§ 367-R — Private duty nursing services worker recruitment and retention program

New York § 367-R

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

§ 367-r. Private duty nursing services worker recruitment and\nretention program. 1. (a) The commissioner of health, with the approval\nof the director of the budget, shall establish fees for the\nreimbursement of private duty nursing services.\n (b) The commissioner of health shall, subject to the provisions of\nparagraph (b) of subdivision two of this section and to the availability\nof federal financial participation, increase medical assistance rates of\npayment by three percent for services provided on and after December\nfirst, two thousand two, for private duty nursing services for the\npurposes of improving recruitment and retention of private duty nurses.\n 2. Medically fragile children and medically fragile adults. (a) In\naddition, the commissioner shall further increase rates for private duty\nnursing services that are provided to medically fragile children to\nensure the availability of such services to such children. Furthermore,\nno later than sixty days after the effective date of the chapter of the\nlaws of two thousand twenty-two that amended this subdivision, increased\nrates shall be extended for private duty nursing services provided to\nmedically fragile adults. In establishing rates of payment under this\nsubdivision, the commissioner shall consider the cost neutrality of such\nrates as related to the cost effectiveness of caring for medically\nfragile children and medically fragile adults in a non-institutional\nsetting as compared to an institutional setting. Medically fragile\nchildren shall, for the purposes of this subdivision, have the same\nmeaning as in subdivision three-a of section thirty-six hundred fourteen\nof the public health law. For purposes of this subdivision, "medically\nfragile adult" shall be defined as including but not limited to any\nindividual who previously qualified as a medically fragile child but no\nlonger meets the age requirement. Such increased rates for services\nrendered to such children and adults may take into consideration the\nelements of cost, geographical differentials in the elements of cost\nconsidered, economic factors in the area in which the private duty\nnursing service is provided, costs associated with the provision of\nprivate duty nursing services to medically fragile children and\nmedically fragile adults, and the need for incentives to improve\nservices and institute economies and such increased rates shall be\npayable only to those private duty nurses who can demonstrate, to the\nsatisfaction of the department of health, satisfactory training and\nexperience to provide services to such children and medically fragile\nadults. Such increased rates shall be determined based on application of\nthe case mix adjustment factor for AIDS home care program services rates\nas determined pursuant to applicable regulations of the department of\nhealth. The commissioner may promulgate regulations to implement the\nprovisions of this subdivision.\n (b) Private duty nursing services providers which have their rates\nadjusted pursuant to paragraph (b) of subdivision one of this section\nand paragraph (a) of this subdivision shall use such funds solely for\nthe purposes of recruitment and retention of private duty nurses or to\nensure the delivery of private duty nursing services to medically\nfragile children and medically fragile adults and are prohibited from\nusing such funds for any other purpose. Funds provided under paragraph\n(b) of subdivision one of this section and paragraph (a) of this\nsubdivision are not intended to supplant support provided by a local\ngovernment. Each such provider, with the exception of self-employed\nprivate duty nurses, shall submit, at a time and in a manner to be\ndetermined by the commissioner of health, a written certification\nattesting that such funds will be used solely for the purpose of\nrecruitment and retention of private duty nurses or to ensure the\ndelivery of private duty nursing services to medically fragile children\nand medically fragile adults. The commissioner of health is authorized\nto audit each such provider to ensure compliance with the written\ncertification required by this subdivision and shall recoup all funds\ndetermined to have been used for purposes other than recruitment and\nretention of private duty nurses or the delivery of private duty nursing\nservices to medically fragile children and medically fragile adults.\nSuch recoupment shall be in addition to any other penalties provided by\nlaw.\n (c) The commissioner of health shall, subject to the provisions of\nparagraph (b) of this subdivision, and the provisions of subdivision\nthree of this section, and subject to the availability of federal\nfinancial participation, annually increase fees for the fee-for-service\nreimbursement of private duty nursing services provided to medically\nfragile children by fee-for-service private duty nursing services\nproviders who enroll and participate in the provider directory pursuant\nto subdivision three of this section, over a period of three years,\ncommencing October first, two thousand twenty, by one-third annual\nincrements, until such fees for reimbursement equal the final benchmark\npayment designed to ensure adequate access to the service. In developing\nsuch benchmark the commissioner of health may utilize the average two\nthousand eighteen Medicaid managed care payments for reimbursement of\nsuch private duty nursing services. The commissioner may promulgate\nregulations to implement the provisions of this paragraph.\n (d) The commissioner of health shall, subject to the provisions of\nparagraph (b) of this subdivision, and the provisions of subdivision\nthree of this section, and subject to the availability of federal\nfinancial participation, increase fees for the fee-for-service\nreimbursement of private duty nursing services provided to medically\nfragile adults by fee-for-service private duty nursing services\nproviders who enroll and participate in the provider directory pursuant\nto subdivision three of this section, no later than sixty days after the\neffective date of the chapter of the laws of two thousand twenty-two\nthat amended this subdivision, so such fees for reimbursement equal the\nbenchmark payment designed to ensure adequate access to the service. In\ndeveloping such benchmark the commissioner of health may utilize the\naverage two thousand twenty Medicaid managed care payments for\nreimbursement of such private duty nursing services. The commissioner\nmay promulgate regulations to implement the provisions of this\nparagraph.\n 3. Provider directory for fee-for-service private duty nursing\nservices provided to medically fragile children and medically fragile\nadults. The commissioner of health is authorized to establish a\ndirectory of qualified providers for the purpose of promoting the\navailability and ensuring delivery of fee-for-service private duty\nnursing services to medically fragile children and medically fragile\nadults. Qualified providers enrolling in the directory shall ensure the\navailability and delivery of and shall provide such services to those\nindividuals as are in need of such services, and shall receive increased\nreimbursement for such services pursuant to paragraphs (c) and (d) of\nsubdivision two of this section. The directory shall offer enrollment to\nall private duty nursing services providers to promote and ensure the\nparticipation in the directory of all nursing services providers\navailable to serve medically fragile children and medically fragile\nadults.\n