S222A-2011 Actions

• Jan 13, 2012: PRINT NUMBER 222A
• Jan 13, 2012: AMEND AND RECOMMIT TO HEALTH
• Jan 4, 2012: REFERRED TO HEALTH
• Jan 5, 2011: REFERRED TO HEALTH

S222A-2011 Memo

BILL NUMBER:S222

TITLE OF BILL:
An act
to amend the social services law, in relation to state reimbursement for
care, treatment, maintenance and nursing services in nursing homes

PURPOSE:
To make the state's Medicaid financing system more equitable for those
counties that operate nursing facilities.

SUMMARY OF PROVISIONS:
This legislation would add a new paragraph to the Social Services Law,
increasing the percentage of Medicaid costs that are reimbursed to
certain counties by the State for long term care services. Currently,
the federal government pays for fifty percent of the cost of Medicaid
Services and local social services districts are reimbursed 81.235%
of the remaining costs (non-federal share) of Medicaid eligible long
term care services by the State. Under this legislation, counties
would be eligible for an enhanced state reimbursement rate if they
had a non-state public nursing facility operating within the county
for the previous twelve months and that nursing facility had
operational losses in that time period. The enhanced rate would be
set at an amount that would offset the losses incurred by the
facility and would apply to all eligible Medicaid long term care
services paid by the county.

JUSTIFICATION:
According to an independent study, county operated nursing facilities
received substantially less revenue than other nursing facilities
because the county operated facilities provided significantly more
care to patients that are less profitable because of income/insurance
status or because of diagnosis (such as Alzheimer's Disease).
Consequently, county government taxpayers are often called upon to
subsidize the operation of these facilities when they incur operating
losses. Unfortunately, these same taxpayers are required to
separately bear the "local share" cost of Medicaid long term care
services. This legislation would ensure that these local taxpayers
are not required to pay a "double tax" to support appropriate long
term care services in their counties. Private sector nursing homes
typically target individuals with the ability to "self-pay" for at
least a limited period of time or who have some level of private
insurance. These individuals relatively quickly "spend-down" the
private source of payment and qualify for the Medicaid program.
However, the high level of private payments received before
qualification for the Medicaid Program often provides the difference
between losses and profits. The nursing home industry in New
York State has long demonstrated that Medicaid rates do not cover
costs that the
difference is made up by private payments. Consequently, individuals
that are already enrolled in the Medicaid program prior to admission
into a nursing home facility are considered money-losing patients to
whom most private sector nursing homes cannot afford to provide
services. Because of the commitment of county governments to providing
services to this population-- and finances by hundreds of millions of
dollars in subsidiaries--county nursing facilities are left to
provide care to this population. Most county facilities have a


written admission policy often times enacted by the county
legislature that requires the county facility to admit individuals
already enrolled in the Medicaid program before admitting individuals
with the ability to pay through private sources of funding. Without
the county facilities, individuals already enrolled in Medicaid would
face significant difficulties in accessing nursing facility services
in a timely manner. This is particularly true of individuals already
enrolled in Medicaid that lack social supports and/or regular and
appropriate medical care and consequently have more medical and
social complications with their primary diagnosis or disability.
Additionally, county facilities are more likely to provide services
to other individuals that are not eligible for desirable levels of
reimbursement. In the cost-based system in place from Medicaid
nursing facility reimbursement prior to 1986, it has been documented
that county facilities provided care to patients
with the highest case mix intensity because other sectors could not
afford to be burdened with these costly cases. In 1986, New York
state instituted a case-payment methodology for Medicaid nursing
facility reimbursement that rewarded nursing facilities for taking
more medically involved, complex cases. However, that resulted in
access problems for many individuals with low medical intensity, but
additional non-medical needs. For example, New York State has had
problems with access to nursing homes for Patients with Alzheimer's
Disease- the combination of low-medical intensity and high staff
costs associated with monitoring result in a reimbursement/cost
imbalance. County facilities now are the provider of last resort for
these individuals reimbursed as "low intensity" but actual higher
costs of care.

