Requires the state Medicaid director to establish a program for specific individuals to become complex care assistants and provide private duty nursing services to certain Medicaid enrollees under increased reimbursement rates.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9034
SPONSOR: Steck TITLE OF BILL:
An act relating to complex care assistants and home care services and
supplementing
PURPOSE:
Authorizes New York State to allow family members of medically fragile
children to be trained and paid to provide care as a complex care
assistant.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. (a) Defines family member. (b) Defines Complex Care Assistant
§ 2. (a)Program establishment by the New York State Department of
Health.
(b) Certification requirement(s) for a family member to become a complex
care assistant or complex care technical assistant.
(c) Training requirement(s) for family member to become a complex care
assistant or complex care technical assistant.
(d) Sets the floor for the rates of pay and requires increase reviews
bi-annually of the rate and increases are required should there be an
increase in the Consumer Price Index.
(e) Reporting requirement.
§ 3. Rules and regulation promulgation.
§ 4. Requiring the Medicaid director to apply for all plan amendments
and waivers to implement this act and secure federal financial partic-
ipation for state Medicaid expenditures.
§ 5. Effective date.
JUSTIFICATION:
Since the COVID-19 Pandemic, the home health care staffing shortage has
reached crisis levels. Nowhere is this felt more by parents of medically
fragile children who require a private duty nurse to attend to their
children's daily needs. Right now, 50 to 70% of private duty nursing
shifts nationwide are going unfilled. This is causing additional pres-
sure and stress for the families who need it.1
According to the 2019/20 New York State Profile of Children and Youth
with Special Health Care Needs (CYSHCN) are defined as children who have
or are at increased risk for a chronic physical, developmental, behav-
ioral, or emotional condition and who also require health and related
services of a type or amount beyond that required by children general-
ly.2
Families of CYSHCN face more financial strain and spend more time coor-
dinating their child's care than families without a CYSHCN (Table 5).
One in 10 families with CYSHCN reported spending at least one hour per
week coordinating their child's health care. Families of CYSHCN were
more likely to reduce or stop working due to their child's health, have
high out-of-pocket medical expenses, and have problems paying medical
bills. Ninety-nine percent (99%) of NYS CYSHCN have health insurance
coverage all year; however, families of CYSHCN were less likely to have
adequate health insurance or insurance benefits that meet their child's
needs.1
Parents of chronically ill children are less likely to work more than
twenty hours per week and more likely to participate in casual than in
regular employment compared to parents with otherwise healthy children.6
A national survey of family caregivers of children with a rare disease
reported that 52 percent of family members had to go to part-time work
or cut hours, 42 percent took a leave of absence, 31 percent turned down
a promotion, 23 percent lost a job benefit, and 21 percent gave up work-
ing or retired early to meet the care needs of their children.3
Currently, the money allocated by the state for private duty nursing is
not being utilized by providers because of the severe staffing shortage
of private duty nurses. Many parents must leave their employment to
ensure care for their children, resulting in even more financial hard-
ship for these families. Medicaid will allow adults to be cared-for by a
family member, but not medically fragile children. To ensure the safety
and quality of life for both these children and their families, it is
time for New York State to allow for family members to be certified and
paid to provide this necessary care.
LEGISLATIVE HISTORY:
New Bill
FISCAL IMPLICATIONS:
TBD
EFFECTIVE DATE:
Immediately after it shall become law.
