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A05685 Summary:

COSPNSRGunther, Galef, Clark, Taylor, Paulin, Abinanti, Bichotte Hermelyn, McDonald, Hevesi, Bronson, Wallace, Steck, Dinowitz, Thiele, Perry, Jacobson, Englebright, Jackson, Anderson, Simon, Barrett, Sillitti, Cook, Colton, McMahon, Aubry, Richardson, Forrest, Kelles, Buttenschon, Santabarbara, Durso, Weinstein, Burgos, Fernandez, Carroll, Cruz, Epstein, Lunsford, Stirpe, Rivera JD, Barron, Zebrowski, Peoples-Stokes, Gonzalez-Rojas, Rodriguez, Reyes, Meeks, Fall, Rosenthal L, Brabenec
Add §2805-aa, Pub Health L
Requires nursing homes to spend at least the resident care amount necessary to achieve a required resident care percentage and a sufficient direct care service amount so it does not have a direct care service deficit.
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A05685 Actions:

02/23/2021referred to health
03/05/2021amend and recommit to health
03/05/2021print number 5685a
03/09/2021reported referred to codes
03/09/2021reported referred to ways and means
03/09/2021reported referred to rules
03/09/2021rules report cal.38
03/09/2021ordered to third reading rules cal.38
03/09/2021passed assembly
03/09/2021delivered to senate
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A05685 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5685A                  Revised 3/8/2021
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to establishing a required resident care spending ratio for nursing homes   PURPOSE OR GENERAL IDEA OF BILL: To require that nursing homes spend at least a set minimum amount of total operating revenue on resident care, and of that, of that at least a set amount on direct care nursing staff   SUMMARY OF SPECIFIC PROVISIONS: Adds a new Public Health Law § 2805-aa to define "resident care" to include direct nursing care (RN, LPN, CNA); support and program services such as housing, laundry, food service, other therapeutics; and recre- ational programs; but excluding administrative costs (other than nurse administration), and capital costs, rent, or debt service. Where direct care is provided through a contract agency, only 80% of that cost will apply towards the required percentage. Nursing homes must spend at least a 70% of total operating revenue on resident care. Within that required spend, 60% of that amount must be spent on direct nursing care. If a nursing home fails to meet the required percentages in a calendar year, it would owe the difference to DOH (to be collected, if necessary, by deducting from Medicaid payments or by lawsuit). The money would go to the Nursing Home Quality Improve- ment Demonstration Program under PHL § 2808-d(6).   JUSTIFICATION: The 2021 report of the State Attorney General found that "The current state reimbursement model for nursing homes gives a financial incentive to owners of for-profit nursing homes to transfer funds to related parties (ultimately increasing their own profit) instead of investing in higher levels of staffing and PPE." The AG's report is the most recent of much analysis that has reached similar conclusions. Some not-for-pro- fit nursing homes also siphon off revenue through contracts and real estate arrangements into various pockets. This bill will require operators and owners to prioritize the care of their residents first and foremost. The stunning growth of the for-pro- fit nursing home industry over the past decade indicates that where there was money being made, that money should be redirected towards improve the wellbeing of residents and the staff that care for them.   PRIOR LEGISLATIVE HISTORY: New bill   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: Immediately
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A05685 Text:

                STATE OF NEW YORK
                               2021-2022 Regular Sessions
                   IN ASSEMBLY
                                    February 23, 2021
          --  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  establishing  a
          required resident care spending ratio for nursing homes
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. The public health law is amended by adding  a  new  section
     2  2805-aa to read as follows:
     3    §  2805-aa.  Nursing  home  resident  care  ratio.  1. As used in this
     4  section, the following terms have the following meanings:
     5    (a) "Resident care" means: (i) direct care provided by certified nurse
     6  aides, licensed practical nurses, and registered  nurses;  (ii)  support
     7  services  including  housing, laundry, housekeeping, food service, nurse
     8  administration, activity program, social services and transportation  as
     9  identified  in  reports  required  by  the  department;  (iii) ancillary
    10  program services including medical,  dental,  podiatric  and  laboratory
    11  services,  inhalation and other physical, mental, occupational therapeu-
    12  tics as identified in reports  required  by  the  department;  and  (iv)
    13  program  services  for residents including personal grooming, as identi-
    14  fied in reports required by  the  department.  Resident  care  does  not
    15  include  administrative costs (other than nurse administration), capital
    16  costs, rent, or debt service.
    17    (b) "Resident care amount" means the amount spent by the nursing  home
    18  for  care of residents of the nursing home; provided that for any amount
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 5685--A                          2
     1  spent for contracted or purchased personal services, only eighty percent
     2  of that amount shall count as spending on resident care.
     3    (c)  "Total operating revenue" means the revenue received by the nurs-
     4  ing home from or on behalf of residents of the nursing home,  government
     5  payers,  or third-party payers, to pay for a resident's occupancy of the
     6  nursing home, resident care, and the operation of the nursing home.
     7    (d) "Required resident care percentage" means the ratio of  a  nursing
     8  home's  resident care amount to its total operating revenue, required by
     9  subdivision two of this section.
    10    (e) "Resident care deficit" means the amount, in dollars, by which the
    11  nursing home's resident care amount is less than the  required  resident
    12  care percentage.
    13    (f)  "Direct  care  service"  means  the  amount, in dollars, spent on
    14  direct care by certified nurse aides,  licensed  practical  nurses,  and
    15  registered  nurses which shall be at least sixty percent of the required
    16  resident care percentage.
    17    2. Every nursing home shall, in every calendar year,  spend  at  least
    18  (a)  the resident care amount necessary to achieve the required resident
    19  care percentage and (b) the sufficient direct care service  amount.  For
    20  the  calendar  year  two thousand twenty-two, and every year thereafter,
    21  the required resident care percentage shall be seventy percent.
    22    3. For any calendar year in which a nursing home has a  resident  care
    23  deficit  or  direct care service deficit, it shall pay to the department
    24  an amount equal to the deficit, payable in a manner and time  determined
    25  by the commissioner in regulations. Where a nursing home does not pay as
    26  required by this subdivision, the commissioner shall sue (represented by
    27  the  state  attorney  general)  the  nursing  home  to obtain the unpaid
    28  amount, or deduct the unpaid amount  from  medical  assistance  payments
    29  otherwise  due  to  the nursing home, or a combination of those methods.
    30  Moneys so collected shall be transferred to  the  nursing  home  quality
    31  improvement  demonstration  program, to be used under subdivision six of
    32  section twenty-eight hundred eight-d  of  this  article  in  support  of
    33  projects  or  programs  designed to improve specific areas of quality of
    34  care.
    35    4. For purposes of this section, a nursing  home's  spending,  revenue
    36  and  percentages  of  various  amounts shall be calculated on an accrual
    37  basis, under regulations of the commissioner.
    38    5. The commissioner shall make regulations,  make  medical  assistance
    39  state  plan  amendments, seek waivers from the federal centers for Medi-
    40  care and Medicaid services, and take other actions reasonably  necessary
    41  to implement this section.
    42    6.  The  commissioner  shall,  by regulations and otherwise, make sure
    43  that reports by nursing homes under section twenty-eight hundred  five-e
    44  of  this article include information as to all items referred to in this
    45  section and organize that information consistent with the terms of  this
    46  section.
    47    § 2. This act shall take effect immediately.
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