senate Bill S2185

Establishes the New York state compact for long term care

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  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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  • 18 / Jan / 2011
    • REFERRED TO AGING
  • 23 / May / 2011
    • REPORTED AND COMMITTED TO FINANCE
  • 16 / Jun / 2011
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 16 / Jun / 2011
    • ORDERED TO THIRD READING CAL.1300
  • 16 / Jun / 2011
    • PASSED SENATE
  • 16 / Jun / 2011
    • DELIVERED TO ASSEMBLY
  • 16 / Jun / 2011
    • REFERRED TO AGING
  • 04 / Jan / 2012
    • DIED IN ASSEMBLY
  • 04 / Jan / 2012
    • RETURNED TO SENATE
  • 04 / Jan / 2012
    • REFERRED TO AGING
  • 30 / May / 2012
    • REPORTED AND COMMITTED TO FINANCE

Summary

Establishes the New York state compact for long term care; requires federal financial participation; requires that the state provide assurance of quality of services in designing the waiver; outlines participation in such compact and pledge amounts; authorizes the waiver of all or part of the participation fee and the requirement that a beneficiary pay the difference between the compact rate and the compact subsidy if the beneficiary's countable income, after deductions of these items is less than certain protected income amounts; describes fraudulent practices.

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Bill Details

See Assembly Version of this Bill:
A4621
Versions:
S2185
Legislative Cycle:
2011-2012
Current Committee:
Senate Finance
Law Section:
Elder Law
Laws Affected:
Add Art 2 Title 4 §§260 - 277, Eld L; add §3229-a, Ins L
Versions Introduced in Previous Legislative Cycles:
2009-2010: S4064B, A5418A
2007-2008: S116A, A8643A

Sponsor Memo

BILL NUMBER:S2185

TITLE OF BILL:
An act
to amend the elder law, in relation to establishing the
New York state compact for long term care; and to amend the tax law,
in relation to providing certain tax
credits

PURPOSE OR GENERAL IDEA OF THE BILL:
To provide a new way to finance long term care in New York State that
will result in greater freedom for the individual in need of services
and in cost savings for the public sector.

SUMMARY OF PROVISIONS:
The bill adds a new Title 4 to Article 2 of the elder law, the Compact
for Long Term Care.

The Compact-which requires a federal waiver to be implemented-provides
for an agreement between an individual and the State (thus a
"compact") under which an individual voluntarily makes a pledge to
pay a certain defined amount, based on resources, for long term care
services;
in return for which the State agrees to pay the major costs of long
term care services the individual needs after the pledge is
fulfilled, an amount which works out to just over 90% of the charges
for care.

Unlike Medicaid, when an individual fulfills the pledge, there are no
claims on resources or income, liens on homes, restrictions on the
choice of service providers, or community spouse requirements, and
the services menu is broader than under Medicaid. Unlike long term
care insurance, an individual who fulfills a pledge cannot be turned
down for coverage.

Key provisions of the bill are as follows:

§ 264. IMPLEMENTATION:
Requires federal financial participation;
further requires that the state provide assurances of quality of
services in designing the waiver.

§ 265. SELECTION OF PROGRAM MANAGEMENT ENTITY:
Establishes a transparent method to select a program manager, which
cannot be a state entity or an insurance company offering insurance
under the Compact. The program management entity coordinates and
manages all aspects of the program and liaises with the Department of
Health, individuals, insurance companies, and others to assure
appropriate collection and verification of data, collection of
payments, verification of assessments, claims tracking, and other
similar administrative responsibilities.

§ 266. PARTICIPATION AND PLEDGE:
Establishes the following:


* COMPACT PARTICIPANT is an individual who:
a) applies for membership
in the Compact, b) is a NYS resident, who has resided in the state
for at least two years prior to application, c) is assessed as a
chronically ill person (HIPAA standards), and d) has voluntarily
agreed to fulfill a pledge to pay for qualified long term care
services. The pledge amount is either:

1. MAXIMUM PLEDGE AMOUNT, equal to 36 months of
payment at the Regional
Rate for nursing home services in the region in which the Participant
resides at the time of application to the compact; or
2. DOLLAR PLEDGE AMOUNT, which is 50% of
countable assets. For a Participant with less
than $40,000 in assets, the pledge amount is the amount in excess of
$20,000.

In formulating the amount of the contributions, countable Asset and
countable income mean the same as under Medicaid, except that
spending for Medicare Supplement Insurance policies, and the Medicare
drug plan are excluded.

A Participant who fulfills a pledge becomes a "Compact Beneficiary"
and is eligible for the compact subsidy. A Participant who fails to
fulfill the pledge cannot become a Compact Beneficiary, but doesn't
surrender eligibility to apply for Medicaid or eligibility to apply
for the Compact subsidy if they later become eligible.

§ 267. BENEFITS OF PARTICIPATION:
A Beneficiary who fulfills the pledge amount:

* RETAINS ASSETS: preserves all remaining resources and receives the
compact subsidy for services.

* RETAINS INCOME: retains 75% (protected amount) of income while
receiving the compact subsidy.

* PAYS AN ANNUAL PARTICIPATION FEE: of 25% of countable income.

* PAYS 10% CAPPED CO-PAY FOR SERVICES: receives services at a rate no
greater than the compact rate, and is not responsible for payment of
any amount greater than the difference between the compact rate and
the compact subsidy (10%).

* RECEIVES A PUBLIC SUBSIDY FOR SERVICES: is eligible to receive the
compact subsidy annually for qualified long term care services from
any willing provider selected by the Beneficiary. The total annual
amount of the subsidy is capped at the average nursing home
institutional rate for the region.

* SURRENDERS NOTHING ELSE: is not required to submit to Medicaid-type
resource requirements or limitations, or to recovery of payments
made, or imposition of liens on homes.

* BENEFICIARY RECEIVED SERVICES PER PLAN OF CARE: receives quality
care services as required through the plan of care.


§ 268. Protected Income.

This section establishes a hardship requirement, allowing the
commissioner to waive all or part of the participation fee and the
co-pay amounts if the Beneficiary's countable income in any month,
after deduction of these items is less than the following protected
income amounts:

Beneficiary Amount not less than

Unmarried Beneficiary and Institutional protected amount of
Receiving care in an $100, indexed to inflation
institutional setting

Receiving care at home Minimum monthly maintenance needs
allowance (MMNA: $2,378 per month)

Married and One Institutional protected amount for
Beneficiary receiving care Beneficiary, and the MMNA for the
in an institutional spouse
setting

One is a Beneficiary Twice the MMNA
receiving care at home

Both are beneficiaries Institutional protected amount of
receiving care in an $100, indexed to inflation for each
institutional setting

Both are beneficiaries
receiving care at home Twice the MMNA

The hardship cannot last longer than 12 months in any 36 month period.

§ 269. IMPOSITION OF LIEN IN CERTAIN CASES:
Nothing prevents imposition of a lien or recovery against property on
account of expenses incorrectly paid under the Compact Subsidy.