1 . Private Duty Nursing Makes Community Living Possible. Advocacy by
The Arc, May 15, 2023
https://thearcore/blog/private-dutv-nursine-makes-community-livine-possi
ble-how-vou-can-hela
2 .New York State Profile of Children and Youth with Special Health Care
Needs, 2019-2020
https://www.health.nv.gov/community/spe_cial needs/docs/c_shcn profile
2019-20.pdf
3.Home Health Care For Children With Medical Complexity: Workforce Gaps,
Policy, And Future Directions 1 Health Affairs, Vol. 3 No. 6, June 2019
https://www.healthaffairs.oredo1/10.1377/hlthaff.2018.05531
STATE OF NEW YORK
________________________________________________________________________
9034
IN ASSEMBLY
February 5, 2024
___________
Introduced by M. of A. STECK -- read once and referred to the Committee
on Health
AN ACT relating to complex care assistants and home care services and
supplementing
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. As used in this act: (a) "family member" means a child,
2 parent, parent-in-law, sibling, grandparent, grandchild, spouse, domes-
3 tic partner, or one partner in a civil union couple, or any other indi-
4 vidual related by blood, and any other individual with a close associ-
5 ation that is the equivalent of a family relationship; and
6 (b) "complex care assistant" means a family member who is certified by
7 the department of health after passing an in-person examination which
8 tests the proficiency and competence of performing the tasks required to
9 care for a medically fragile child which can include, but is not limited
10 to, medication administration, airway clearance therapies, tracheostomy
11 care, intravenous line care, ventilator care, enteral care and other
12 tasks approved by the board of nursing for an individual under 21 years
13 of age.
14 § 2. (a) No later than one year after the effective date of this act
15 and receipt of federal approval for the program established pursuant to
16 this act, the state Medicaid director within the department of health
17 shall establish a program under which a family member of an enrollee in
18 Medicaid may be certified as a complex care assistant and, after receiv-
19 ing such certification may, under the direction of a registered nurse,
20 provide complex care assistant services to the enrollee through a
21 private duty nursing agency under the reimbursement rates established
22 under subdivision (d) of this section, provided that the enrollee is a
23 medically fragile child as defined in section 4401 of the public health
24 law and qualifies for private duty nursing services under Medicaid. Such
25 program shall operate as a New York Medicaid private duty nursing bene-
26 fit. The department shall develop an assessment tool that will allow the
27 division to identify enrollees who meet these eligibility criteria read-
28 ily.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13449-03-4
A. 9034 2
1 (b) The program established under this act shall require a family
2 member to complete all training, testing, and other qualification crite-
3 ria required under state and federal law for certification as a complex
4 care assistant. The private duty nursing agency that will employ the
5 family member to provide complex care assistant services to the enrollee
6 shall pay all costs for the family member to become certified as a
7 complex care assistant and to receive certification as a complex care
8 assistant from the department of health, before providing services under
9 the program established pursuant to this act. In no case shall a family
10 member who becomes a complex care assistant under the provisions of this
11 section be required to repay or reimburse the licensed home care
12 services and certified private duty nursing agencies for the costs of
13 the family member becoming certified as a complex care assistant under
14 the program.
15 (c) An individual certified to practice as a complex care assistant
16 must complete a training program and shall pass an in-person examination
17 approved by the department that demonstrates the applicant's competence
18 and proficiency. Such training program shall include the following:
19 medication administration, airway clearance therapies, tracheostomy
20 care, intravenous line care, ventilator care, enteral care and other
21 tasks approved by the board of nursing for an individual under 21 years
22 of age.
23 (d) Complex care assistant services provided by a family member of a
24 Medicaid enrollee who becomes certified as a complex care assistant
25 under the program established pursuant to this act shall be reimbursed
26 to a private duty nursing agency at a rate of no less than thirty-six
27 dollars for complex care assistant services downstate and thirty-three
28 dollars upstate. For care assistant high tech services it shall be at a
29 rate no less than forty-two dollars downstate and thirty-seven dollars
30 upstate. Cost of living adjustments to such rates shall be reviewed by
31 the department bi-annually and such rates adjusted accordingly based
32 upon any increases to the United States bureau of labor statistics
33 consumer price index.
34 (e) The state Medicaid director, no later than three years after the
35 date the program is established under this act, shall prepare and submit
36 a report to the governor and the legislature concerning the viability of
37 such program and the director's recommendations concerning such program.
38 § 3. The state Medicaid director shall adopt rules and regulations as
39 necessary to implement the provisions of this act.
40 § 4. The state Medicaid director shall apply for such state plan
41 amendments or waivers as may be necessary to implement the provisions of
42 this act and secure federal financial participation for state Medicaid
43 expenditures under the federal Medicaid program.
44 § 5. This act shall take effect immediately.
