Relates to rates of payment for an AIDS assisted living program.
Ayes (59): Adams, Addabbo, Alesi, Aubertine, Bonacic, Breslin, Diaz, Dilan, Duane, Espada, Farley, Flanagan, Foley, Fuschillo, Golden, Griffo, Hannon, Hassell-Thomps, Huntley, Johnson C, Johnson O, Klein, Krueger, Kruger, Lanza, Larkin, LaValle, Leibell, Libous, Little, Marcellino, Maziarz, McDonald, Montgomery, Nozzolio, Onorato, Oppenheimer, Padavan, Parker, Peralta, Perkins, Ranzenhofer, Robach, Saland, Sampson, Savino, Schneiderman, Serrano, Seward, Skelos, Smith, Squadron, Stachowski, Stavisky, Stewart-Cousins, Thompson, Valesky, Volker, Young
Nays (2): DeFrancisco, Winner
Excused (1): Morahan
TITLE OF BILL: An act to amend the public health law, in relation to rates of payment for an AIDS assisted living program
PURPOSE: To enhance the Medicaid Assisted Living Program (ALP) payment rates to include both real property construction and lease costs for certain HIV/AIDS residential health care facilities.
SUMMARY OF PROVISIONS: Section 1 adds a new paragraph 6-c to subdivision six of section 3614 of the public health law.
Section 2 provides for an immediate effective date.
JUSTIFICATION: Today, many people living with HIV/AIDS can be stabilized after a short-stay in a skilled nursing facility and moved to a less-restrictive setting. However, the majority of these people, many of whom are aging, cannot manage HIV/AIDS on their own because even after being stabilized, they still have an accompanying psychiatric diagnosis, as well as a history of substance abuse and/or other medical conditions that require continued supervision and professional attention to maintain their treatment regimen. Thus, discharge to a private home is not realistic for this population, but neither do they need the intensive care found in a skilled nursing facility; rather, they require something in-between. The solution is an AIDS ALP, which will be able to deliver a variety of health care services for this growing segment of the HIV/AIDS population, in a setting that is much less restrictive and far less costly than a skilled nursing facility.
Continued stigma is also an unfortunate reality for this population, especially for older New Yorkers living with HIV/AIDS. According to the recent Research on Older Adults with HIV (ROAH) Study, persons over age 55 living with HIV/AIDS reported feeling significant external stigma, and cite this stigma as a barrier to seeking appropriate health care services and engaging in the community. Also according to the ROAH study, 44% of HIV-positive people over 50 admit they have no place to turn for help in effectively managing their disease. An AIDS ALP would be the ideal setting for these individuals by offering the necessary clinical expertise and care, coupled with the freedom of a less-restrictive setting, at a fraction of the cost of skilled nursing care in a traditional nursing home setting.
However, the pertinent section of the Public Health Law establishing payment rates for nursing facilities currently does not contemplate the less-intensive, long-term health care needs of people living and growing older with HIV/AIDS, because it does not establish the necessary payment methodology for the efficient co-location of an AIDS ALP within an existing HIV/AIDS nursing home. Accordingly, this legislation will amend the Public Health law to allow for appropriate rates of payment for AIDS Medicaid ALP programs located within existing HIV/AIDS nursing facilities.
LEGISLATIVE HISTORY: None - new bill.
FISCAL IMPLICATIONS: By revising the existing payment methodology under Section 3614 of the Public Health Law, thereby effectively
allowing existing HIV/AIDS nursing facilities to convert high-cost skilled nursing beds to lower-cost assisted living beds, this legislation will immediately achieve significant cost savings to the state.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 7829 IN SENATE May 14, 2010 ___________Introduced by Sen. DUANE -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to rates of payment for an AIDS assisted living program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 6 of section 3614 of the public health law, as amended by chapter 645 of the laws of 2003 and paragraph (a) as amended by section 17 of part D of chapter 58 of the laws of 2009, is amended to read as follows: 6. (a) The commissioner shall, subject to the approval of the state director of the budget, establish capitated rates of payment for services provided by assisted living programs as defined by paragraph (a) of subdivision one of section four hundred sixty-one-l of the social services law. Such rates of payment shall be related to costs incurred by residential health care facilities. The rates shall reflect the wage equalization factor established by the commissioner for residential health care facilities in the region in which the assisted living program is provided and real property capital construction costs associ- ated with the construction of a free-standing assisted living program
[such rate shall include], INCLUDING a payment equal to the cost of interest owed and depreciation costs of such construction. The rates shall also reflect the efficient provision of a quality and quantity of services to patients in such residential health care facilities, with needs comparable to the needs of residents served in such assisted living programs. Such rates of payment shall be equal to fifty percent of the amounts which otherwise would have been expended, based upon the mean prices for the first of July, nineteen hundred ninety-two (utiliz- ing nineteen hundred eighty-three costs) for freestanding, low intensity residential health care facilities with less than three hundred beds, and for years subsequent to nineteen hundred ninety-two, adjusted for inflation in accordance with the provisions of subdivision ten of section twenty-eight hundred seven-c of this chapter, to provide the appropriate level of care for such residents in residential health careEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD17256-01-0 S. 7829 2
facilities in the applicable wage equalization factor regions plus an amount equal to capital construction costs associated with the construction of an assisted living program facility as provided for in this subdivision. (b) For purposes of this subdivision, real property capital construction costs shall only be included in rates of payment for assisted living programs if: (i) the facility is operated by a not-for- profit corporation; (ii) the facility commenced operation after nineteen hundred ninety-eight and at least ninety-five percent of the certified approved beds are provided to residents who are subject to the assisted living program; and (iii) the assisted living program is in a county with a population of no less than two hundred eighty thousand persons. The methodology used to calculate the rate for such capital construction costs shall be the same methodology used to calculate the capital construction costs at residential health care facilities for such costs. (C) (1) AS USED IN THIS SUBDIVISION, "AIDS ASSISTED LIVING" MEANS AN ENTITY DESIGNATED BY THE COMMISSIONER THAT IS (A) AN ASSISTED LIVING PROGRAM AS DEFINED BY PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION FOUR HUNDRED SIXTY-ONE-L OF THE SOCIAL SERVICES LAW ALL OF WHOSE RESIDENTS ARE PERSONS WITH HIV/AIDS, (B) OPERATED BY A NOT-FOR-PROFIT CORPORATION, AND (C) AFFILIATED BY COMMON OWNERSHIP WITH AN AIDS RESIDENTIAL HEALTH CARE FACILITY OPERATING AS SUCH UNDER REGULATIONS OF THE COMMISSIONER. (2) RATES OF PAYMENT UNDER PARAGRAPH (A) OF THIS SUBDIVISION FOR AN AIDS ASSISTED LIVING PROGRAM SHALL, IN ADDITION TO ITEMS UNDER PARAGRAPH (A) OF THIS SUBDIVISION, INCLUDE A PAYMENT FOR REAL PROPERTY CAPITAL CONSTRUCTION COSTS UNDER PARAGRAPH (B) OF THIS SUBDIVISION, AND A PAYMENT EQUAL TO ANY PROPERTY LEASE COSTS FOR THE REAL PROPERTY REQUIRED TO OPERATE THE AIDS ASSISTED LIVING PROGRAM. THE CAPITAL CONSTRUCTION AND PROPERTY LEASE COSTS SHALL BE REIMBURSED WHETHER THE FACILITY IS FREE-STANDING OR NOT. S 2. This act shall take effect immediately.