2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-R - Private Duty Nursing Services Worker Recruitment and Retention Program.

§ 367-r.   Private   duty  nursing  services  worker  recruitment  and
retention program. 1. (a) The commissioner of health, with the  approval
of   the   director   of  the  budget,  shall  establish  fees  for  the
reimbursement of private duty nursing services.
(b) The commissioner of health shall, subject  to  the  provisions  of
paragraph (b) of subdivision two of this section and to the availability
of federal financial participation, increase medical assistance rates of
payment  by  three  percent  for services provided on and after December
first, two thousand two, for  private  duty  nursing  services  for  the
purposes of improving recruitment and retention of private duty nurses.
2.  Medically  fragile  children  and medically fragile adults. (a) In
addition, the commissioner shall further increase rates for private duty
nursing services that are provided  to  medically  fragile  children  to
ensure  the availability of such services to such children. Furthermore,
no later than sixty days after the effective date of the chapter of  the
laws of two thousand twenty-two that amended this subdivision, increased
rates  shall  be  extended for private duty nursing services provided to
medically fragile adults. In establishing rates of  payment  under  this
subdivision, the commissioner shall consider the cost neutrality of such
rates  as  related  to  the  cost  effectiveness of caring for medically
fragile children and medically fragile  adults  in  a  non-institutional
setting  as  compared  to  an  institutional  setting. Medically fragile
children shall, for the purposes of  this  subdivision,  have  the  same
meaning as in subdivision three-a of section thirty-six hundred fourteen
of  the  public health law. For purposes of this subdivision, "medically
fragile adult" shall be defined as including  but  not  limited  to  any
individual  who previously qualified as a medically fragile child but no
longer meets the age requirement.  Such  increased  rates  for  services
rendered  to  such  children  and adults may take into consideration the
elements of cost, geographical differentials in  the  elements  of  cost
considered,  economic  factors  in  the  area  in which the private duty
nursing service is provided, costs  associated  with  the  provision  of
private   duty  nursing  services  to  medically  fragile  children  and
medically fragile  adults,  and  the  need  for  incentives  to  improve
services  and  institute  economies  and  such  increased rates shall be
payable only to those private duty nurses who can  demonstrate,  to  the
satisfaction  of  the  department  of  health, satisfactory training and
experience to provide services to such children  and  medically  fragile
adults. Such increased rates shall be determined based on application of
the case mix adjustment factor for AIDS home care program services rates
as  determined  pursuant  to applicable regulations of the department of
health. The commissioner may promulgate  regulations  to  implement  the
provisions of this subdivision.
(b)  Private  duty  nursing  services providers which have their rates
adjusted pursuant to paragraph (b) of subdivision one  of  this  section
and  paragraph  (a)  of this subdivision shall use such funds solely for
the purposes of recruitment and retention of private duty nurses  or  to
ensure  the  delivery  of  private  duty  nursing  services to medically
fragile children and medically fragile adults and  are  prohibited  from
using  such  funds for any other purpose. Funds provided under paragraph
(b) of subdivision one  of  this  section  and  paragraph  (a)  of  this
subdivision  are  not  intended  to supplant support provided by a local
government. Each such provider,  with  the  exception  of  self-employed
private  duty  nurses,  shall  submit,  at  a time and in a manner to be
determined by  the  commissioner  of  health,  a  written  certification
attesting  that  such  funds  will  be  used  solely  for the purpose of
recruitment and retention of  private  duty  nurses  or  to  ensure  the
delivery  of private duty nursing services to medically fragile children

and medically fragile adults. The commissioner of health  is  authorized
to  audit  each  such  provider  to  ensure  compliance with the written
certification required by this subdivision and shall  recoup  all  funds
determined  to  have  been  used for purposes other than recruitment and
retention of private duty nurses or the delivery of private duty nursing
services to medically fragile children  and  medically  fragile  adults.
Such  recoupment shall be in addition to any other penalties provided by
law.
(c) The commissioner of health shall, subject  to  the  provisions  of
paragraph  (b)  of  this  subdivision, and the provisions of subdivision
three of this section,  and  subject  to  the  availability  of  federal
financial  participation, annually increase fees for the fee-for-service
reimbursement of private duty nursing  services  provided  to  medically
fragile  children  by  fee-for-service  private  duty  nursing  services
providers who enroll and participate in the provider directory  pursuant
to  subdivision  three  of  this  section, over a period of three years,
commencing October first,  two  thousand  twenty,  by  one-third  annual
increments,  until such fees for reimbursement equal the final benchmark
payment designed to ensure adequate access to the service. In developing
such benchmark the commissioner of health may utilize  the  average  two
thousand  eighteen  Medicaid  managed care payments for reimbursement of
such private duty nursing  services.  The  commissioner  may  promulgate
regulations to implement the provisions of this paragraph.
(d)  The  commissioner  of  health shall, subject to the provisions of
paragraph (b) of this subdivision, and  the  provisions  of  subdivision
three  of  this  section,  and  subject  to  the availability of federal
financial  participation,  increase   fees   for   the   fee-for-service
reimbursement  of  private  duty  nursing services provided to medically
fragile  adults  by  fee-for-service  private  duty   nursing   services
providers  who enroll and participate in the provider directory pursuant
to subdivision three of this section, no later than sixty days after the
effective date of the chapter of the laws  of  two  thousand  twenty-two
that  amended this subdivision, so such fees for reimbursement equal the
benchmark payment designed to ensure adequate access to the service.  In
developing  such  benchmark  the  commissioner of health may utilize the
average  two  thousand  twenty  Medicaid  managed  care   payments   for
reimbursement  of  such  private duty nursing services. The commissioner
may  promulgate  regulations  to  implement  the  provisions   of   this
paragraph.
3.   Provider  directory  for  fee-for-service  private  duty  nursing
services provided to medically fragile children  and  medically  fragile
adults.  The  commissioner  of  health  is  authorized  to  establish  a
directory of qualified  providers  for  the  purpose  of  promoting  the
availability  and  ensuring  delivery  of  fee-for-service  private duty
nursing services to medically fragile  children  and  medically  fragile
adults.  Qualified providers enrolling in the directory shall ensure the
availability and delivery of and shall provide such  services  to  those
individuals as are in need of such services, and shall receive increased
reimbursement  for  such  services pursuant to paragraphs (c) and (d) of
subdivision two of this section. The directory shall offer enrollment to
all private duty nursing services providers to promote  and  ensure  the
participation  in  the  directory  of  all  nursing  services  providers
available to serve medically  fragile  children  and  medically  fragile
adults.