Bill S825-2011

Relates to payments for residential health care facilities in Essex county

Relates to allowing residential health care facilities meeting certain requirements located in Essex county reimbursement at rate of forty percent above the rate set forth in 10 NYCRR section 86-2.10.

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  • Jan 4, 2012: REFERRED TO HEALTH
  • Jan 5, 2011: REFERRED TO HEALTH

Memo

BILL NUMBER:S825

TITLE OF BILL: An act to amend the social services law, in relation to payments for residential health care facilities in Essex county

PURPOSE: To ensure the provisions of the long term care services for frail and impoverished elderly patients, and to prevent future closures of nursing homes.

SUMMARY OF PROVISIONS: Section 1: This legislation will create a special Medicaid reimbursement rate 40% higher than what is called for in previous regulations. The rate will apply to facilities that meet five of the six criteria: 75% or more Medicaid payer mix, hospital affiliation, not-for-profit status, the creation or retention of at least 150 jobs at the facility, location in a non-metropolitan statistical area and in a county where more than 15% of the population is aged 65 and located in Essex County.

Section 2 Effective date.

JUSTIFICATION: Essex County is at a disadvantage because the rate at which Medicaid reimburses nursing homes has been significantly below the cost to provide care. In many cases, the reimbursement has been $50 to $60 below cost, per Medicaid patient, per day, resulting in losses that have exceeded $1,500,000 a year for some nursing homes. This has caused a situation where the nursing homes that have high percentages of patients on Medicaid are being forced to shut down and layoff workers.

In the past year, two hospital based Long Term Care Units have closed in the North Country. In Rouses Point, one facility has closed in the past 48 months, resulting in the loss of over fifty jobs. In the Adirondack Park, where any single health care facility is 50 miles away from the next. The loss of one 156 bed nursing home would sharply curtail the hospital's ability to discharge patients, thereby escalating Medicaid cost while the hospital patient awaits nursing home placement.

As such, this legislation is necessary to avoid significant loss of jobs and closure of facilities where the percentage of residents on Medicaid is very high, and where rates of poverty are substantially higher than the statewide average. In Essex County, 14.7% of the individuals are at or below the poverty level.

LEGISLATIVE HISTORY: 04/09/10 S.7431 Reported to Health 06/15/10 A.10678 Reported to Ways & Means

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: This act shall take effect immediately, with provisions.


Text

STATE OF NEW YORK ________________________________________________________________________ S. 825 A. 519 2011-2012 Regular Sessions S E N A T E - A S S E M B L Y (PREFILED) January 5, 2011 ___________
IN SENATE -- Introduced by Sen. LITTLE -- read twice and ordered print- ed, and when printed to be committed to the Committee on Health IN ASSEMBLY -- Introduced by M. of A. SAYWARD -- read once and referred to the Committee on Social Services AN ACT to amend the social services law, in relation to payments for residential health care facilities in Essex county THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The social services law is amended by adding a new section 367-x to read as follows: S 367-X. PAYMENT FOR RESIDENTIAL HEALTH CARE FACILITIES IN ESSEX COUN- TY. 1. NOTWITHSTANDING ANY LAW, RULE OR REGULATION TO THE CONTRARY, RESIDENTIAL HEALTH CARE FACILITIES MEETING FIVE OF THE FOLLOWING SIX CATEGORIES: (A) THE FACILITY IS A NOT-FOR-PROFIT FACILITY LOCATED IN A RURAL AREA; (B) THE FACILITY IS A HOSPITAL AFFILIATED FACILITY; (C) THE FACILITY IS IN A RURAL AREA AND IN A COUNTY WHERE MORE THAN FIFTEEN PERCENT OF THE TOTAL POPULATION IS OVER THE AGE OF SIXTY-FIVE; (D) THE FACILITY HAS OVER SEVENTY-FIVE PERCENT OF MEDICAID PAYOR MIX; (E) THERE IS JOB RETENTION AND/OR CREATION FOR AT LEAST ONE HUNDRED FIFTY PEOPLE PER FACILITY; AND (F) THE FACILITY IS LOCATED IN ESSEX COUNTY; SHALL BE REIMBURSED AT A RATE OF FORTY PERCENT ABOVE THE RATE SET FORTH IN 10 NYCRR SECTION 86-2.10 FOR ALL CARE PROVIDED AT SUCH FACILITY. 2. THE TERM "RESIDENTIAL HEALTH CARE FACILITIES" SHALL MEAN ALL FACIL- ITIES OR ORGANIZATIONS COVERED BY THE TERM "NURSING HOME" AS DEFINED IN SUBDIVISION TWO OF SECTION TWENTY-EIGHT HUNDRED ONE OF THE PUBLIC HEALTH LAW, INCLUDING HOSPITAL-BASED RESIDENTIAL HEALTH CARE FACILITIES, AND NURSING FACILITIES AS DEFINED IN SECTION 1919 OF THE FEDERAL SOCIAL
SECURITY ACT, PROVIDED THAT SUCH FACILITY POSSESSES A VALID OPERATING CERTIFICATE ISSUED BY THE STATE COMMISSIONER OF HEALTH AND, WHERE REQUIRED, HAS BEEN ESTABLISHED BY THE PUBLIC HEALTH COUNCIL. 3. THE COMMISSIONER OF HEALTH IS HEREBY AUTHORIZED AND DIRECTED TO ADOPT RULES AND REGULATIONS TO IMPLEMENT THE PROVISIONS OF THIS SECTION. S 2. This act shall take effect immediately, provided, however, that the commissioner of health shall promulgate any rules and regulations necessary for the implementation of this act on or before such date.

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