§ 270. PROHIBITED ACTS:
This lays out a series of consumer protections, including prohibiting
individuals engaged in the development, marketing, advertising or sale
of insurance plans designed to satisfy the pledge amount from giving
legal advice, or otherwise engaging in the practice of law, or using
or advertising the title of lawyer or attorney at law or accredited
representative of the department of health that could cause an
individual to believe that the person possesses special professional
skills or is authorized to provide advice on matter related to the
compact. The purpose of this section is to keep the selling of
insurance and legal estate planning and counseling separate.

§ 271. FRAUDULENT PRACTICES:

* PARTICIPANTS.us off;: A Participant who engages in fraudulent
practices in claiming to have fulfilled a pledge is disqualified from
the compact. In addition, making false statements, or helping someone
qualify who is not entitled to is a class A misdemeanor.


* VENDORS: Submitting false claims or false information in order to
obtain greater compensation is a class A misdemeanor.

* The department can impose a lien or recovery against the property of
an individual who has committed an act or acts in violation of this
section.

§ 271a. PAYMENTS AND DEFAULTS:
Establishes which entity pays which portion of the payments. In the
Beneficiary period, for example, the compact rate is paid to the
service provider by the program management entity, and the Beneficiary
pays the program management entity the 10% co-pay. A Beneficiary who
knowingly defaults on a pledge or a co-payment is disenrolled from the
program, and in the case of the co-payment, is liable to the program
management entity for the amount of the co-pay. Failure to pay bills
due within 90 days results in disenrollment.

§ 272. APPEALS:
Appeals during the private portion of the program would be handled
like other insurance appeals outside the Compact, with Fair Hearing
during the subsidy portion.

§ 273. TREATMENT OF ASSETS:
The program imposes a five year look back rule on most assets. Of
note:

* Homestead. The homestead is treated as in the NYS Partnership
Program for long term care run through the State Health Department.
However, a homestead purchased within five years period is a countable
asset, unless it is a replacement for a homestead sold within a year
prior. The difference between the sale price of the old homestead and
the purchase price of the new homestead is a countable asset.

* Additional exemptions. The Commissioner, acting on recommendation of
the advisory committee, may exempt certain income and resources of an
individual and of the individual's spouse from inclusion as a
countable asset.

* Additional provisions.

- ANNUITIES: The principal of an annuity is a countable asset if it
was purchased within three years of application to the compact;
however, the principle is not deemed a countable asset if a level
payment schedule has been in force for three years or more prior to
the date of application, as long as it has been in permanent payout
status for three years prior to that date.
- TRANSFERS TO TRUSTS: The value of an asset transferred into an
irrevocable trust for less than full consideration within three years
prior to enrollment in the Compact program shall be deemed a countable
asset.
- PRE-PAID FUNERALS: purchased for self, spouse or children with
disabilities are not included as countable assets, if made prior to
the date on which the Participant fulfills the Pledge Amount.
- DEBTS: including but not limited to outstanding debt on credit
cards, auto payments, mortgages, home equity loans, reverse mortgages,
and any other such similar debt instruments are deducted when
calculating the total value of countable assets.


§ 274. SPECIAL PROVISIONS REGARDING COUPLES:
Special rules apply to assets of couples affected by pre- and
post-nuptial agreements, or situations in which one spouse is enrolled
and the other is not.

§ 275. ADVISORY COMMITTEE:
The Commissioner is required to convene an 11-person advisory
committee including: two persons (2) from the Elder Law section of the
State Bar Association, including the Chair who shall serve ex officio;
two (2) from statewide advocacy groups concerned with senior issues;
four (4) from providers of services, including two representing
institutional providers of services and two representing
non-institutional providers; two (2) from insurers selling long term
care insurance in New York State who shall be persons with at least
five years experience in the development of long term care insurance
products and who are or who shall have been, so far as shall be
practicable, in executive positions; and (1) one with at least five
(5) years actuarial experience in long term care insurance matters.

§ 277. REQUIREMENT FOR CONFIDENTIALITY:
Requires the commissioner to promulgate rules for confidentiality.

§ 278. EDUCATION AND INFORMATION:
The program management entity, with the Superintendent of Insurance
and the Commissioner, will establish an education and outreach
program, or coordinate a program with any similar publicly sponsored
program.

JUSTIFICATION:
Long-term care is so costly that for most people who remain in the
system for any length of time impoverishment is inevitable. This
result is ruinous to individuals, irrational public policy, and
counter-productive: The threat of losing a lifetime's worth of
resources leads some individuals to take advantage of such legal
devices as Medicaid trusts or the rule of halves, which artificially
impoverish them and require the public sector to pay their health :are
costs. The irony in this situation is that the state's refusal to
address the care costs of individuals prior to impoverishment is
resulting in increased reliance on the state to pay for care. In place
of this unsustainable situation, the compact offers something
new-shared responsibility.

The compact is a voluntary agreement between the State and an
individual under which the individual pledges to pay a certain amount
for long term care, and when the pledge is met, the state pays 90% of
the individual's long term care needs, with the individual paying the
rest, plus a participation fee.

The state gets a partner in paying for long term care. It pays nothing
until the pledge is met--that is, until its partner has met his or her
responsibilities. In return, the individual gets to preserve assets
and income, gains control of his or her health care, using providers
that he or she chooses from a broader menu of services. than under
traditional Medicaid. Moreover, an individual who meets a pledge and
other criteria cannot be turned down; participation is guaranteed.
This measure is a win-win for everyone.


LEGISLATIVE HISTORY:
S.4064-B of 2010 - Referred to Aging
S.116A of 2008 - Referred to Aging, Reported and Committed to Finance
S.3530 of 2005 - Referred to Aging, 2006, Passed Senate

FISCAL IMPLICATIONS:
Millman Actuaries determined that the state will save money under
every scenario, from $21 million to $500 million annually.

EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2185

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 18, 2011
                               ___________

Introduced  by Sens. GOLDEN, DeFRANCISCO, GRISANTI, LAVALLE, RANZENHOFER
  -- read twice and ordered printed, and when printed to be committed to
  the Committee on Aging

AN ACT to amend the elder law and the  insurance  law,  in  relation  to
  establishing the New York state compact for long term care

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Article 2 of the elder law is amended by adding a new title
4 to read as follows:
                                 TITLE 4
                       COMPACT FOR LONG TERM CARE
SECTION 260.   SHORT TITLE.
        261.   DEFINITIONS.
        262.   COMPACT FOR LONG TERM CARE CREATED; PURPOSES.
        263.   REQUIREMENT FOR CONSULTATION.
        264.   IMPLEMENTATION.
        265.   SELECTION OF PROGRAM MANAGEMENT ENTITY.
        266.   PARTICIPATION AND PLEDGE.
        267.   BENEFITS OF PARTICIPATION.
        268.   PROTECTED INCOME.
        269.   IMPOSITION OF LIEN IN CERTAIN CASES.
        270.   PROHIBITED ACTS.
        271.   FRAUDULENT PRACTICES.
        271-A. PAYMENTS AND DEFAULTS.
        272.   APPEALS.
        273.   TREATMENT OF ASSETS.
        274.   SPECIAL PROVISIONS REGARDING COUPLES.
        275.   ADVISORY COMMITTEE.
        276.   REQUIREMENT FOR CONFIDENTIALITY.
        277.   EDUCATION AND INFORMATION.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04236-01-1

S. 2185                             2

  S 260. SHORT TITLE. THIS TITLE SHALL BE KNOWN AND MAY BE CITED AS  THE
"NEW YORK STATE COMPACT FOR LONG TERM CARE".
  S 261. DEFINITIONS. AS USED IN THIS TITLE:
  1. "ASSESSMENT" MEANS AN ASSESSMENT TO DETERMINE WHETHER AN INDIVIDUAL
IS  A  CHRONICALLY ILL INDIVIDUAL WHO QUALIFIES AS A PARTICIPANT OR AS A
BENEFICIARY IN THE COMPACT, AND TO PROVIDE INFORMATION FOR THE  PLAN  OF
CARE  REQUIRED  HEREUNDER  FOR  SUCH  ENROLLEES.  AN  ASSESSMENT  MAY BE
PERFORMED ONLY BY A LICENSED  HEALTH  CARE  PRACTITIONER  CONTRACTED  TO
PERFORM  SUCH  ASSESSMENTS  WITH  AN  INSURER,  THE COMMISSIONER, OR THE
PROGRAM MANAGEMENT ENTITY.  THE ASSESSMENT SHALL BE  PERFORMED  ANNUALLY
OR  WHENEVER A CHANGE IN THE CONDITION OF THE BENEFICIARY OR PARTICIPANT
WARRANTS AN UPDATE TO THE PLAN OF CARE. THE COST OF AN ASSESSMENT  SHALL
BE PAID BY AN INDIVIDUAL SEEKING TO ENROLL IN THE COMPACT.
  2.  "ADVISORY  COMMITTEE"  MEANS  THE  ADVISORY  COMMITTEE ESTABLISHED
PURSUANT TO THIS TITLE.
  3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
  4. "COMPACT" MEANS THE COMPACT FOR LONG TERM CARE  PROGRAM  AUTHORIZED
BY THIS TITLE.
  5.  "COMPACT  BENEFICIARY" OR "BENEFICIARY" MEANS A PARTICIPANT WHO BY
PAYING HIS OR HER PLEDGE AMOUNT AND MEETING  OTHER  REQUIREMENTS  ESTAB-
LISHED BY THIS TITLE HAS BECOME ELIGIBLE FOR THE COMPACT SUBSIDY.
  6. "COMPACT PARTICIPANT" OR "PARTICIPANT" MEANS AN INDIVIDUAL WHO: (A)
HAS  APPLIED  FOR  MEMBERSHIP  IN  THE  COMPACT; (B) IS A STATE RESIDENT
RESIDING IN THIS STATE AT THE TIME OF SUCH APPLICATION AND  HAS  BEEN  A
STATE  RESIDENT FOR AT LEAST TWO YEARS PRIOR TO THE DATE OF APPLICATION;
(C) HAS BEEN DETERMINED BY AN ASSESSMENT TO BE A CHRONICALLY ILL PERSON,
AND A PLAN OF CARE HAS BEEN DEVELOPED  FOR  SUCH  PERSON;  AND  (D)  HAS
AGREED  TO  PAY A PLEDGE AMOUNT AS PROVIDED IN THIS TITLE. A PARTICIPANT
SHALL BE DEEMED ENROLLED IN THE COMPACT.
  7. "COMPACT RATE" MEANS THE RATE THAT A PROVIDER MAY CHARGE A  COMPACT
BENEFICIARY  FOR A SERVICE PROVIDED PURSUANT TO THE COMPACT. THE COMPACT
RATE SHALL BE COMPUTED BY THE COMMISSIONER AT ONE HUNDRED TEN PERCENT OF
THE COMPACT SUBSIDY FOR THE SERVICE.
  8. "COMPACT SUBSIDY" OR "SUBSIDY" MEANS THE SUBSIDY PROVIDED  PURSUANT
TO  THE  COMPACT  FOR  THE COSTS OF ANY QUALIFIED LONG TERM CARE SERVICE
RECEIVED BY A COMPACT BENEFICIARY PURSUANT TO  THE  PLAN  OF  CARE.  THE
AMOUNT  OF THE SUBSIDY SHALL EQUAL THE MEDICAID RATE ESTABLISHED FOR THE
SAME OR A SIMILAR  SERVICE  IN  THE  REGION  IN  WHICH  THE  BENEFICIARY
RESIDES.  IF  THERE  IS  NO MEDICAID RATE FOR A SERVICE IN A REGION, THE
COMMISSIONER SHALL ESTABLISH A RATE ON RECOMMENDATION  OF  THE  ADVISORY
COMMITTEE  WHICH  SHALL BE APPLICABLE IN THE REGION FOR THE SERVICE. THE
COMMISSIONER SHALL ADJUST THE METHODOLOGY FOR ESTABLISHING THE AMOUNT OF
THE COMPACT SUBSIDY ONLY ON RECOMMENDATION OF THE ADVISORY COMMITTEE.
  9. "COUNTABLE ASSET" SHALL HAVE THE SAME MEANING AS THE TERM  "ASSETS"
IN  CLAUSE  (I) OF SUBPARAGRAPH ONE OF PARAGRAPH (D) OF SUBDIVISION FIVE
OF SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW APPLICABLE
TO TRANSFERS MADE AFTER AUGUST  TENTH,  NINETEEN  HUNDRED  NINETY-THREE,
EXCEPT  AS OTHERWISE PROVIDED HEREIN OR BY RULES ESTABLISHED PURSUANT TO
THIS TITLE.  COUNTABLE ASSET DOES NOT INCLUDE INCOME.
  10. "COUNTABLE INCOME" MEANS INCOME REQUIRED TO BE CONSIDERED  IN  THE
CASE OF A PERSON APPLYING FOR MEDICAID PURSUANT TO SECTION THREE HUNDRED
SIXTY-SIX OF THE SOCIAL SERVICES LAW, EXCEPT AS OTHERWISE PROVIDED HERE-
IN  OR BY RULES ESTABLISHED PURSUANT TO THIS TITLE. THE FOLLOWING HEALTH
CARE EXPENDITURES SHALL BE EXCLUDED FROM COUNTABLE INCOME:  EXPENDITURES
FOR  MEDICARE  SUPPLEMENTAL  INSURANCE  POLICIES  MEETING  THE STANDARDS
ESTABLISHED PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED  EIGHTEEN  OF

