NY A04162

Establishes minimum payment rates for private duty nursing services provided to Medicaid enrollees through managed care organizations and health maintenance organizations, effective January 1, 2026

Requires payments for hourly home care services, including nursing services, to match at minimum the fee-for-service rates calculated under public health law

Sets private duty nursing service payments at no less than 80% of the CHAMPUS/TRICARE maximum allowable charge based on New York locality, effective July 1, 2026

Requires the Department of Health to publish a private duty rate schedule at least 30 days before the effective date of rate increases and annually thereafter

Applies to services provided through licensed home care services agencies under payment rate methodology agreements negotiated with providers