New York A 8604: Allows water authorities to make certain purchases and to contract for certain services

Bill Text

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A08604 Summary:

BILL NOA08604 

&nbsp

SAME ASSAME AS S09507

&nbsp

SPONSORPaulin

&nbsp

COSPNSRSimon

&nbsp

MLTSPNSR

&nbsp

Amd 4406-i, add 4406-j & 4406-k, Pub Health L; amd 3217-j, Ins L

&nbsp

Provides additional support to medically fragile children who rely on community-based or home health services.

Go to top A08604 Actions:

BILL NOA08604 

&nbsp

05/22/2025referred to health

01/07/2026referred to health

Go to topA08604 Committee&nbspVotes:

Go to topA08604 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA08604 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 8604

 2025-2026 Regular Sessions

 IN ASSEMBLY

 May 22, 2025
 ___________

 Introduced by M. of A. PAULIN -- read once and referred to the Committee
 on Health

 AN ACT to amend the public health law and the insurance law, in relation
 to supporting medically fragile children who require community-based
 and home health services

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Section 4406-i of the public health law, as added by chap-
 2 ter 170 of the laws of 2023, is amended to read as follows:
 3 § 4406-i. Utilization review determinations for medically fragile
 4 children. 1. Notwithstanding any inconsistent provision of the health
 5 maintenance organization's clinical standards, the health maintenance
 6 organization, and any utilization review agent under contract with such
 7 health maintenance organization, shall administer and apply the clinical
 8 standards (and make determinations of medical necessity) for inpatient,
 9 outpatient and community-based services regarding medically fragile
 10 children in accordance with the requirements of this section and any
 11 regulations with special considerations and processes for utilization
 12 review related to medically fragile children.
 13 2. Health maintenance organizations shall undertake the following with
 14 respect to medically fragile children, and as applicable, shall ensure
 15 that their contracted utilization review agents undertake the following
 16 with respect to medically fragile children:
 17 (a) Consider as medically necessary all covered services that assist
 18 medically fragile children in reaching their maximum functional capaci-
 19 ty, taking into account the appropriate functional capacities of chil-
 20 dren of the same age. In the case of community-based long-term services
 21 and supports, those shall include but not be limited to skilled nursing,
 22 home-based private duty nursing, personal care services, consumer
 23 directed personal assistance program services, home health aide, phys-
 24 ical therapy, occupational therapy, speech therapy, and feeding therapy.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD13172-01-5

 A. 8604 2

 1 In the case of Medicaid managed care, health maintenance organizations
 2 shall continue to cover services until that child achieves age-appropri-
 3 ate functional capacity.
 4 (b) Shall not base determinations solely upon review standards appli-
 5 cable to (or designed for) adults to medically fragile children. Deter-
 6 minations shall take into consideration the specific needs of the child
 7 and the circumstances pertaining to their growth and development. The
 8 determinations shall consider the level of care required for a medically
 9 fragile child, including twenty-four hour, seven-day per week and/or
 10 institutional level of care and determinations shall be made on a case-
 11 by-case basis taking into account the particular needs of the child and
 12 family.
 13 (c) Accommodate unusual stabilization and prolonged discharge plans
 14 for medically fragile children, as appropriate. Health maintenance
 15 organizations, and as applicable their contracted utilization review
 16 agents, shall consider when developing and approving discharge plans
 17 issues including sudden reversals of condition or progress which may
 18 make discharge decisions uncertain or more prolonged than for other
 19 children or adults.
 20 (c-1) In the case of community-based long term care services for
 21 medically fragile children, the health maintenance organizatio