S. 2185                             3

THE  INSURANCE  LAW,  EXPENDITURES FOR A MEDICARE PRESCRIPTION DRUG PLAN
APPROVED PURSUANT TO PROCEDURES ESTABLISHED BY THE  U.S.  DEPARTMENT  OF
HEALTH  AND  HUMAN  SERVICES, AND PREMIUMS FOR THE PURCHASE OF LONG TERM
CARE INSURANCE.
  11. "DIRECTOR" MEANS THE DIRECTOR OF THE STATE OFFICE FOR THE AGING.
  12.  "FEDERAL ACT" MEANS THE HEALTH INSURANCE PORTABILITY AND ACCOUNT-
ABILITY ACT OF 1996 OR ANY  SUCCESSOR  THERETO,  AND  RULES  PROMULGATED
THEREUNDER.  THE  FOLLOWING  TERMS SHALL HAVE THE SAME MEANINGS AS UNDER
THE FEDERAL ACT: "QUALIFIED LONG TERM CARE SERVICES";  "LICENSED  HEALTH
CARE  PRACTITIONER";  "ACTIVITIES  OF  DAILY  LIVING";  "CHRONICALLY ILL
PERSON."  ANY PROVISION OF ANY OTHER LAW TO THE  CONTRARY  NOTWITHSTAND-
ING,  THE  DEPARTMENT OF HEALTH SHALL NOT BE AUTHORIZED TO ISSUE, ENACT,
PROMULGATE, OR ENFORCE ANY REQUIREMENT, RULE, REGULATION  OR  DEFINITION
THAT IS MORE RESTRICTIVE THAN THE MEANINGS ASCRIBED TO SUCH TERMS PURSU-
ANT TO THE FEDERAL ACT.  IN ADDITION:
  (A)  THE  FOREGOING  TO  THE  CONTRARY  NOTWITHSTANDING AND SOLELY FOR
PURPOSES OF DETERMINING  WHETHER  A  PARTICIPANT  OR  A  BENEFICIARY  IS
SUFFERING  FROM  "SEVERE  COGNITIVE  IMPAIRMENT," THE COMMISSIONER SHALL
REQUIRE THAT SUCH CONDITION BE CHARACTERIZED BY A DETERIORATION OR IRRE-
VERSIBLE LOSS IN INTELLECTUAL CAPACITY THAT REQUIRES SUBSTANTIAL  SUPER-
VISION TO ASSURE THE SAFETY OF THE PARTICIPANT OR OF OTHERS, AND THAT IT
SHALL  BE  ESTABLISHED  BY CLINICAL EVIDENCE AND STANDARDIZED TESTS THAT
RELIABLY MEASURE: SHORT-TERM OR  LONG-TERM  MEMORY;  ORIENTATION  AS  TO
PEOPLE,  PLACE OR TIME; DEDUCTIVE OR ABSTRACT REASONING; AND JUDGMENT AS
IT RELATES TO SAFETY AWARENESS.  THE MEANS OF DETERMINATION AS TO WHETH-
ER A PERSON HAS SUFFERED SEVERE COGNITIVE IMPAIRMENT  SHALL  INSOFAR  AS
PRACTICAL  BE  THE  SAME  AS  THOSE  USED PURSUANT TO THE FEDERAL ACT TO
DETERMINE SEVERE COGNITIVE IMPAIRMENT.    "SUBSTANTIAL  SUPERVISION"  AS
USED  IN THIS TITLE MEANS CONTINUAL OVERSIGHT THAT MAY INCLUDE CUEING BY
VERBAL PROMPTING, GESTURES OR OTHER DEMONSTRATIONS  BY  ANOTHER  PERSON,
AND  THAT IS NECESSARY TO PROTECT THE PATIENT FROM THREATS TO HIS OR HER
HEALTH OR SAFETY.
  (B) "LICENSED HEALTH CARE PRACTITIONER" SHALL BE LIMITED TO  A  PHYSI-
CIAN,  AS  DEFINED IN SECTION 1861(R)(1) OF THE SOCIAL SECURITY ACT OR A
REGISTERED PROFESSIONAL NURSE, PROVIDED THAT SUCH PERSON IS NOT A FAMILY
MEMBER AND FURTHER PROVIDED THAT  SUCH  INDIVIDUAL  SHALL  BE  LICENSED,
REGISTERED, OR CERTIFIED TO WORK IN NEW YORK.
  (C)  ANY LIMITATIONS IMPOSED BY THE FOREGOING TO THE CONTRARY NOTWITH-
STANDING, "QUALIFIED LONG TERM CARE SERVICES" SHALL INCLUDE ANY EXPENSES
FOR LONG TERM MEDICAL CARE AND SERVICES WHICH ARE OR, IN THE CASE OF  AN
INDIVIDUAL WHO IS NOT A TAXPAYER, WHICH WOULD BE DEDUCTIBLE FROM FEDERAL
GROSS  INCOME FOR SUCH TAXPAYER OR INDIVIDUAL AS LONG TERM CARE SERVICES
PURSUANT TO THE INTERNAL REVENUE CODE, AND BOTH MEDICAL AND  NON-MEDICAL
SERVICES,  INCLUDING  HOME  MODIFICATION  AND  THE PROVISION OF SERVICES
COORDINATION REQUIRED PURSUANT  TO  THE  PLAN  OF  CARE  PREPARED  BY  A
LICENSED  HEALTH CARE PRACTITIONER IN ORDER TO MAINTAIN A PARTICIPANT OR
BENEFICIARY IN HIS OR HER OWN HOME, AND SUCH ADDITIONAL SERVICES AS  MAY
BE  APPROVED  BY  THE  COMMISSIONER  UPON RECOMMENDATION OF THE ADVISORY
COMMITTEE, SO LONG AS THE COMMISSIONER SHALL BE SATISFIED THAT INCLUSION
OF SUCH ADDITIONAL SERVICES DOES NOT PREVENT RECEIPT OF  FEDERAL  FINAN-
CIAL  PARTICIPATION  UNDER  THE  MEDICAL ASSISTANCE PROGRAM OR UNDER THE
COMPACT.
  13. "FULFILLED PLEDGE" MEANS A PLEDGE AMOUNT THAT HAS BEEN FULLY PAID.
ONLY PAYMENTS MADE BY A PARTICIPANT, OR  BY  ANY  PERSON  OR  ENTITY  ON
BEHALF  OF  SUCH  PARTICIPANT  SHALL BE COUNTED AS ELIGIBLE PAYMENTS FOR
FULFILLING A PLEDGE. ELIGIBLE  PAYMENTS  SHALL  INCLUDE  REASONABLE  AND

