BILL NUMBER: S7705
SPONSOR: RYAN C
 
TITLE OF BILL:
An act to amend the public health law and the social services law, in
relation to rates of reimbursement for private duty nursing
 
PURPOSE OR GENERAL IDEA OF BILL:
To set a benchmark rate for private duty nursing services consistent
with the current fee-for-service rate.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends Public Health Law § 3614 subdivision 11 to add a new
paragraph which mandates organizations operating under article 44 of the
public health law and article 43 of the insurance law pay private duty
services at a rate no lower than the Medicaid fee for service rate.
Section 2 amends section 364-j of the social services law to provide for
the same rate mandate as in section 1.
Section 3 states that effective July 1, 2026, payments for private duty
nursing services shall be no less than 80t of the appropriate
CHAMPUS/TRICARE maximum allowable charge based on the New York locality.
The Department of Health is required to publish a private duty rate
schedule at least 30 days prior to the effective date of the increase
and to continue this annually.
 
JUSTIFICATION:
Access to Private Duty Nursing (PDN) allows eligible medically fragile
individuals, to remain in their homes and continue to receive quality
skilled nursing care. When access to PDN services is not available to
these vulnerable and high-acuity patients, they are relegated to care in
a hospital or facility, which is not only a more expensive option but
also often not the best option for the patient's or family's quality of
life and responsiveness to care. The state sets fee-for-service
reimbursement rates for PDN services. Unfortunately, Medicaid-managed
care organizations often reimburse at a lower rate, making it difficult
to recruit nurses to this program and for agencies to continue to
provide PDN services. This bill would set the floor for Medicaid-managed
care reimbursement at the same level as the fee-for-service rate thus
ensuring this vulnerable population continues to have access to the
professional and quality services of private duty nursing.
This is generally a relatively small cohort of the patient population,
who require intensive long-term continuous care due to a birth condition
that requires a ventilator, tracheostomy, intubation tuber etc. and this
would also care for adults who may suffer from conditions such as ALS or
Parkinson's disease or following a stroke. PDNs provide comprehensive
hourly long-term nursing care, anywhere from four to 24 hours per day.
They are skilled in managing medical equipment and technology and have
specific training to manage pediatric acuities and other medical
complexities.
 
PRIOR LEGISLATIVE HISTORY:
New bill.
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
Immediate

Statutes affected:
S7705: 3614 public health law, 3614(11) public health law, 364-j social services law