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A05905 Summary:

COSPNSRMcDonald, Stirpe, Magnarelli, Clark, Thiele, Jensen, Fahy, Hunter, Lunsford, Lupardo, Weprin, Stern, Lavine, Solages, Smith, Durso, Giglio JA, Fitzpatrick, Flood, McDonough, Simpson, Jones, Manktelow
Amd 2808, Pub Health L
Provides for updates to rates for residential health care facilities.
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A05905 Text:

                STATE OF NEW YORK
                               2023-2024 Regular Sessions
                   IN ASSEMBLY
                                     March 24, 2023
        Introduced  by  M.  of A. WOERNER, McDONALD -- read once and referred to
          the Committee on Health -- committee discharged, bill amended, ordered
          reprinted as amended and recommitted to said committee
        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
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

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

        A. 5905--A                          3
     1  tation  with  the stakeholders described in this paragraph and the work-
     2  group set forth in paragraph (b-1) of this subdivision. For purposes  of
     3  facilitating quality improvements through the establishment of a nursing
     4  home  quality pool to be funded at the discretion of the commissioner by
     5  (i) adjustments in medical assistance rates, (ii) funds  made  available
     6  through  state  appropriations,  or  (iii)  a combination thereof, those
     7  facilities that contribute to the quality pool, but are deemed  ineligi-
     8  ble  for  quality  pool  payments  due exclusively to a specific case of
     9  employee misconduct, shall nevertheless be eligible for a  quality  pool
    10  payment  if the facility properly reported the incident, did not receive
    11  a survey citation from the commissioner or the Centers for Medicare  and
    12  Medicaid Services establishing the facility's culpability with regard to
    13  such  misconduct  and, but for the specific case of employee misconduct,
    14  the facility would have otherwise received a quality pool payment. Regu-
    15  lations pertaining to the facilitation of  quality  improvement  may  be
    16  made  effective  for  periods  on  and after January first, two thousand
    17  thirteen.
    18    § 2. This act shall take effect immediately.
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