S. 2185                             4

NECESSARY  PAYMENTS FOR QUALIFIED LONG TERM CARE SERVICES, AND ANY ADDI-
TIONAL EXPENSES FOR SERVICES AS MAY BE APPROVED BY THE COMMISSIONER UPON
RECOMMENDATION OF THE  ADVISORY  COMMITTEE.  SUCH  PAYMENTS  SHALL  ALSO
INCLUDE   PAYMENTS  FOR  QUALIFIED  LONG  TERM  CARE  SERVICES  FOR  THE
THREE-MONTH PERIOD PRIOR TO AN INDIVIDUAL BECOMING A PARTICIPANT. COUNT-
ABLE PAYMENTS MADE FOR A QUALIFIED LONG TERM CARE SERVICE IN  FULFILLING
A  PLEDGE  SHALL  NOT BE GREATER THAN THE AMOUNT USUALLY AND CUSTOMARILY
CHARGED FOR SUCH SERVICE BY A PROVIDER TO A NON-MEDICAID RECIPIENT.
  14. "PLAN OF CARE" MEANS A WRITTEN, INDIVIDUALIZED PLAN FOR  CARE  AND
SUPPORT SERVICES DEVELOPED BY A LICENSED HEALTH CARE PRACTITIONER FOR AN
INDIVIDUAL  SEEKING  TO ENROLL IN THE COMPACT AND AT OTHER SUCH TIMES AS
PROVIDED HEREIN. THE PLAN OF CARE SHALL BE DEVELOPED AS A RESULT  OF  AN
ASSESSMENT AND SHALL INCORPORATE ANY INFORMATION PROVIDED BY AN INDIVID-
UAL'S  PERSONAL  PHYSICIAN OR, AS APPROPRIATE, OTHER PHYSICIANS TREATING
THE INDIVIDUAL. IT SHALL FAIRLY, ACCURATELY, AND  APPROPRIATELY  ADDRESS
THE  INDIVIDUAL'S  LONG  TERM  CARE AND SUPPORT SERVICE NEEDS, AND SHALL
SPECIFY THE TYPE, FREQUENCY, AND DURATION OF ALL  SERVICES  REQUIRED  TO
MEET  THOSE  NEEDS  AND  THE  PROVIDERS  APPROPRIATE  TO  FURNISH  THOSE
SERVICES. A PLAN OF CARE SHALL BE COMPLETED AT THE SAME TIME THE ASSESS-
MENT IS PERFORMED, AND SHALL BE UPDATED ANNUALLY ON  THE  BASIS  OF  THE
ANNUAL ASSESSMENT OR WHENEVER A CHANGE IN THE CONDITION OF THE BENEFICI-
ARY  OR  PARTICIPANT  WARRANTS  AN  UPDATE. THE COST OF THE PLAN OF CARE
SHALL BE PAID BY AN INDIVIDUAL SEEKING TO ENROLL IN THE COMPACT.
  15. "PLEDGE AMOUNT" MEANS THE AMOUNT PLEDGED BY A PARTICIPANT FOR  THE
COST  OF  QUALIFIED  LONG TERM CARE SERVICES. THE PLEDGE AMOUNT SHALL BE
THE LESSER OF: (A) THE "MAXIMUM  PLEDGE  AMOUNT,"  WHICH  SHALL  BE  THE
AMOUNT  EQUAL  TO THIRTY-SIX MONTHS OF PAYMENT FOR NURSING HOME SERVICES
IN THE REGION IN WHICH THE PARTICIPANT RESIDES,  AS  APPLICABLE  AT  THE
TIME OF APPLICATION TO THE COMPACT; OR
  (B) THE "DOLLAR PLEDGE AMOUNT" WHICH SHALL BE AN AMOUNT EQUAL TO FIFTY
PERCENT  OF  A  PARTICIPANT'S COUNTABLE ASSETS. IN THE CASE OF A PARTIC-
IPANT WHOSE COUNTABLE ASSETS ARE LESS THAN FORTY THOUSAND  DOLLARS,  THE
DOLLAR  PLEDGE  AMOUNT  SHALL  BE  LIMITED  TO THE AMOUNT IN EXCESS OF A
DEDUCTIBLE AMOUNT OF TWENTY THOUSAND DOLLARS, AND THE COMMISSIONER SHALL
CALCULATE SUCH DOLLAR  PLEDGE  AMOUNT  BY  SUBTRACTING  SUCH  DEDUCTIBLE
AMOUNT  OF  TWENTY  THOUSAND  DOLLARS  FROM  THE PARTICIPANT'S COUNTABLE
ASSETS AND THE REMAINDER AMOUNT SHALL EQUAL THE  DOLLAR  PLEDGE  AMOUNT;
PROVIDED  THAT THE COMMISSIONER SHALL ANNUALLY INCREASE OR DECREASE SUCH
FORTY THOUSAND DOLLAR ASSET  AMOUNT  AND  SUCH  TWENTY  THOUSAND  DOLLAR
DEDUCTIBLE  AMOUNT  AT  THE  SAME  PERCENTAGE  RATE  AS  THE INCREASE OR
DECREASE IN THE REGIONAL RATE FOR NURSING HOME SERVICES FOR  THE  REGION
IN WHICH THE ELIGIBLE INDIVIDUAL RESIDES.
  16.  "REGION" MEANS THE FOLLOWING REGIONS: LONG ISLAND, NEW YORK CITY,
NORTHERN METROPOLITAN NEW YORK, NORTHEASTERN  NEW  YORK,  UTICA  REGION,
CENTRAL NEW YORK, ROCHESTER REGION AND WESTERN NEW YORK.
  17. "REGIONAL RATE" MEANS THE RATE SET ANNUALLY BY THE COMMISSIONER AT
EQUAL TO THE AVERAGE OF ALL RATES, EXCLUSIVE OF MEDICAID RATES, PAID FOR
THE  SAME  OR  SIMILAR  SERVICES WITHIN A REGION. THE COMMISSIONER SHALL
COMPUTE AND ANNUALLY UPDATE REGIONAL RATES FOR EACH REGION OF THE  STATE
FOR  ANY  YEAR  NOT  LATER  THAN  THE  LAST WEEK OF DECEMBER OF THE YEAR
PRECEDING SUCH YEAR.
  S 262. COMPACT FOR LONG TERM CARE CREATED; PURPOSES. THE  COMPACT  FOR
LONG  TERM CARE IS HEREBY CREATED. ITS PURPOSE SHALL BE TO PROVIDE COOR-
DINATED PUBLIC AND PRIVATE COVERAGE FOR THE EXPENSES OF PROVIDING QUALI-
FIED LONG TERM CARE SERVICES TO ELIGIBLE INDIVIDUALS PURSUANT TO A  PLAN
OF CARE, A PURPOSE HEREBY DECLARED TO BE IN EVERY RESPECT AN APPROPRIATE

