BILL NUMBER: S3599
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, in relation to regional minimum
hourly base reimbursement rates for home care aides
 
PURPOSE:
To establish a reliable and predictable mechanism to ensure that home
care providers receive adequate reimbursement from managed care organ-
izations for the purpose of paying their employees mandated wages and
benefits and to cover other costs of the employer.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 would add new subdivisions 5-12 to section 3614-f of the
Public Health Law as it relates to the home care minimum wage increase.
The bill would require the Commissioner of Health to establish a
regional minimum hourly base reimbursement rate for providers employing
home care and personal care aides. The legislation would also identify
specific elements of the rate that must be included in its development,
including direct care-related payments, components to reflect opera-
tional expenses necessary to comply with state and federal mandates, and
administrative and general expenses components. The legislation would
require the rates to reflect regional variation and not be less than the
established fee for service county rates. The legislation would also
require the rates to be adjusted annually by a trend factor.
Requires the Department of Health (DOH) to apply for federal approval
for a state-directed payment for fully capitated Medicaid managed care
plans to support the regional minimum hourly base reimbursement rate.
Requires for partially capitated managed long-term care plans, and where
federal approval is not secured for state-directed payment, that plans
justify contracts offering deviations from the regional minimum hourly
base reimbursement rate. Providers would have an opportunity to respond.
Ensure that the DOH provides managed care organizations with sufficient
capitation payments to ensure rate adequacy to comply with the require-
ments of regional minimum hourly base reimbursement rates.
Require the DOH to amend the Medicaid managed care model contract rates
to comply with the requirements of the bill. Require the DOH to publicly
post the regional minimum hourly base reimbursement rates. Require the
DOH to publicly post cost report data of plans and providers In a simple
and understandable manner.
Grant the comptroller the authority to review contracts to ensure rate
adequacy. Section 2 establishes a severability clause. Section 3
provides an effective date.
 
JUSTIFICATION:
The need for a reliable and predictable mechanism to ensure that home
care providers receive adequate reimbursement from managed care organ-
izations to pay their employees was made clear in October 2022, when the
$2 per hour wage increase went into effect for home care workers. There
was overall confusion about what the expectations were concerning rate
sufficiency, timing, and process. Legislation to set clear standards for
the plans, providers, and the State is required.
Currently, there is no common understanding of what constitutes an
adequate rate to cover a worker's wages and benefits. This legislation
would require the DOH to set a minimum hourly base reimbursement rate,
including the elements that are articulated by statute and determined by
the DOH. This will help establish an objective standard against which to
measure negotiated rates. By articulating the elements of the rate that
must be accounted for by the DOH, this legislation would drive the rate
to a formula and bring clarity and predictability to the current proc-
ess. It would set objective expectations for providers, plans, and the
State regulators. The regional minimum hourly base reimbursement rate
development process should be informed by provider cost reports and
Medicaid Managed Care Operating Reports. This information should be
available broadly and in a searchable format.
The regional minimum hourly base reimbursement rate would set expecta-
tions based on agreed-upon standards. The legislation would propose two
mechanisms to ensure that the minimum hourly base reimbursement rate
reaches the provider. For fully-capitated plans (mainstream managed
care, PACE, MAP), the State would apply to the U.S. Centers for Medicare
& Medicaid Services (CMS) for a state-directed payment of minimum fee
schedules for home care agencies and fiscal intermediaries. Where there
is no approved state-directed payment and for Managed Long Term Care
(MLTC) plans, which are not fully capitated, the legislation would
establish a reporting mechanism for plans where they are paying less
than the minimum hourly base reimbursement rate. The plan's report must
include a rationale for paying under the minimum hourly base reimburse-
ment rate; the impacted provider would also have the opportunity to
address the report in writing. This approach would be paired with DOH
collecting and publicly reporting this data on a regular basis. Imple-
menting these processes would bring visibility as to whether there are
patterns of unjustified and/or unfair behavior. The bill would make
exceptions, however, where the provider and a plan mutually agree to
enter into a value-based contract.
Finally, the bill would authorize the Comptroller to review contracts
between plans and providers to ensure compliance with regional minimum
hourly base reimbursement rates.
 
LEGISLATIVE HISTORY:;
2023-2024: S6963-A1A7335-A Paulin
 
FISCAL IMPLICATIONS:
None noted.
 
EFFECTIVE DATE:z
This act shall take effect immediately.

Statutes affected:
S3599: 3614-f public health law