Bill Text: NY S03193 | 2023-2024 | General Assembly | Amended

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

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Bill Title: Relates to reimbursement for residential habilitation services.

Spectrum: Bipartisan Bill

Status: (Introduced) 2024-03-20 - PRINT NUMBER 3193B [S03193 Detail]

Download: New_York-2023-S03193-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         3193--A

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 30, 2023
                                       ___________

        Introduced  by  Sens.  MANNION, HINCHEY, KENNEDY, LANZA, PALUMBO -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee  on  Disabilities  --  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  for services provided by any facility or program licensed, operated
    10  or approved by the office for people  with  developmental  disabilities;
    11  provided,  however,  that such rules and regulations shall be subject to
    12  the approval of the office for people  with  developmental  disabilities
    13  and shall take into account the policies and goals of such office.
    14    (d)  (i)  For  purposes of this subdivision, the following terms shall
    15  have the following meanings:
    16    (1) "Retainer days" are days of medical leave  or  an  associated  day
    17  where  any other institutional or in-patient medical payment is made for
    18  providing residential habilitation services to  a  person  eligible  for
    19  medical  assistance  pursuant  to  title  eleven  of article five of the
    20  social services law.
    21    (2) "Service days" are days when residential habilitation services are
    22  provided in a community residence under  the  home  and  community-based
    23  waiver operated by the office for people with developmental disabilities

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04991-02-3
        S. 3193--A                          2

     1  and  pursuant  to  regulations  promulgated  by  the commissioner of the
     2  office for people with developmental disabilities to  a  person  who  is
     3  either present in the community residence or is absent from the communi-
     4  ty  residence  and  residential  habilitation  services are performed by
     5  staff. Such services shall  include  habilitation  services,  protective
     6  oversight  services, supervision services, nursing supervision of direct
     7  care staff and coordination of a person's health care needs, the coordi-
     8  nation of necessary medical appointments, follow-up reports from medical
     9  appointments, follow-up and  interface  with  hospital  staff  regarding
    10  emergency  room visits and other hospitalizations, services and supplies
    11  related to program-related transportation, nutrition  services  directly
    12  related  to habilitation services and psychology services that support a
    13  person's need for behavioral supports in a service setting.
    14    (3) "Therapy days" are days when a person eligible for medical assist-
    15  ance pursuant to title eleven of article five of the social services law
    16  is away from a supervised  community  residence  and  is  not  otherwise
    17  receiving  services  from  paid  residential  habilitation staff and the
    18  absence is for the purpose of visiting with  family  or  friends,  or  a
    19  vacation. The therapy day must be described in the person's plan of care
    20  to  be eligible for payment and the person may not receive another Medi-
    21  caid-funded residential or in-patient service on that day.
    22    (4) "Occupancy adjustment" is an adjustment to  the  calculated  daily
    23  rate  of an agency which provides residential habilitation services in a
    24  supervised community residence to account for vacancy days.
    25    (5) "Vacancy days" are days for which the provider is unable  to  bill
    26  for  Medicaid  due  to a person residing in a community residence having
    27  moved from one residential site to another, or due to the death  of  the
    28  individual.
    29    (ii)  Notwithstanding  any  inconsistent provision of this section, or
    30  any other law or regulation to the contrary and subject  to  the  avail-
    31  ability  of  federal  financial participation, for any reimbursement for
    32  residential habilitation services provided  in  a  supervised  community
    33  residence  according  to  a  daily unit of service as promulgated by the
    34  commissioner of health:
    35    (1) retainer days shall be reimbursed at one hundred percent the daily
    36  rate as determined pursuant to regulations promulgated  by  the  commis-
    37  sioner  of health, provided, however a provider is limited to being paid
    38  fourteen retainer days per rate year, multiplied by certified capacity;
    39    (2) therapy days shall be reimbursed at one hundred percent the  daily
    40  rate  as  determined  pursuant to regulations promulgated by the commis-
    41  sioner of health, provided, however, a provider is limited to being paid
    42  ninety-six therapy days per rate year per person; and
    43    (3) for the rate periods beginning July first,  two  thousand  twenty-
    44  one,  providers  shall  receive an occupancy adjustment to the operating
    45  component of their rate, as the operating component  of  their  rate  is
    46  determined  pursuant  to  regulations promulgated by the commissioner of
    47  health, for vacancy days. The occupancy adjustment percentage  shall  be
    48  calculated  by  dividing  the  sum  of a provider's rate period reported
    49  retainer days, service days and therapy days by one hundred  percent  of
    50  the provider's certified capacity. The certified capacity of the provid-
    51  er  is calculated by taking into account capacity changes throughout the
    52  year, multiplied by one hundred percent of the year's days. The  adjust-
    53  ment  will  begin  on  July  first, two thousand twenty-one and shall be
    54  recalculated on an annual basis based on the most current  and  complete
    55  twelve months of experience.  The occupancy adjustment will be the lower
        S. 3193--A                          3

     1  of  the  provider's  actual  occupancy  adjustment  percentage  or  five
     2  percent.
     3    §  2.  This  act  shall take effect immediately and shall be deemed to
     4  have been in full force and effect on and after April 1, 2024.