S. 2185                             5

PUBLIC  PURPOSE  CONDUCTED FOR THE BENEFIT OF THE PEOPLE OF THE STATE OF
NEW YORK.
  S 263. REQUIREMENT FOR CONSULTATION. ANY PROVISION OF ANY OTHER LAW TO
THE  CONTRARY  NOTWITHSTANDING, AND IN ADDITION TO ANY OTHER REQUIREMENT
IMPOSED BY THIS TITLE, THE COMMISSIONER SHALL CONSULT WITH THE  DIRECTOR
AND  WITH  THE  SUPERINTENDENT OF INSURANCE PRIOR TO TAKING ANY MATERIAL
ACTION CONCERNING POLICY OR PROGRAM MATTERS  REQUIRED  OR  PERMITTED  BY
THIS  TITLE,  PROVIDED  HOWEVER  THAT THE FAILURE TO RESPOND TIMELY TO A
REQUEST FOR CONSULTATION AND ADVICE SHALL NOT IMPAIR OR  INVALIDATE  ANY
SUCH ACTION TAKEN BY THE COMMISSIONER.
  S  264. IMPLEMENTATION. ANY PROVISION OF ANY OTHER LAW TO THE CONTRARY
NOTWITHSTANDING, THE COMMISSIONER IS  HEREBY  AUTHORIZED  TO  AND  SHALL
IMPLEMENT  THE  COMPACT  FOR  LONG  TERM CARE PROGRAM AUTHORIZED BY THIS
TITLE AND SHALL SUBMIT SUCH WAIVER APPLICATIONS AND/OR STATE PLAN AMEND-
MENTS AS MAY BE NECESSARY FOR SUCH IMPLEMENTATION,  PROVIDED  THAT  SUCH
PROGRAM  AND  THE  PROVISIONS OF THIS TITLE SHALL BE IMPLEMENTED ONLY IF
AND FOR SO LONG AS THE COMMISSIONER SHALL BE SATISFIED THAT THEY DO  NOT
PREVENT  RECEIPT  OF  FEDERAL  FINANCIAL PARTICIPATION UNDER THE MEDICAL
ASSISTANCE PROGRAM OR UNDER THE COMPACT. IN APPLYING FOR THE WAIVER, THE
COMMISSIONER  SHALL  CONSULT  WITH  THE  ADVISORY  COMMITTEE  CONCERNING
SUBMISSION  OF APPROPRIATE CRITERIA FOR ASSURING THAT A SERVICE IS PROP-
ERLY PROVIDED AND MEETS APPROPRIATE STANDARDS OF QUALITY AND COST.
  S 265. SELECTION OF PROGRAM MANAGEMENT ENTITY. 1. THE COMMISSIONER  IS
HEREBY AUTHORIZED TO AND SHALL CONTRACT WITH A PROGRAM MANAGEMENT ENTITY
TO  ADMINISTER  THE COMPACT. THE PROCESS FOR SELECTING A PROGRAM MANAGE-
MENT ENTITY TO MANAGE THE COMPACT PROGRAM SHALL BE  GOVERNED  SOLELY  BY
THIS TITLE.
  2. INSOFAR AS PERMITTED UNDER ANY FEDERAL WAIVERS OR STATE PLAN AMEND-
MENTS  REQUIRED  FOR  IMPLEMENTATION,  THE COMPACT SHALL BE MANAGED BY A
PROGRAM MANAGEMENT ENTITY CONTRACTED TO AND SELECTED BY THE COMMISSIONER
BY A REQUEST FOR PROPOSALS OR A REQUEST FOR QUALIFICATIONS ISSUED PURSU-
ANT TO THIS TITLE. SUCH ENTITY SHALL BE RESPONSIBLE FOR COORDINATING AND
MANAGING ALL ASPECTS OF  THE  COMPACT  PROGRAM  AND  LIAISING  WITH  THE
DEPARTMENT  OF  HEALTH, INDIVIDUALS, INSURANCE COMPANIES AND OTHER ENTI-
TIES  TO  ASSURE  APPROPRIATE  COLLECTION  AND  VERIFICATION  OF   DATA,
COLLECTION OF PAYMENTS REQUIRED TO BE MADE TO THE STATE PURSUANT TO THIS
TITLE,  VERIFICATION OF ASSESSMENTS AND CLAIMS TRACKING, AND OTHER SIMI-
LAR ADMINISTRATIVE RESPONSIBILITIES. THE PROGRAM MANAGEMENT ENTITY SHALL
NOT BE AN INSURANCE ENTITY OFFERING AN INSURANCE PLAN UNDER THE  COMPACT
OR,  UNLESS  REQUIRED  BY FEDERAL LAW OR REGULATION OR AS A CONDITION OF
FEDERAL APPROVAL OF ANY WAIVERS OR STATE PLAN  AMENDMENTS  NECESSARY  TO
IMPLEMENT  THE  COMPACT,  A  STATE AGENCY OR A COVERED AUTHORITY AS SUCH
TERMS ARE DEFINED IN SECTION TWO-A OF THE STATE FINANCE LAW.
  3. THE COMMISSIONER, AFTER CONSULTATION WITH THE DIRECTOR OF THE DIVI-
SION OF THE BUDGET, SHALL WITHIN NINETY DAYS AFTER THE EFFECTIVE DATE OF
THIS SECTION, REPORT TO THE GOVERNOR AND THE LEGISLATURE WITH  RECOMMEN-
DATIONS  FOR  THE  IMPLEMENTATION  OF THE SELECTION PROCESS. SUCH REPORT
SHALL DETAIL:
  (A) THE CRITERIA TO BE USED IN SELECTING THE ENTITY;
  (B) THE PROCESS TO BE USED IN THE SELECTION, INCLUDING THE ISSUANCE OF
REQUESTS FOR PROPOSALS, REQUESTS FOR QUALIFICATIONS OR OTHER MEANS;
  (C) THE NAMES OF ANY ENTITIES ENGAGED TO DEVELOP CRITERIA  AND  ASSIST
IN THE SELECTION;
  (D)  TIMELINESS  FOR  THE  SELECTION  OF  THE  ENTITY  AND ISSUANCE OF
CONTRACTS;
  (E) MARKETING PLANS FOR THE PROGRAM;

