What's happening
This bill requires an independent actuary to review reimbursement rates for home and community-based long term care services to ensure adequate worker compensation and workforce retention.
Why it matters
Ensures wage and benefit standards for home care workers. By mandating that reimbursement rates cover not just basic wages but also wage parity requirements, overtime, benefits, and regional living wage laws, the bill aims to guarantee fair compensation for home and community-based long term care workers.
Targets workforce recruitment and retention challenges. The independent actuary’s review must consider costs related to hiring, training, and keeping direct care staff, aiming to address chronic workforce shortages and turnover that can affect quality of care for vulnerable populations.
Creates accountability and transparency in Medicaid rate-setting. Requiring annual actuarial reports to be shared with legislative leaders, and specifying the data and methodology used, increases oversight of how Medicaid dollars are spent and helps ensure rates are based on real cost factors, not just budget targets.
Potentially impacts service quality for recipients. By explicitly linking reimbursement rates to the ability to retain a qualified workforce, the bill connects financial decisions to the maintenance of high-quality care for people relying on home and community-based services, including seniors and people with disabilities.
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Who cares
Department of Health
The bill would require the department to hire an independent actuary to review Medicaid home and community-based long-term care reimbursement methodologies and report the findings to state leaders.
Home care providers and fiscal intermediaries
The review would examine reimbursement that supports workforce retention and covers compensation, recruitment, training, mandatory benefits and an annually indexed administrative cost factor.
- Likely support
Home care aides and consumer-directed personal assistants
The study would assess reimbursement needed to support legally required wages, overtime and other compensation costs in both wage-parity and non-wage-parity regions.
Medicaid insurers
Their reimbursement arrangements for the covered services would be subject to an independent actuarial review of payment adequacy.
Headline styles
Review Home Care Payment Rules
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Returned to senate
- Died in assembly
- Referred to health
- Delivered to assembly
- Passed senateVote 63–0
- Ordered to third reading cal.2048
- Committee discharged and committed to rules
- Reported and committed to finance
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5841
2017-2018 Regular Sessions
IN SENATE
May 2, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to the review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 18 of section 364-j of the social services law, as amended by chapter 649 of the laws of 1996, paragraph (b) as amended by chapter 433 of the laws of 1997, paragraph (c) as added by section 40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d) as added by section 55 of part B of chapter 57 of the laws of 2015, is amended to read as follows:
18. (a) The department of health may, where not inconsistent with the rate setting authority of other state agencies and subject to approval of the director of the division of the budget, develop reimbursement methodologies and fee schedules for determining the amount of payment to be made to managed care providers under the managed care program. Such reimbursement methodologies and fee schedules may include provisions for payment of managed care fees and capitation arrangements.
(b) The department of health in consultation with organizations representing managed care providers shall select an independent actuary to review any such reimbursement rates. Such independent actuary shall review and make recommendations concerning appropriate actuarial assumptions relevant to the establishment of rates including but not limited to the adequacy of the rates in relation to the population to be served adjusted for case mix, the scope of services the plans must provide, the utilization of services and the network of providers necessary to meet state standards. The independent actuary shall issue a report no later than December thirty-first, nineteen hundred ninety-eight and annually
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02956-02-7
S. 5841 2
thereafter. Such report shall be provided to the governor, the temporary president and the minority leader of the senate and the speaker and the minority leader of the assembly. The department of health shall assess managed care providers under the managed care program on a per enrollee basis to cover the cost of such report.
(c) In setting such reimbursement methodologies, the department shall consider costs borne by the managed care program to ensure actuarially sound and adequate rates of payment to ensure quality of care.
[(c)] (d) The department of health shall require the independent actuary selected pursuant to paragraph (b) of this subdivision to provide a complete actuarial memorandum, along with all actuarial assumptions made and all other data, materials and methodologies used in the development of rates, to managed care providers thirty days prior to submission of such rates to the centers for medicare and medicaid services for approval. Managed care providers may request additional review of the actuarial soundness of the rate setting process and/or methodology.
[(d)] (e)(i) The department of health shall select and contract with an independent actuary to study and review adequate reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services provided under this article, by fiscal intermediaries operating pursuant to section three hundred sixty-five-f of this title or rates of payment for such services under the medical assistance program to ensure such contracts or rates shall support compensation for persons providing such home care aide services and consumer directed personal assistance services to ensure the retention of a qualified workforce capable of providing high quality care to recipients of such services in both wage parity and non-wage parity regions. Such compensation shall at a minimum include wage parity compensation as required under section thirty-six hundred fourteen-c of the public health law or such wage as required under article nineteen or nineteen-A of the labor law as required together with the following costs: recruitment, training and retention of direct care personnel including wage; salary; mandatory contributions pursuant to Title 26, Subtitle C, Chapter 21 of the United States Code (FICA); costs attributed to workers compensation; county living wage laws as appropriate; provisions of the federal Fair Labor Standards Act for employees' overtime and other mandatory benefits; and an administrative and general cost factor indexed annually.
(ii) The department of health shall report on the results of the independent actuary findings under this paragraph to the governor, the temporary president of the senate, the speaker of the assembly, the chairs of the senate health committee and assembly health committee on or before January fifteenth, two thousand eighteen.
(f) The department of health shall annually provide to the temporary president of the senate and the speaker of the assembly the annual Medicaid managed care operating reports submitted to the department from managed care plans that contract with the state to manage services provided under the Medicaid program.
§ 2. This act shall take effect immediately; provided that the amendments made to section 364-j of the social services law by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to the review of reimbursement methodologies under contracts or agreements with insurers under the medical assistance program for home and community-based long term care services
Purpose
Directs the Department of Health to provide for the study and review of adequate reimbursement methodologies under managed care contracts and fee-for-service Medicaid rates to ensure such are sufficient to support compensation for persons providing home care aide services and consumer directed personal assistance services.
Summary of provisions
Section one adds a new paragraph (e) to section 364-j of the Social Services Law requiring the Department of Health to select and contract with an independent actuary to study and review adequate reimbursement methodologies for home and community based long term care providers. In addition, it provides that the Department shall report to the Governor, the Temporary President of the Senate, the Speaker of the Assembly, the Health Chairs on or before January 15, 2018 on the findings of such study and review.
Justification
New York State has long recognized the importance of home care services as a critical component of the State's health care delivery system. Home care plays an important role in reducing health care costs and improving consumer satisfaction by providing cost-effective care at a fraction of the cost of institutional settings - all in the patient-preferred setting of the home. However, compliance with existing State and Federal wage and benefit mandates, and the implementation of new requirements going into effect, are putting an enormous strain on home care providers operating within both the Medicaid fee-for-service and managed care environments.
This legislation aims to ensure that the home care industry in New York, whether provided by a agencies or through consumer directed care, can continue to provide a high level of quality care to the state's Medicaid population.
The review will assist the State in determining the overall adequacy of current home care reimbursement rates. Results will offer insight and a better understanding of the reimbursement needs of the home care system within the context of the changing health care delivery system and implementation of new and rising wage and benefit requirements, and help to identify reimbursement gaps or areas in need of additional oversight and/or State intervention.
Legislative history
New bill.
Fiscal implications
No net fiscal impact - the state currently contracts with actuaries.
Effective date
Immediately
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.