Bill > A04162

This bill addresses Medicaid reimbursement rates for private duty nursing services, with key provisions aimed at ensuring fair compensation for home care providers. Starting July 1, 2026, the bill requires that payments for private duty nursing services be set at no less than 80% of the CHAMPUS/TRICARE maximum allowable charge (CHAMPUS is the Civilian Health and Medical Program of the Uniformed Services, now known as TRICARE, which sets healthcare rates for military personnel and their families). The Department of Health (DOH) must publish a private duty rate schedule at least 30 days before the rate increase and annually thereafter. The bill amends both the public health law and social services law to mandate that for Medicaid enrollees as of January 1, 2026, payments for hourly home care services through private duty nursing must be at least equal to the existing fee-for-service rate. This applies to services provided by licensed home care agencies, health maintenance organizations, and other qualifying healthcare providers, with the goal of ensuring more consistent and adequate compensation for private duty nursing services under Medicaid.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A4162