Relates to Medicaid reimbursement rates for private duty nursing; requires DOH to publish a private duty rate schedule.
Summary
This bill would change how New York reimburses private duty nursing services under Medicaid and related managed care arrangements. For Medicaid enrollees covered as of October 1, 2026 under a negotiated payment rate methodology agreement with a licensed home care services provider, the bill requires that hourly home care services provided through private duty nursing be paid at least at a benchmark rate tied to the Medicaid fee-for-service rate in effect when the services were delivered. A parallel provision applies to Medicaid managed care organizations and health maintenance organizations, requiring payment rates to be no less than what would be paid under the public health law benchmark.
Beginning October 1, 2026, the bill also sets a separate floor for private duty nursing reimbursement: payments must be at least 80% of the applicable CHAMPUS/TRICARE maximum allowable charge for the New York locality. The Department of Health would be required to publish a private duty rate schedule at least 30 days before the effective date of the increase and annually thereafter. The bill takes effect immediately, while the Medicaid managed care amendment is tied to the repeal of the underlying section of law.
Impact
The bill would amend both the Public Health Law and the Social Services Law, specifically section 3614 of the Public Health Law and section 364-j of the Social Services Law, to establish minimum reimbursement standards for private duty nursing under Medicaid and managed care. It would affect licensed home care services providers, licensed home care services agencies, Medicaid managed care organizations, HMOs, and private duty nursing providers by setting payment floors linked to fee-for-service Medicaid rates and TRICARE benchmark charges. It also imposes an administrative obligation on the Department of Health to publish a rate schedule, which could influence future rate-setting and provider contracting practices.
Sentiment
The available voting history suggests broad support in committee, with unanimous Senate Health Committee votes of 12-0 and 13-0. No committee transcript was provided, but the bill’s advancement without recorded opposition indicates generally favorable sentiment toward increasing or stabilizing reimbursement for private duty nursing services. The measure appears to be framed as a provider-rate adequacy and access-to-care bill rather than a controversial restructuring of benefits.
Contention
The main policy issue is reimbursement adequacy versus cost containment. Supporters are likely to favor the bill because it raises minimum payment levels for private duty nursing and ties them to established benchmarks, which may help provider participation and patient access. Potential concerns would come from Medicaid managed care plans, the state budget, and other payers that may face higher costs from mandated minimum rates and the new TRICARE-based floor. Another possible point of contention is the use of benchmark formulas and the Department of Health’s role in publishing rate schedules, which could be seen as limiting flexibility in negotiated payment arrangements.
Enacts "Vincent Scheppa's law" authorizing, in certain cases, the provision of private duty nursing services to a medical assistance recipient by a relative who is a registered professional nurse.