Establishes a program for specific individuals to become complex care assistants and provide private duty complex care services to children or young adults with developmental disabilities who are Medicaid enrollees.
STATE OF NEW YORK
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7583
2025-2026 Regular Sessions
IN ASSEMBLY
April 1, 2025
___________
Introduced by M. of A. ALVAREZ -- read once and referred to the Commit-
tee on Health
AN ACT to amend the social services law, in relation to authorizing
Medicaid coverage for complex care assistant services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The social services law is amended by adding a new section
2 365-q to read as follows:
3 § 365-q. Complex care assistant services program. 1. As used in this
4 section:
5 (a) "family member" means a parent, sibling, grandparent, legal guard-
6 ian or any other individual related by blood; and
7 (b) "complex care assistant" means a family member who is certified by
8 the department after passing an in-person examination which tests the
9 proficiency and competence of performing the tasks required to care for
10 a child or young adult with developmental disabilities which can
11 include, but is not limited to, all adaptive living skills (ADL's) and
12 instrumental activities of daily living (IADL's), and providing academic
13 assistance in accordance to such child or young adult's level of need.
14 2. (a) No later than one year after this section shall have become a
15 law and receipt of federal approval for the program established pursuant
16 to this section, the state Medicaid director shall establish a program
17 under which a family member of an enrollee in Medicaid may be certified
18 as a complex care assistant and, after receiving such certification may,
19 under the direction of a certified complex care assistant, provide
20 complex care assistant services to the enrollee through a complex care
21 agency under the reimbursement rates established under paragraph (f) of
22 this subdivision, provided that the enrollee is a child or young adult
23 with developmental disabilities as defined in subdivision twenty-two of
24 section 1.03 of the mental hygiene law and qualifies for services under
25 Medicaid. Such program shall operate as a New York Medicaid private duty
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11246-01-5
A. 7583 2
1 nursing benefit. The department shall develop an assessment tool that
2 will allow the division to identify enrollees who meet these eligibility
3 criteria readily.
4 (b) The program established under this section shall require a family
5 member to complete all training, testing, and other qualification crite-
6 ria required under state and federal law for certification as a complex
7 care assistant. The agency that will employ the family member to provide
8 complex care assistant services to the enrollee shall pay all costs for
9 the family member to become certified as a complex care assistant and to
10 receive certification as a complex care assistant from the department of
11 health, before providing services under the program established pursuant
12 to this section. In no case shall a family member who becomes a complex
13 care assistant under the provisions of this section be required to repay
14 or reimburse the licensed home care services and certified complex care
15 agencies for the costs of the family member becoming certified as a
16 complex care assistant under the program.
17 (c) An individual certified to practice as a complex care assistant
18 must complete a training program and shall pass an in-person examination
19 approved by the department of health that demonstrates the applicant's
20 competence and proficiency. If the department of health selects the
21 option of utilizing designated home care providers to provide the train-
22 ing, the department shall adequately reimburse such designated providers
23 for providing the training to family caregivers of eligible relatives.
24 (d) The services received under this program by an eligible member
25 from a complex care assistant shall not exceed forty hours per week.
26 Nothing in this paragraph shall restrict unpaid services provided as
27 part of the family caregiver's familial or household relationship to the
28 eligible relative.
29 (e) A complex care assistant shall not provide qualified complex care
30 assistant services to an eligible member unless the plan of care for the
31 eligible member is recertified by the provider at least every one
32 hundred eighty calendar days. Registered nurse supervisory visits shall
33 occur regularly to ensure support for all complex care assistants
34 assigned to an eligible member and the ability to complete all tasks as
35 outlined in the member's care plan.
36 (f) Complex care assistant services provided by a family member of a
37 Medicaid enrollee who becomes certified as a complex care assistant
38 under the program established pursuant to this section shall be reim-
39 bursed to a complex care agency at a rate that is no more than the
40 current base reimbursement rate for complex care services and dependent
41 upon whether the services are provided in the downstate region or
42 upstate region, provided, however, that such agencies shall ensure that
43 no less than sixty-five percent of such reimbursement is passed through
44 to a complex care assistant. Cost of living adjustments to such rates
45 shall be reviewed by the department bi-annually and such rates adjusted
46 accordingly based upon any increases to the United States bureau of
47 labor statistics consumer price index.
48 (g) The department shall require complex care assistants providing
49 qualified complex care assistant services under the Medicaid program to
50 utilize an electronic visit verification established in accordance with
51 federal law.
52 (h) The New York state Medicaid director, no later than three years
53 after the date the program is established under this section, and every
54 two years thereafter, shall prepare and submit a report to the governor
55 and make such report publicly available on the department's website. The
56 report shall include but not be limited to the following:
A. 7583 3
1 (1) the number of hospitalizations and emergency room visits of eligi-
2 ble members participating in the program;
3 (2) the number of agency private duty nursing hours each eligible
4 member participating in the program has received and an analysis of
5 whether such hours have increased or decreased since their participation
6 in the program;
7 (3) the number of qualified complex care assistant services that were
8 provided by complex care assistants to each eligible member enrolled in
9 the program;
10 (4) the number of overpayments made to each provider employing complex
11 care assistants and other metrics determined by the state that may be
12 used to determine the amount of fraud, waste, and abuse in the program;
13 (5) an analysis of whether the state's waitlist for private duty nurs-
14 ing services or other home and community-based services under the Medi-
15 caid program has improved or declined since the introduction of the
16 program; and
17 (6) reporting concerning the viability of such program and the Medi-
18 caid director's recommendations concerning such program.
19 § 2. The state Medicaid director shall apply for such state plan
20 amendments or waivers as may be necessary to implement the provisions of
21 this act and secure federal financial participation for state Medicaid
22 expenditures under the federal Medicaid program.
23 § 3. This act shall take effect immediately. The state Medicaid direc-
24 tor shall adopt rules and regulations as necessary to implement the
25 provisions of this act.