S. 2185                             6

  (F) MEANS TO MAKE THE SELECTION PROCESS AS TRANSPARENT AS POSSIBLE;
  (G) MEANS BY WHICH TRADE AND COMPETITIVE SECRETS SHALL BE PROTECTED;
  (H)  MEANS BY WHICH INDIVIDUAL IDENTIFYING INFORMATION RELATING TO ANY
PATIENT OR CONSUMER ACQUIRED BY THE PROGRAM SHALL BE KEPT  CONFIDENTIAL;
AND
  (I)  ANY  OTHER INFORMATION THE DIRECTOR OF THE DIVISION OF THE BUDGET
OR THE COMMISSIONER SHALL DEEM PERTINENT.
  IN PREPARING THE REPORT, THE DIRECTOR OF THE DIVISION  OF  THE  BUDGET
AND  THE  COMMISSIONER SHALL CONSULT WITH THE ADVISORY COMMITTEE AND THE
SUPERINTENDENT OF INSURANCE, AND SHALL ADDITIONALLY CONVENE AN  ADVISORY
GROUP  OF  INSURERS AUTHORIZED TO WRITE LONG TERM CARE INSURANCE IN THIS
STATE TO PROVIDE COMMENTS ON THE REPORT,  OR  IF  CONVENING  SUCH  GROUP
SHALL  PROVE IMPRACTICABLE OR INAPPROPRIATE, SHALL SHARE THE REPORT WITH
SUCH INSURERS AND INCLUDE ANY WRITTEN COMMENTS RECEIVED FROM SUCH INSUR-
ERS AND THE ADVISORY COMMITTEE WHEN THE REPORT IS ISSUED TO THE GOVERNOR
AND THE LEGISLATURE.
  4. AFTER CONSIDERATION OF ANY COMMENTS THEY MAY RECEIVE CONCERNING THE
REPORT, THE COMMISSIONER AND/OR THE DIRECTOR  OF  THE  DIVISION  OF  THE
BUDGET, AS APPROPRIATE, SHALL PROMULGATE RULES AND REGULATIONS GOVERNING
THE  SELECTION  PROCESS  FOR A PROGRAM MANAGEMENT ENTITY. SUCH RULES AND
REGULATIONS SHALL REFLECT THE RECOMMENDATIONS IN THE REPORT  INSOFAR  AS
PRACTICABLE AND ANY RECOMMENDATIONS RECEIVED BY THE COMMISSIONER AND THE
DIRECTOR  OF  THE  DIVISION OF THE BUDGET. THE PROGRAM MANAGEMENT ENTITY
SHALL BE SELECTED THROUGH ISSUANCE OF A  REQUEST  FOR  PROPOSALS  OR  IF
APPROPRIATE  AND APPROVED BY THE DIRECTOR OF THE DIVISION OF THE BUDGET,
BY ISSUANCE OF A  REQUEST  FOR  QUALIFICATIONS,  AND  SUCH  REQUEST  FOR
PROPOSALS  OR  REQUEST FOR QUALIFICATIONS SHALL INCORPORATE THE CRITERIA
AND OTHER CONDITIONS AGREED UPON AS A RESULT OF THE PROCESS REQUIRED  IN
THIS SECTION.
  S 266. PARTICIPATION AND PLEDGE. 1. AN INDIVIDUAL WHO MEETS THE CRITE-
RIA FOR BECOMING A PARTICIPANT SHALL BE ENROLLED IN THE COMPACT PROGRAM.
IN  MEETING  SUCH  CRITERIA, THE INDIVIDUAL SHALL HAVE THE OPTION AT THE
TIME OF APPLICATION TO PLEDGE EITHER THE MAXIMUM PLEDGE  AMOUNT  OR  THE
DOLLAR PLEDGE AMOUNT.
  (A) AN INDIVIDUAL WHO ELECTS TO PLEDGE THE MAXIMUM PLEDGE AMOUNT SHALL
PAY  OR HAVE PAID ON HIS OR HER BEHALF BY ANY PERSON OR ENTITY AN AMOUNT
FOR THE PURCHASE OF QUALIFIED LONG TERM CARE SERVICES THAT IS  EQUAL  TO
THIRTY-SIX  MONTHS  OF  PAYMENT  AT  THE  REGIONAL RATE FOR NURSING HOME
SERVICES IN THE REGION IN WHICH THE PARTICIPANT RESIDES AS OF  THE  DATE
THE INDIVIDUAL APPLIES TO BECOME A PARTICIPANT.
  (B)  AN INDIVIDUAL WHO ELECTS TO PLEDGE THE DOLLAR PLEDGE AMOUNT SHALL
PAY OR HAVE PAID ON HIS OR HER BEHALF BY ANY PERSON OR ENTITY AN  AMOUNT
FOR  THE  PURCHASE OF QUALIFIED LONG TERM CARE SERVICES THAT IS EQUAL TO
FIFTY PERCENT OF A PARTICIPANT'S  COUNTABLE  ASSETS.    SUCH  INDIVIDUAL
SHALL SUBMIT: (I) A VERIFIED STATEMENT OF COUNTABLE ASSETS UNDER PENALTY
OF  PERJURY  LISTING ALL COUNTABLE CURRENT ASSETS HELD BY THE INDIVIDUAL
AT THE TIME OF APPLICATION AND ANY ASSET TRANSFERS FOR  LESS  THAN  FULL
VALUE DURING THE FIVE YEARS PRECEDING SUCH DATE OF APPLICATION, (II) THE
INDIVIDUAL'S  FIVE  MOST  RECENT  YEARS  OF STATE AND FEDERAL INCOME TAX
RETURNS, AND (III) ADDITIONAL DOCUMENTATION AS  THE  PROGRAM  MANAGEMENT
ENTITY, WITH THE APPROVAL OF THE COMMISSIONER UPON RECOMMENDATION OF THE
ADVISORY  COMMITTEE,  SHALL  DEEM  REASONABLE  AND APPROPRIATE TO VERIFY
ASSETS, THE VALUES OF SUCH  ASSETS,  AND  THE  VALIDITY  OF  THE  PLEDGE
AMOUNT.
  (C)  DOCUMENTATION  CONCERNING  THE  PLEDGE AMOUNT, THE RESULTS OF THE
ASSESSMENT AND EVIDENCE OF A FULFILLED PLEDGE SHALL BE SUBMITTED TO  THE

