NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7488
SPONSOR: Paulin 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 services rate
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends Public Health Law § 3614 subdivision 11 to ass 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.
JUSTIFICATION:
Access to Private Duty Nursing (PDN) allows eligible medically fragile
individuals, to remain in their home 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 at 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 condi-
tion that requires a ventilator, tracheostomy, intubation tube, etc and
this care also cares for adults who may suffer from conditions such as
ALS or Parkinson's disease or following a stroke. PDNs provide compre-
hensive 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
STATE OF NEW YORK
________________________________________________________________________
7488
2023-2024 Regular Sessions
IN ASSEMBLY
May 25, 2023
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Health
AN ACT to amend the public health law and the social services law, in
relation to rates of reimbursement for private duty nursing
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 11 of section 3614 of the public health law is
2 amended by adding a new paragraph (d) to read as follows:
3 (d) For enrollees covered by Medicaid as of January first, two thou-
4 sand twenty-four under a payment rate methodology agreement negotiated
5 with a licensed home care services provider, including but not limited
6 to services provided through licensed home care services agencies,
7 payments for all hourly home care services provided through private duty
8 nursing, including but not limited to nursing services, provided to
9 patients eligible for medical assistance pursuant to title eleven of
10 article five of the social services law made by organizations operating
11 in accordance with the provisions of article forty-four of this chapter
12 or by health maintenance organizations organized and operating in
13 accordance with article forty-three of the insurance law shall, at a
14 minimum, be at a benchmark rate which is to be the fee-for-service rate
15 calculated pursuant to this chapter and as in effect at the time such
16 services were provided.
17 § 2. Section 364-j of the social services law is amended by adding a
18 new subdivision 40 to read as follows:
19 40. For enrollees covered by Medicaid as of January first, two thou-
20 sand twenty-four under a payment rate methodology agreement negotiated
21 with a licensed home care services provider, including but not limited
22 to services provided through licensed home care services agencies,
23 payments for all hourly home care services provided through private duty
24 nursing, including but not limited to nursing services, provided to
25 patients eligible for medical assistance under this title made by organ-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11370-01-3
A. 7488 2
1 izations operating in accordance with the provisions of article forty-
2 four of the public health law or by health maintenance organizations
3 organized and operating in accordance with article forty-three of the
4 insurance law shall, at a minimum, be the rates of payment that would be
5 paid for such patients pursuant to subdivision fourteen of section thir-
6 ty-six hundred fourteen of the public health law.
7 § 3. This act shall take effect immediately.