LEGISLATIVE HISTORY:
S.1051 of 2009/2010; Referred to Health
S.46 of 2007/2008; Referred to Senate Social Services, Children and
Family Committee
S.1164-A of 2005/2006; Referred to Senate Social Services Committee
S.5854 of 2004; Referred to Senate Social Services Committee

FISCAL IMPLICATIONS:
Operational losses incurred by county operated nursing facilities over
the past several years range from periods where the statewide average
was over $40 million in annual losses a year to years where there
were no losses.

EFFECTIVE DATE:
This act shall take effect April 1, 2012.

S222A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 222--A
 2011-2012 Regular Sessions
 I N  SENATE
 (PREFILED)
 January 5, 2011
 
 Introduced  by  Sens.  MAZIARZ,  ALESI,  BONACIC, DeFRANCISCO, FLANAGAN,
 GOLDEN, SEWARD -- read twice and ordered printed, and when printed  to
 be  committed to the Committee on Health -- recommitted to the Commit
 tee on Health in accordance with Senate Rule 6, sec.  8  --  committee
 discharged, bill amended, ordered reprinted as amended and recommitted
 to said committee
 

AN ACT to amend the social services law, in relation to state reimburse
 ment  for care, treatment, maintenance and nursing services in nursing
 homes
 THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section  1.  Subdivision 1 of section 368-a of the social services law
 is amended by adding a new paragraph (g-1) to read as follows:

 (G-1) (I) BEGINNING APRIL FIRST, TWO THOUSAND THIRTEEN,  REIMBURSEMENT
 FOR SERVICES CALCULATED PURSUANT TO PARAGRAPH (G) OF THIS SUBDIVISION TO
 AN  ELIGIBLE SOCIAL SERVICES DISTRICT AS DEFINED BY SUBPARAGRAPH (II) OF
 THIS PARAGRAPH SHALL BE ADJUSTED EACH SUBSEQUENT TWELVE MONTH PERIOD  BY
 INCREASING  THE APPLICABLE PER CENTUM AS SPECIFIED IN SUBPARAGRAPH (III)
 OF THIS PARAGRAPH.
 (II) FOR THE PURPOSES OF THIS PARAGRAPH, AN ELIGIBLE  SOCIAL  SERVICES
 DISTRICT  SHALL  BE  A  DISTRICT  WHICH: (A) MADE A TRANSFER PURSUANT TO
 SECTION TWO HUNDRED TWENTY-TWO OF CHAPTER FOUR HUNDRED  SEVENTY-FOUR  OF
 THE  LAWS  OF  NINETEEN  HUNDRED NINETY-SIX IN TWO THOUSAND NINE; (B) IN
 SUCH DISTRICT THERE IS A NON-STATE OPERATED  PUBLIC  RESIDENTIAL  HEALTH
 CARE  FACILITY  OPERATING  FOR THE PREVIOUS TWELVE MONTH PERIOD; AND (C)
 THE SUM OF COSTS FROM  OPERATIONS  FOR  ALL  SUCH  FACILITIES  WITHIN  A
 DISTRICT  EXCEED THE SUM OF REVENUES FROM OPERATIONS, AS REPORTED TO THE
 DEPARTMENT OF HEALTH FOR THE MOST RECENT RATE YEAR AVAILABLE.
 (III) THE PER CENTUM SPECIFIED IN PARAGRAPH (G)  OF  THIS  SUBDIVISION
 SHALL BE INCREASED BY ADDING TO IT A PER CENTUM CALCULATED BY TAKING THE
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD01311-02-1
 
       S. 222--A                           2
 AMOUNT  THAT  THE  SUM  OF COSTS FROM OPERATIONS FOR ALL SUCH FACILITIES
 WITHIN A DISTRICT  EXCEED  THE  SUM  OR  REVENUES  FROM  OPERATIONS,  AS
 REPORTED  TO  THE  DEPARTMENT  OF  HEALTH  FOR THE MOST RECENT RATE YEAR
 AVAILABLE,  AND DIVIDED BY THE TOTAL AMOUNT OF REIMBURSEMENT PROVIDED TO
 THE DISTRICT PURSUANT TO PARAGRAPH (G) OF THIS SUBDIVISION IN THE PREVI
 OUS APRIL FIRST THROUGH MARCH THIRTY-FIRST PERIOD.
 

S 2. This act shall take effect April 1, 2013.

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