Relates to rates of payment for an AIDS assisted living program

BILL NUMBER:S7829

Title of bill

An act to amend the public health law, in relation to rates of payment for an AIDS assisted living program

Purpose

To enhance the Medicaid Assisted Living Program (ALP) payment rates to include both real property construction and lease costs for certain HIV/AIDS residential health care facilities.

Summary of provisions

Section 1 adds a new paragraph 6-c to subdivision six of section 3614 of the public health law.

Section 2 provides for an immediate effective date.

Justification

Today, many people living with HIV/AIDS can be stabilized after a short-stay in a skilled nursing facility and moved to a less-restrictive setting. However, the majority of these people, many of whom are aging, cannot manage HIV/AIDS on their own because even after being stabilized, they still have an accompanying psychiatric diagnosis, as well as a history of substance abuse and/or other medical conditions that require continued supervision and professional attention to maintain their treatment regimen. Thus, discharge to a private home is not realistic for this population, but neither do they need the intensive care found in a skilled nursing facility; rather, they require something in-between. The solution is an AIDS ALP, which will be able to deliver a variety of health care services for this growing segment of the HIV/AIDS population, in a setting that is much less restrictive and far less costly than a skilled nursing facility.

Continued stigma is also an unfortunate reality for this population, especially for older New Yorkers living with HIV/AIDS. According to the recent Research on Older Adults with HIV (ROAH) Study, persons over age 55 living with HIV/AIDS reported feeling significant external stigma, and cite this stigma as a barrier to seeking appropriate health care services and engaging in the community. Also according to the ROAH study, 44% of HIV-positive people over 50 admit they have no place to turn for help in effectively managing their disease. An AIDS ALP would be the ideal setting for these individuals by offering the necessary clinical expertise and care, coupled with the freedom of a less-restrictive setting, at a fraction of the cost of skilled nursing care in a traditional nursing home setting.

However, the pertinent section of the Public Health Law establishing payment rates for nursing facilities currently does not contemplate the less-intensive, long-term health care needs of people living and growing older with HIV/AIDS, because it does not establish the necessary payment methodology for the efficient co-location of an AIDS ALP within an existing HIV/AIDS nursing home. Accordingly, this legislation will amend the Public Health law to allow for appropriate rates of payment for AIDS Medicaid ALP programs located within existing HIV/AIDS nursing facilities.

Legislative history

None - new bill.

Fiscal implications

By revising the existing payment methodology under Section 3614 of the Public Health Law, thereby effectively

allowing existing HIV/AIDS nursing facilities to convert high-cost skilled nursing beds to lower-cost assisted living beds, this legislation will immediately achieve significant cost savings to the state.

Effective date

This act shall take effect immediately.