Bill Text: NY A05905 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Provides for updates to rates for residential health care facilities.

Spectrum: Slight Partisan Bill (Democrat 16-9)

Status: (Introduced) 2024-05-08 - print number 5905b [A05905 Detail]

Download: New_York-2023-A05905-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5905

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 24, 2023
                                       ___________

        Introduced  by M. of A. WOERNER -- read once and referred to the Commit-
          tee 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:

     1    Section  1.    Paragraphs  (a), (b), (c) and (d) of subdivision 2-c of
     2  section 2808 of the public health law, paragraphs (a), (b)  and  (c)  as
     3  added  by  section 95 of part H of chapter 59 of the laws of 2011, para-
     4  graph (d) as amended by section 2 of part M of chapter 57 of the laws of
     5  2022, are amended and new paragraph (b-1) is added to read as follows:
     6    (a) Notwithstanding any inconsistent provision of this section or  any
     7  other  contrary  provision  of  law  and  subject to the availability of
     8  federal financial participation, the non-capital component of  rates  of
     9  payment  by  governmental  agencies  for  inpatient services provided by
    10  residential health care facilities on or after October first, two  thou-
    11  sand eleven, but no later than January first, two thousand twelve, shall
    12  reflect a direct statewide price component, and indirect statewide price
    13  component,  and  a facility specific non-comparable component, utilizing
    14  allowable operating costs for a base year as determined by  the  commis-
    15  sioner by regulation. Such rate components shall be periodically updated
    16  to  reflect  changes in operating costs, provided however that such rate
    17  components shall be updated no later than January  first,  two  thousand
    18  twenty-five and no less than every five years thereafter, using the most
    19  currently  available  cost  report data, which updates shall include but
    20  not be limited to an update of rate components to  reflect  actual  base
    21  year costs.
    22    (b)  The  direct  and  indirect  statewide  price  components shall be
    23  adjusted by a wage equalization factor and such other factors as  deter-
    24  mined  to  be appropriate to recognize legitimate cost differentials and
    25  the direct statewide price component shall be  subject  to  a  case  mix

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10005-01-3
        A. 5905                             2

     1  adjustment  utilizing the patients that are eligible for medical assist-
     2  ance pursuant to title eleven of article five  of  the  social  services
     3  law.  Such  wage  equalization factor and other factors shall be period-
     4  ically  updated  to  reflect  current labor market and other conditions,
     5  provided however that such updates shall be implemented  no  later  than
     6  January  first,  two  thousand  twenty-five, and no less than every five
     7  years thereafter, based on the  most  currently  available  cost  report
     8  data.
     9    (b-1)  For  purposes of the updates required by paragraphs (a) and (b)
    10  of this subdivision and associated changes in the rate-setting methodol-
    11  ogy, the department shall establish and consult with a technical assist-
    12  ance workgroup that includes external experts with  professional  exper-
    13  tise in nursing home rate setting.
    14    (c) The non-capital component of the rates for: (i) AIDS facilities or
    15  discrete AIDS units within facilities; (ii) discrete units for residents
    16  receiving care in a long-term inpatient rehabilitation program for trau-
    17  matic  brain injured persons; (iii) discrete units providing specialized
    18  programs for residents requiring behavioral interventions; (iv) discrete
    19  units for long-term ventilator dependent residents; and  (v)  facilities
    20  or  discrete  units  within  facilities  that provide extensive nursing,
    21  medical, psychological and counseling support services solely  to  chil-
    22  dren  shall  reflect  the rates in effect for such facilities on January
    23  first, two thousand nine, as adjusted for inflation and rate appeals  in
    24  accordance  with applicable statutes, provided, however, that such rates
    25  for facilities described in subparagraph (i)  of  this  paragraph  shall
    26  reflect the application of the provisions of section twelve of part D of
    27  chapter  fifty-eight  of  the  laws  of  two thousand nine, and provided
    28  further, however, that insofar as such rates reflect  trend  adjustments
    29  for  trend  factors attributable to the two thousand eight and two thou-
    30  sand nine calendar years the  aggregate  amount  of  such  trend  factor
    31  adjustments  shall be subject to the provisions of section two of part D
    32  of chapter fifty-eight of the laws of two  thousand  nine,  as  amended.
    33  Notwithstanding  the elimination of a trend factor from rates of payment
    34  paid to other residential health care facilities or any other inconsist-
    35  ent provision of law, commencing on and after January first,  two  thou-
    36  sand twenty-three, the non-capital component of rates established pursu-
    37  ant to this paragraph shall be adjusted for inflation.
    38    (d)  The commissioner shall promulgate regulations, and may promulgate
    39  emergency regulations, to implement the provisions of this  subdivision,
    40  including  regulations  to  implement the updates to the rate components
    41  and associated changes in the methodology as set forth in paragraphs (a)
    42  and (b) of this subdivision.   Such regulations shall  be  developed  in
    43  consultation  with  the nursing home industry and advocates for residen-
    44  tial health care facility residents and, further, the commissioner shall
    45  provide notification concerning such regulations to the  chairs  of  the
    46  senate  and  assembly health committees, the chair of the senate finance
    47  committee and the chair of the assembly ways and means  committee.  Such
    48  regulations  shall  include  provisions  for rate adjustments or payment
    49  enhancements to facilitate a minimum four-year transition of  facilities
    50  to  the rate-setting methodology established by this subdivision and may
    51  also include, but not be limited to, provisions for facilitating quality
    52  improvements in residential health  care  facilities,  provided  however
    53  that  regulations  governing the updates set forth in paragraphs (a) and
    54  (b) of this subdivision and associated changes in  the  methodology  may
    55  include a transition period as determined by the commissioner in consul-
    56  tation  with  the stakeholders described in this paragraph and the work-
        A. 5905                             3

     1  group set forth in paragraph (b-1) of this subdivision. For purposes  of
     2  facilitating quality improvements through the establishment of a nursing
     3  home  quality pool to be funded at the discretion of the commissioner by
     4  (i)  adjustments  in medical assistance rates, (ii) funds made available
     5  through state appropriations, or  (iii)  a  combination  thereof,  those
     6  facilities  that contribute to the quality pool, but are deemed ineligi-
     7  ble for quality pool payments due exclusively  to  a  specific  case  of
     8  employee  misconduct,  shall nevertheless be eligible for a quality pool
     9  payment if the facility properly reported the incident, did not  receive
    10  a  survey citation from the commissioner or the Centers for Medicare and
    11  Medicaid Services establishing the facility's culpability with regard to
    12  such misconduct and, but for the specific case of  employee  misconduct,
    13  the facility would have otherwise received a quality pool payment. Regu-
    14  lations  pertaining  to  the  facilitation of quality improvement may be
    15  made effective for periods on and  after  January  first,  two  thousand
    16  thirteen.
    17    § 2. This act shall take effect immediately.