Bill > A04162

This bill mandates that starting October 1, 2026, Medicaid reimbursement rates for private duty nursing services, which are hourly home care services including nursing, provided to eligible patients must meet a minimum benchmark. This benchmark is set at 80% of the appropriate CHAMPUS/TRICARE maximum allowable charge for the New York locality, based on rates in effect on April 1 of the fiscal year the services are provided. The Department of Health (DOH) is required to publish a private duty rate schedule at least 30 days before this effective date and annually thereafter. This change applies to enrollees covered by Medicaid under payment rate agreements with licensed home care services providers, including those operating as licensed home care services agencies, or health maintenance organizations. The bill also amends sections of the Public Health Law and Social Services Law to reflect these new requirements, ensuring that payments are at least equivalent to the fee-for-service rates calculated under the Public Health Law.

Health and Social Services

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