Provides that such rates of payment shall be updated to reflect the most current mean price for freestanding residential health care facilities with less than three hundred beds each time that the cost basis of residential health care facility rates is updated.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7553
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law, in relation to certain rates of
payment for services provided by assisted living programs
PURPOSE OF THE BILL:
This legislation would update rates of payment for Medicaid assisted
living program providers based on 2022 costs, and require that the
Department of Health periodically update those rates.
SUMMARY OF SPECIFIC PROVISIONS:
Section one of the bill amends paragraph (a) of subdivision 6 of section
3416 of the public health law to require rates of payment to Medicaid
assisted living program providers to be updated based on costs estab-
lished in 2022. It further requires that the Department of Health update
those rates whenever Medicaid rates of payment for residential health
care facilities are updated.
Section two of the bill establishes an effective date of January 1,
2025.
JUSTIFICATION:
Medicaid rates of payment for assisted living providers are set in stat-
ute at fifty percent of nursing home prices established in 1992.
Although this thirty year old statutory base year was trended to 2002,
it remains too low to support the program. This update will more
adequately reflect program costs. The base year should also continue to
be updated on a regular basis.
Medicaid funded assisted living programs serve individuals who are
medically eligible for nursing home care in a less intensive, lower cost
setting. They has saved New York tens of millions of dollars since the
program's inception by keeping frail, elderly people out of nursing
homes.
However, the current inadequate rates result in programs closing their
doors. Unfortunately, this program is at risk of being decimated due to
the historically low reimbursement rates. Assisted living programs are
starting to close because of the increasing costs of providing services,
and residents most often end up being transferred to nursing homes at a
much higher cost to the State.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Positive to the State. Since assisted living programs, which serve nurs-
ing home eligible patients, are paid fifty percent of the nursing home
rate, updating their payment rates will generate savings to the State by
avoiding more costly placements and will prevent program from closing.
EFFECTIVE DATE:
This act shall take effect January 1, 2025.
STATE OF NEW YORK
________________________________________________________________________
7553
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, in relation to certain rates of
payment for services provided by assisted living programs
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph (a) of subdivision 6 of section 3614 of the
2 public health law, as amended by section 4-a of part D of chapter 56 of
3 the laws of 2012, is amended to read as follows:
4 (a) The commissioner shall, subject to the approval of the state
5 director of the budget, establish capitated rates of payment for
6 services provided by assisted living programs as defined by paragraph
7 (a) of subdivision one of section four hundred sixty-one-l of the social
8 services law. Such rates of payment shall be related to costs incurred
9 by residential health care facilities. The rates shall reflect the wage
10 equalization factor established by the commissioner for residential
11 health care facilities in the region in which the assisted living
12 program is provided and real property capital construction costs associ-
13 ated with the construction of a free-standing assisted living program
14 such rate shall include a payment equal to the cost of interest owed and
15 depreciation costs of such construction. The rates shall also reflect
16 the efficient provision of a quality and quantity of services to
17 patients in such residential health care facilities, with needs compara-
18 ble to the needs of residents served in such assisted living programs.
19 Such rates of payment shall be equal to fifty percent of the amounts
20 which otherwise would have been expended, based upon the [mean prices]
21 costs for [the first of July, nineteen hundred ninety-two (utilizing
22 nineteen hundred eighty-three costs)] two thousand twenty-two for free-
23 standing[, low intensity] residential health care facilities with less
24 than three hundred beds[, and for years subsequent to nineteen hundred
25 ninety-two,] adjusted for inflation in accordance with the provisions of
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11563-01-3
A. 7553 2
1 subdivision ten of section twenty-eight hundred seven-c of this chapter,
2 to provide the appropriate level of care for such residents in residen-
3 tial health care facilities in the applicable wage equalization factor
4 regions plus an amount equal to capital construction costs associated
5 with the construction of an assisted living program facility as provided
6 for in this subdivision. Such rates of payment shall be updated to
7 reflect the most current mean price for free-standing residential health
8 care facilities with less than three hundred beds each time that the
9 cost basis of residential health care facility rates is updated. The
10 commissioner shall also promulgate regulations, and may promulgate emer-
11 gency regulations, to provide for reimbursement of the cost of preadmis-
12 sion assessments conducted directly by assisted living programs.
13 § 2. This act shall take effect January 1, 2025.
