Makes technical corrections to provisions of law relating to rates of payment for residential health care facilities

1 Co-sponsor

• Ronald Canestrari

BILL NUMBER:A9944

Title of bill

An act to amend the public health law, in relation to rates of payment for residential health care facilities

Purpose or general idea of bill

The purpose of this legislation is to ensure continuation of a consistent Medicaid nursing home reimbursement rate for a specialty nursing home that treats neurologically impaired children who cannot be appropriately discharged into the community when they age.

Summary of specific provisions

This legislation provides that a resi- dential health care facility with fewer than sixty beds as of July 1, 2007, which provides services primarily to neurologically impaired indi- viduals and is located in a county with of population between 290,000 - 310,000- as of July 1, 2007, shall receive one Medicaid reimbursement rate, which shall be based solely on the methodology to establish rates for a specialty children's nursing home.

Justification

Prior to the enactment of Chapter 414 of the Laws of 2007, the facility received two different Medicaid rates under the Health Departments rate setting -one for individuals under 16 and one for individuals 16 and over, despite the fact that virtually the same services were provided. Because of the differences in the way the two rates were calculated, the rate for those 16 and over was considerably less than that for those under 16. The rate for those over 16 .did not cover the cost of care for these vulnerable individuals. Chapter 414 of the laws of 2007 mandated that the facility receive one rate of payment based solely on the methodology used to establish rates for facilities which provide extensive nursing, medical, psychological and counseling support services solely to children.

However, the facility has now received certificate of need approval to add 36 beds, which will result in a facility with more than 60 beds. Without a change in the law, the facility would no longer receive one rate as it would no longer meet the qualification of having less than 60 beds (when chapter 414 of the Laws of 2007 was enacted, the facility did not envision increasing its number of beds) - even though the rationale that resulted in the enactment of chapter 414 of the Laws of 2007 still applies. The beds being added are pediatric beds, not beds for the young adult neurologically impaired population aged 16 and over, which will remain at 20 beds (therefore, there is no change in the number of beds the higher rate applies to).

Prior legislative history

New Bill

Fiscal implications

Since this amendment simply allows for the contin- uation of establishing one, rather than two, rates for the facility, there would be no increase in Medicaid expenditures - the status quo would be continued.

Effective date

Immediately