New York Senate Bill S09464

New York 2025-2026 Regular Session

• Introduced: 3/13/26
• Refer: 3/13/26

Caption

Modifies the rates of payment related to adult day health care services.

Summary

This bill amends the Public Health Law to change how New York sets payment rates for adult day health care services provided by residential health care facilities. It preserves the existing historical cost-based rate rules through April 1, 2026, and then replaces them with a new formula for services provided on and after that date. Under the new approach, the operating component of the rate would generally equal 65 percent of the sponsoring facility’s inpatient rate, subject to minimum floor amounts in New York City and in Nassau, Suffolk, and Westchester counties, as well as a separate floor for the rest of the state. The bill also keeps the current exclusion of transportation costs from the operating component of adult day health care rates and authorizes the commissioner to adopt or amend regulations on an emergency basis to implement the changes. It takes effect immediately, but the new payment methodology is delayed until April 1, 2026, giving facilities and the state time to prepare for the transition.

Impact

The bill would substantially revise section 2808 of the Public Health Law as it applies to adult day health care reimbursement for residential health care facilities. It shifts the rate-setting framework away from the existing occupancy- and cost-report-based methodology toward a formula tied to a percentage of the sponsoring facility’s inpatient rate, while also establishing minimum payment floors and limiting annual rate increases to no more than 50 percent over the prior year. Adult day health care providers, sponsoring nursing homes, and Medicaid reimbursement systems would be directly affected, and the Department of Health would need to update regulations and payment calculations.

Sentiment

Based on the bill text and the absence of recorded committee debate or votes, the measure appears to be a technical reimbursement reform rather than a highly contested policy change. The structure of the bill suggests an intent to stabilize and standardize adult day health care payment rates, which may be viewed favorably by providers seeking more predictable reimbursement. At the same time, the inclusion of rate caps and formula changes indicates an effort to balance provider funding with cost containment, implying likely support from some stakeholders and caution from others concerned about fiscal impact.

Contention

The main points of potential contention are the new 65 percent inpatient-rate formula, the minimum rate floors for downstate counties and the rest of the state, and the 50 percent annual increase cap. Providers may argue that the new floors are necessary to prevent underpayment and preserve access to adult day health care, while payors or budget-focused stakeholders may view the floors and formula as increasing state spending. Another possible issue is the delayed transition date of April 1, 2026, which may be seen as necessary for implementation but could also postpone relief or savings depending on stakeholder perspective.