Bill Text: NY A06965 | 2023-2024 | General Assembly | Amended

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Bill Title: Relates to reimbursement for residential habilitation services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-04-11 - print number 6965a [A06965 Detail]

Download: New_York-2023-A06965-Amended.html

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                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.