A 7583: Establishes a program for specific individuals to become complex care assistants and provide private duty complex care services to children or young adults with developmental disabilities who are Medicaid enrollees.

  
  STATE OF NEW YORK ________________________________________________________________________ 7583 2025-2026 Regular Sessions  IN ASSEMBLY April 1, 2025 ___________ Introduced by M. of A. ALVAREZ -- read once and referred to the Commit- tee on Health AN ACT to amend the social services law, in relation to authorizing Medicaid coverage for complex care assistant services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The social services law is amended by adding a new section 2 365-q to read as follows: 3 § 365-q. Complex care assistant services program. 1. As used in this 4 section: 5 (a) "family member" means a parent, sibling, grandparent, legal guard- 6 ian or any other individual related by blood; and 7 (b) "complex care assistant" means a family member who is certified by 8 the department after passing an in-person examination which tests the 9 proficiency and competence of performing the tasks required to care for 10 a child or young adult with developmental disabilities which can 11 include, but is not limited to, all adaptive living skills (ADL's) and 12 instrumental activities of daily living (IADL's), and providing academic 13 assistance in accordance to such child or young adult's level of need. 14 2. (a) No later than one year after this section shall have become a 15 law and receipt of federal approval for the program established pursuant 16 to this section, the state Medicaid director shall establish a program 17 under which a family member of an enrollee in Medicaid may be certified 18 as a complex care assistant and, after receiving such certification may, 19 under the direction of a certified complex care assistant, provide 20 complex care assistant services to the enrollee through a complex care 21 agency under the reimbursement rates established under paragraph (f) of 22 this subdivision, provided that the enrollee is a child or young adult 23 with developmental disabilities as defined in subdivision twenty-two of 24 section 1.03 of the mental hygiene law and qualifies for services under 25 Medicaid. Such program shall operate as a New York Medicaid private duty EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11246-01-5 
 A. 7583 2 1 nursing benefit. The department shall develop an assessment tool that 2 will allow the division to identify enrollees who meet these eligibility 3 criteria readily. 4 (b) The program established under this section shall require a family 5 member to complete all training, testing, and other qualification crite- 6 ria required under state and federal law for certification as a complex 7 care assistant. The agency that will employ the family member to provide 8 complex care assistant services to the enrollee shall pay all costs for 9 the family member to become certified as a complex care assistant and to 10 receive certification as a complex care assistant from the department of 11 health, before providing services under the program established pursuant 12 to this section. In no case shall a family member who becomes a complex 13 care assistant under the provisions of this section be required to repay 14 or reimburse the licensed home care services and certified complex care 15 agencies for the costs of the family member becoming certified as a 16 complex care assistant under the program. 17 (c) An individual certified to practice as a complex care assistant 18 must complete a training program and shall pass an in-person examination 19 approved by the department of health that demonstrates the applicant's 20 competence and proficiency. If the department of health selects the 21 option of utilizing designated home care providers to provide the train- 22 ing, the department shall adequately reimburse such designated providers 23 for providing the training to family caregivers of eligible relatives. 24 (d) The services received under this program by an eligible member 25 from a complex care assistant shall not exceed forty hours per week. 26 Nothing in this paragraph shall restrict unpaid services provided as 27 part of the family caregiver's familial or household relationship to the 28 eligible relative. 29 (e) A complex care assistant shall not provide qualified complex care 30 assistant services to an eligible member unless the plan of care for the 31 eligible member is recertified by the provider at least every one 32 hundred eighty calendar days. Registered nurse supervisory visits shall 33 occur regularly to ensure support for all complex care assistants 34 assigned to an eligible member and the ability to complete all tasks as 35 outlined in the member's care plan. 36 (f) Complex care assistant services provided by a family member of a 37 Medicaid enrollee who becomes certified as a complex care assistant 38 under the program established pursuant to this section shall be reim- 39 bursed to a complex care agency at a rate that is no more than the 40 current base reimbursement rate for complex care services and dependent 41 upon whether the services are provided in the downstate region or 42 upstate region, provided, however, that such agencies shall ensure that 43 no less than sixty-five percent of such reimbursement is passed through 44 to a complex care assistant. Cost of living adjustments to such rates 45 shall be reviewed by the department bi-annually and such rates adjusted 46 accordingly based upon any increases to the United States bureau of 47 labor statistics consumer price index. 48 (g) The department shall require complex care assistants providing 49 qualified complex care assistant services under the Medicaid program to 50 utilize an electronic visit verification established in accordance with 51 federal law. 52 (h) The New York state Medicaid director, no later than three years 53 after the date the program is established under this section, and every 54 two years thereafter, shall prepare and submit a report to the governor 55 and make such report publicly available on the department's website. The 56 report shall include but not be limited to the following: 
 A. 7583 3 1 (1) the number of hospitalizations and emergency room visits of eligi- 2 ble members participating in the program; 3 (2) the number of agency private duty nursing hours each eligible 4 member participating in the program has received and an analysis of 5 whether such hours have increased or decreased since their participation 6 in the program; 7 (3) the number of qualified complex care assistant services that were 8 provided by complex care assistants to each eligible member enrolled in 9 the program; 10 (4) the number of overpayments made to each provider employing complex 11 care assistants and other metrics determined by the state that may be 12 used to determine the amount of fraud, waste, and abuse in the program; 13 (5) an analysis of whether the state's waitlist for private duty nurs- 14 ing services or other home and community-based services under the Medi- 15 caid program has improved or declined since the introduction of the 16 program; and 17 (6) reporting concerning the viability of such program and the Medi- 18 caid director's recommendations concerning such program. 19 § 2. The state Medicaid director shall apply for such state plan 20 amendments or waivers as may be necessary to implement the provisions of 21 this act and secure federal financial participation for state Medicaid 22 expenditures under the federal Medicaid program. 23 § 3. This act shall take effect immediately. The state Medicaid direc- 24 tor shall adopt rules and regulations as necessary to implement the 25 provisions of this act.