Relates to reimbursement of home care aides; requires the commissioner of health to ensure rate ranges for Medicaid managed care organizations comply with certain reimbursement rates.
STATE OF NEW YORK
________________________________________________________________________
10506
IN ASSEMBLY
March 6, 2026
___________
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 regional minimum
hourly base reimbursement rates for home care aides
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 3614-f of the public health law is amended by
2 adding six new subdivisions 5, 6, 7, 8, 9 and 10 to read as follows:
3 5. (a) No Medicaid managed care organization shall reimburse providers
4 employing workers subject to the minimum wage provisions established in
5 subdivision two of this section in an amount that is less than the most
6 current average fee for service county rates for level two personal care
7 service for each region as posted by the department for personal care
8 agencies or other providers delivering like services through other Medi-
9 caid programs.
10 (b) Alternatively, the commissioner may require Medicaid managed care
11 organizations to pay a regional minimum hourly base reimbursement rate,
12 which the commissioner will develop based on the total direct care
13 related costs for home care aides and other direct care related staff
14 necessary to comply with federal and state statutory and regulatory
15 requirements for such providers and informed by provider cost reports
16 filed with the department, provided that such resulting rate is not less
17 than the fee for service rate in paragraph (a) of this subdivision. If
18 the commissioner chooses to exercise this option, the minimum rate iden-
19 tified in paragraph (a) of this subdivision shall apply until the
20 regional minimum hourly base reimbursement rate is developed and imple-
21 mented.
22 6. For mainstream managed care and fully capitated Medicaid managed
23 care products for those dually eligible for both Medicaid and Medicare,
24 the commissioner shall submit any and all necessary applications for
25 approvals and/or waivers to the federal centers for Medicare and Medi-
26 caid services to secure approval, if necessary, under subdivision five
27 of this section.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15106-01-6
A. 10506 2
1 (a) If approved by the federal centers for Medicare and Medicaid
2 services, directed payments shall be made to such providers of Medicaid
3 services through contracts with managed care organizations where appli-
4 cable, provided that the commissioner ensures that such directed
5 payments are in accordance with the terms of this section.
6 (b) If the state directed payment is not approved, the provisions of
7 subdivision seven of this section shall apply.
8 7. For partially capitated managed long term care plans, or where
9 state directed payments pursuant to subdivision six of this section have
10 not been approved, the department shall require plans to justify
11 contracts offering deviations from the reimbursement rate set in subdi-
12 vision five of this section in a report to the department. Such report
13 shall be sent to the department, with a copy to the provider prior to
14 the finalizing of any contract, unless otherwise permitted by this
15 section, within five working days of the contract being offered to a
16 provider with rate deviations. Any report shall include a rationale for
17 paying below the reimbursement rate set in subdivision five of this
18 section, and the impacted provider shall have the opportunity to respond
19 to the report within thirty days of filing with the department. The
20 department shall compile such reports and publish and post a summary of
21 them semi-annually.
22 8. The commissioner shall take action to ensure rate ranges for Medi-
23 caid managed care organizations are actuarially sound in order to comply
24 with this section.
25 9. Nothing in this section shall preclude providers employing home
26 health aides covered under this section or payers from paying or
27 contracting for services at rates higher than those established under
28 subdivision five of this section if the parties mutually agree to such
29 terms. Notwithstanding subdivision seven of this section, plans and
30 providers can also mutually agree to enter into value-based contracts at
31 a rate less than that established in subdivision five of this section.
32 10. The commissioner shall amend the model managed care contracts to
33 reflect the requirements of this section.
34 § 2. Severability. If any provision of this act, or any application of
35 any provision of this act, is held to be invalid, or to violate or be
36 inconsistent with any federal law or regulation, that shall not affect
37 the validity or effectiveness of any other provision of this act, or any
38 other application of any provision of this act which can be given effect
39 without that provision or application; and to that end, the provisions
40 and applications of this act are severable.
41 § 3. This act shall take effect immediately.
