STATE OF NEW YORK
________________________________________________________________________
6965--A
2023-2024 Regular Sessions
IN ASSEMBLY
May 9, 2023
___________
Introduced by M. of A. SEAWRIGHT -- read once and referred to the
Committee on Mental Health -- recommitted to the Committee on Mental
Health in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the mental hygiene law, in relation to reimbursement for
residential habilitation services
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. Paragraph (ii) of subdivision (c) of section 43.02 of the
2 mental hygiene law, as amended by section 3 of part OO of chapter 58 of
3 the laws of 2015, is amended and a new subdivision (d) is added to read
4 as follows:
5 (ii) methodologies used in the establishment of the schedules of rates
6 or fees pursuant to this section provided, however, that in accordance
7 with subdivision (d) of this section, the commissioner of health shall
8 adopt rules and regulations including methodologies developed by [him or
9 her] such commissioner for services provided by any facility or program
10 licensed, operated or approved by the office for people with develop-
11 mental disabilities; provided, however, that such rules and regulations
12 shall be subject to the approval of the office for people with develop-
13 mental disabilities and shall take into account the policies and goals
14 of such office.
15 (d) (i) For purposes of this subdivision, the following terms shall
16 have the following meanings:
17 (1) "Retainer days" are days of medical leave or an associated day
18 where any other institutional or in-patient medical payment is made for
19 providing residential habilitation services to a person eligible for
20 medical assistance pursuant to title eleven of article five of the
21 social services law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04991-04-4
A. 6965--A 2
1 (2) "Service days" are days when residential habilitation services are
2 provided in a community residence under the home and community-based
3 waiver operated by the office for people with developmental disabilities
4 and pursuant to regulations promulgated by the commissioner of the
5 office for people with developmental disabilities to a person who is
6 either present in the community residence or is absent from the communi-
7 ty residence and residential habilitation services are performed by
8 staff. Such services shall include habilitation services, protective
9 oversight services, supervision services, nursing supervision of direct
10 care staff and coordination of a person's health care needs, the coordi-
11 nation of necessary medical appointments, follow-up reports from medical
12 appointments, follow-up and interface with hospital staff regarding
13 emergency room visits and other hospitalizations, services and supplies
14 related to program-related transportation, nutrition services directly
15 related to habilitation services and psychology services that support a
16 person's need for behavioral supports in a service setting.
17 (3) "Therapy days" are days when a person eligible for medical assist-
18 ance pursuant to title eleven of article five of the social services law
19 is away from a supervised community residence and is not otherwise
20 receiving services from paid residential habilitation staff and the
21 absence is for the purpose of visiting with family or friends, or a
22 vacation. The therapy day must be described in the person's plan of care
23 to be eligible for payment and the person may not receive another Medi-
24 caid-funded residential or in-patient service on that day.
25 (4) "Occupancy adjustment" is an adjustment to the calculated daily
26 rate of an agency which provides residential habilitation services in a
27 supervised community residence to account for vacancy days.
28 (5) "Vacancy days" are days for which the provider is unable to bill
29 for Medicaid due to a person residing in a community residence having
30 moved from one residential site to another, or due to the death of the
31 individual.
32 (ii) Notwithstanding any inconsistent provision of this section, or
33 any other law or regulation to the contrary and subject to the avail-
34 ability of federal financial participation, for any reimbursement for
35 residential habilitation services provided in a supervised community
36 residence according to a daily unit of service as promulgated by the
37 commissioner of health:
38 (1) retainer days shall be reimbursed at one hundred percent the daily
39 rate as determined pursuant to regulations promulgated by the commis-
40 sioner of health, provided, however a provider is limited to being paid
41 fourteen retainer days per rate year, multiplied by certified capacity;
42 (2) therapy days shall be reimbursed at one hundred percent the daily
43 rate as determined pursuant to regulations promulgated by the commis-
44 sioner of health, provided, however, a provider is limited to being paid
45 ninety-six therapy days per rate year per person; and
46 (3) for the rate periods beginning July first, two thousand twenty-
47 two, providers shall receive an occupancy adjustment to the operating
48 component of their rate, as the operating component of their rate is
49 determined pursuant to regulations promulgated by the commissioner of
50 health, for vacancy days. The occupancy adjustment percentage shall be
51 calculated by dividing the sum of a provider's rate period reported
52 retainer days, service days and therapy days by one hundred percent of
53 the provider's certified capacity. The certified capacity of the provid-
54 er is calculated by taking into account capacity changes throughout the
55 year, multiplied by one hundred percent of the year's days. The adjust-
56 ment will begin on July first, two thousand twenty-two and shall be
A. 6965--A 3
1 recalculated on an annual basis based on the most current and complete
2 twelve months of experience. The occupancy adjustment will be the lower
3 of the provider's actual occupancy adjustment percentage or five
4 percent.
5 § 2. This act shall take effect immediately and shall be deemed to
6 have been in full force and effect on and after April 1, 2025.