 55 any provision of this act, is held to be invalid, or to violate or be 56 inconsistent with any federal law or regulation, that shall not affectA. 1112 4 1 the validity or effectiveness of any other provision of this act, or any 2 other application of any provision of this act which can be given effect 3 without that provision or application; and to that end, the provisions 4 and applications of this act are severable. 5 § 3. This act shall take effect immediately.
