Provides for the payment of capitated rates for services provided by assisted living programs, whether freestanding or not

1 Co-sponsor

• Thomas K. Duane

BILL NUMBER:S4918A

Title of bill

An act to amend the public health law, in relation to capitated rates of payment for services provided by assisted living programs

Purpose

This bill will give the Commissioner authority to expand the criteria for ALPs to obtain Medicaid reimbursement for real property capital construction costs.

Summary of specific provisions

Section one of the bill amends subdivision 6 of section 3614 of the public health law, by amending paragraphs (a) and (b) to broaden the criteria for eligibility for capital reimbursement.

Section two provides for an immediate effective date.

Justification

Currently, there is a very small capital component in the Medicaid ALP rate, which does not reflect current true capital costs. Current state policy is encouraging a transition from nursing home beds to ALP beds to "rightsize" the system of care. This initiative will help save Medicaid dollars by enabling low-income seniors and other individuals in need of care to reside in ALPs at half the cost of the nursing home rate. It also enables residents to live in a more home-like, community-oriented setting. Rightsizing projects are impossible without capital funding, however.

In addition, many of the original ALP programs (or adult care facilities seeking ALP licensure) are housed in aging buildings that require significant capital improvements to update physical plants to meet the needs of more frail residents who might otherwise need nursing home care. Funding is needed for resident safety and quality of life, as well as to meet increasing structural requirements imposed by the Department of Health.

This bill amends existing law by allowing Medicaid reimbursement for real property capital construction costs for certain ALPs. Providing a capital component in the ALP rate for these facilities will enable true rightsizing of long term care. The viability of the ALP program is essential because Medicaid eligible individuals who need ALP services will go to a nursing home at a greater cost if there is no ALP bed available in their community. The ALP is the only assisted living option for Medicaid-eligible individuals, whether they are seniors or individuals suffering from HIV/AIDS and related complications, who need care but at a level less intensive than skilled nursing care. Finally, this bill specifically requires that the capital component will only be available for facilities that are able to establish with the Department of Health that the conversion will result in net fiscal savings to the state, thereby ensuring the cost-effectiveness of this legislation.

Prior legislative history

New Bill.

Fiscal implications

None to the State as Commissioner must determine that it will result in a net fiscal savings to the state.

Effective date

Immediately.