March 13, 2024

Senate and Assembly One-House Budget Bills - (R.1952; S.8307-B / E.948; A.8807-B)

The Senate and Assembly have advanced their One-House Budget bills and accompanying resolutions, setting forth their respective negotiating positions pertaining to the FY 2024-25 State Budget. The following is a summary of some of the provisions either included or excluded in both House’s proposals affecting skilled nursing and assisted living providers. Medicaid Rate Adequacy For SNFs:

Senate: Increases the Medicaid reimbursement rate by 9.5% (6.5% increase plus 3% across the board).

Assembly: Increase the Medicaid reimbursement rate by 10.5% (7.5% increase plus 3% across the board).

For ALPs:

Senate: Increases the Medicaid reimbursement rate by 9.5% (6.5% increase plus 3% across the board).

Assembly: Increase the Medicaid reimbursement rate by 10.5% (7.5% increase plus 3% across the board).

Medicaid Rebasing

Senate: Adds new language to support Medicaid rate rebasing by January 1, 2026 and no less than every five years thereafter.

Assembly does not address.

Medicaid Base Rate for ALPs

Senate: Adds language to increase the base Medicaid rate for ALPs to 2022 levels and regularly thereafter to align with preexisting statute (50% of the cost for SNFs), for facilities with less than 300 beds.

Assembly: Does not address.

Capital Rate for SNFs

Senate & Assembly: Both reject the Governor’s proposal to institute a 10% capital rate cut.

Case Mix Freeze

Senate: Rejects the Governor’s 30-day amendment proposal to change the case mix freeze date from January 1, 2024 to July 1, 2023.

Assembly: Modifies the Governor’s 30-day amendment proposal to change the case mix freeze date from January 1, 2024 to July 1, 2023 “to establish a rate freeze on the operating component of skilled nursing facility rates until a new case mix methodology is developed by amending the date of the freeze to October 1, 2023.” (NYSHFA is seeking clarification on this language.)

Certified Medication Aides

Senate & Assembly: Both reject the Governor’s proposal to authorize certified medication aides to work in skilled nursing facilities.

Vital Access Provider Assurance Program

Senate: Adds $753 million to restore funding to Medicaid for programs such as the VAPAP.

Assembly: Provides $75 million to maintain the $100 million per year allocated to the Program.

Special Needs Assisted Living Residence Voucher Program

Senate: Includes the Governor’s proposal to make permanent the SNALR Voucher Program but eliminates the provision that calls for up to 200 vouchers to be issued. The Senate proposal also modifies the residency requirement.

Assembly: Includes the Governor’s proposal to make permanent the SNALR Voucher Program and modifies the residency requirement.

Assisted Living Quality Reporting Standards

Senate: Includes the Governor’s proposal to create quality reporting standards for ALRs, EALRs, and SNALRs, but amends language regarding the cadence of surveys which shall be performed by the Department on an unannounced basis for all facilities as opposed to 12-18 months for those facilities that receive advanced standing classification per the Governor’s proposal. Rejects the Governor’s language regarding nationally recognized accreditation.

Assembly: Rejects the Governor’s proposal to create quality reporting standards and accreditation processes for ALRs

Additional Provisions

Assembly: Adds language to create a Medicaid Investment Fund with revenue from the tax of managed care organizations for the funding of the non-federal share of investments in Medicaid that support healthcare delivery, among other things.

Senate & Assembly:  Rejects the Governor’s proposal to expand the scope of practice for medical providers and the introduction of the Interstate Licensure Compact and Nurse Licensure Compact.

Senate:  Adds $1.6 billion for the Statewide Health Care Facility Transformation Program (“Statewide VI”) to ensure geographical balancing of fund disbursement; and

Senate:  Adds $10 million to the Governor’s proposal to increase the personal needs allowance (PNA) for SNF residents.

NYSHFA | NYSCAL will continue to provide updates as the FY 2024-25 State Budget negotiations progress. NYSHFA | NYSCAL CONTACTS:  Stephen B. Hanse, Esq. President & CEO 518-462-4800 x11 Kristin DeVries, MA, MPP Director of Government Relations 518-462-4800 x14
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