S. 2185                             7

PROGRAM MANAGEMENT ENTITY IN A FORM AND MANNER PRESCRIBED BY THE COMMIS-
SIONER.
  (D)  THE FOREGOING PROVISIONS OF THIS SECTION TO THE CONTRARY NOTWITH-
STANDING, THE PLEDGE AMOUNT MAY BE ADJUSTED IN THE EVENT THAT  AN  INDI-
VIDUAL  IS  SUBJECT  TO EXTRAORDINARY CIRCUMSTANCES, AS THE COMMISSIONER
SHALL DETERMINE, BUT THE  DESCRIPTION  OR  DEFINITION  OF  EXTRAORDINARY
CIRCUMSTANCES SHALL BE ESTABLISHED ONLY UPON RECOMMENDATION OF THE ADVI-
SORY COMMITTEE.
  2.  A  PARTICIPANT  WHO  FULFILLS  HIS OR HER PLEDGE SHALL BE DEEMED A
BENEFICIARY AND SHALL BE ELIGIBLE FOR THE COMPACT SUBSIDY. A PARTICIPANT
WHO FAILS TO FULFILL HIS OR HER PLEDGE SHALL NOT BE ELIGIBLE TO BECOME A
BENEFICIARY, BUT SHALL NOT SURRENDER ELIGIBILITY TO APPLY  FOR  MEDICAID
OR  ELIGIBILITY  TO  APPLY  FOR  THE COMPACT SUBSIDY IF SUCH PARTICIPANT
SHALL LATER BECOME ELIGIBLE.
  3. NOTWITHSTANDING  ANY  SIMILARITY  IN  ELIGIBILITY  REQUIREMENTS  OR
COMMONALITY  IN  THE  DEFINITIONS  OF  ASSET, INCOME OR OTHER ITEMS, AND
EXCEPT AS OTHERWISE PROVIDED IN THIS TITLE, A PARTICIPANT  OR  BENEFICI-
ARY,  AS THE CASE MAY BE, SHALL BE EXEMPT FROM THE RESOURCE TESTS, LIENS
AND OTHER REQUIREMENTS AND IMPOSITIONS THAT WOULD OTHERWISE BE  APPLICA-
BLE TO PERSONS APPLYING FOR OR RECEIVING MEDICAID.
  4.  THE  PURCHASE OF QUALIFIED LONG TERM CARE SERVICES FOR THE PURPOSE
OF FULFILLING THE PLEDGE SHALL BE RESTRICTED TO THE PURCHASE  OF  QUALI-
FIED  LONG  TERM  CARE  SERVICES  IN THE STATE SO LONG AS THE INDIVIDUAL
MEETS THE REQUIREMENTS OF THIS TITLE  WITH  RESPECT  TO  FULFILLING  THE
PLEDGE,  AND  PROVIDED  FURTHER  THAT A BENEFICIARY MAY ONLY RECEIVE THE
COMPACT SUBSIDY FOR SERVICES RECEIVED WITHIN THIS STATE.
  5. COUNTABLE PAYMENTS MADE FOR A QUALIFIED LONG TERM CARE  SERVICE  IN
FULFILLING  A  PLEDGE  SHALL  NOT BE GREATER THAN THE AMOUNT USUALLY AND
CUSTOMARILY CHARGED FOR SUCH SERVICE BY A  PROVIDER  TO  A  NON-MEDICAID
RECIPIENT  AND  SHALL INCLUDE REASONABLE AND NECESSARY EXPENSES PAID FOR
SUCH SERVICES, PROVIDED, HOWEVER THAT THE COMMISSIONER,  ON  RECOMMENDA-
TION OF THE ADVISORY COMMITTEE, MAY ESTABLISH CRITERIA FOR ASSURING THAT
A SERVICE IS PROPERLY PROVIDED AND MEETS APPROPRIATE STANDARDS OF QUALI-
TY  AND  COST.  THE  PROGRAM  MANAGEMENT  ENTITY  SHALL BE AUTHORIZED TO
UTILIZE SUCH CRITERIA IN ESTABLISHING PARAMETERS FOR PROPER  AND  APPRO-
PRIATE  PAYMENT FOR SERVICES AND ASSURANCES OF QUALITY. THE COMMISSIONER
SHALL REQUIRE SUBMISSION TO THE PROGRAM MANAGEMENT  ENTITY  OF  PERIODIC
UPDATES OF PAYMENTS MADE TOWARD FULFILLING THE PLEDGE AND REVIEW OF SUCH
PAYMENTS  BY  THE PROGRAM MANAGEMENT ENTITY FOR ELIGIBILITY. THE PROGRAM
MANAGEMENT ENTITY SHALL ADVISE THE PARTICIPANT OF ANY  INELIGIBILITY  OF
ANY SUCH PAYMENTS.
  6.  THE COMMISSIONER SHALL ESTABLISH A SEAMLESS PROCESS FOR TRANSITION
OF AN INDIVIDUAL FROM PARTICIPANT TO BENEFICIARY  WHEN  SUCH  INDIVIDUAL
HAS  FULFILLED THE REQUIREMENTS ESTABLISHED PURSUANT TO THIS TITLE. SUCH
SEAMLESS PROCESS MAY INCLUDE, FOR EXAMPLE, APPLICATION  TO  RECEIVE  THE
PUBLIC  SUBSIDY  AS  A  BENEFICIARY AT THE SAME TIME THAT THE INDIVIDUAL
ENROLLS AS A PARTICIPANT IN THE COMPACT, SO  THAT  WHEN  THE  PLEDGE  IS
FULFILLED,  THE  INDIVIDUAL  AUTOMATICALLY  TRANSITIONS TO THE STATUS OF
BENEFICIARY ELIGIBLE FOR THE COMPACT SUBSIDY. INSOFAR AS  FEASIBLE,  THE
TRANSITION SHOULD BE MANAGED BY THE PROGRAM MANAGEMENT ENTITY.
  S  267.  BENEFITS OF PARTICIPATION.  1. A BENEFICIARY WHO FULFILLS THE
PLEDGE SHALL BE ENTITLED TO PRESERVE HIS OR HER RESOURCES AND  SHALL  BE
ELIGIBLE TO RECEIVE THE COMPACT SUBSIDY.
  2.  A BENEFICIARY SHALL NOT BE REQUIRED TO SUBMIT TO RESOURCE REQUIRE-
MENTS OR LIMITATIONS, OR TO THE RECOVERY OF PAYMENTS MADE BY  THE  STATE
FROM  THE  ESTATES OF SUCH INDIVIDUALS, OR TO THE IMPOSITION OF LIENS ON

S. 2185                             8

THE HOMES OF PERSONS, SUCH AS THOSE WHICH ARE IMPOSED  ON  BENEFICIARIES
OF  THE  MEDICAID PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-SIX OR
SECTION THREE HUNDRED SIXTY-NINE OF  THE  SOCIAL  SERVICES  LAW,  UNLESS
OTHERWISE PROVIDED IN OR PURSUANT TO THIS TITLE.
  3.  A  BENEFICIARY  SHALL  BE ELIGIBLE TO HAVE THE SUBSIDY PAID TO THE
PROVIDER OF SERVICES FOR THE COSTS OF QUALIFIED LONG TERM CARE  SERVICES
FROM ANY WILLING PROVIDER SELECTED BY SUCH BENEFICIARY.
  4. A BENEFICIARY SHALL BE ELIGIBLE TO RECEIVE QUALIFIED LONG TERM CARE
SERVICES AT A RATE CHARGED BY A PROVIDER OF SERVICES WHICH IS NO GREATER
THAN THE COMPACT RATE.
  5.  A BENEFICIARY SHALL NOT BE RESPONSIBLE FOR PAYMENT FOR SUCH QUALI-
FIED LONG TERM CARE SERVICES OF ANY AMOUNT GREATER THAN  THE  DIFFERENCE
BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY.
  6.  A BENEFICIARY SHALL ANNUALLY REMIT A PARTICIPATION FEE TO MAINTAIN
ELIGIBILITY IN THE COMPACT, EQUAL TO TWENTY-FIVE PERCENT OF SUCH BENEFI-
CIARY'S COUNTABLE INCOME.  SUCH FEE SHALL BE REMITTED TO THE COMMISSION-
ER OR, IF SO DIRECTED BY THE COMMISSIONER,  TO  THE  PROGRAM  MANAGEMENT
ENTITY  FOR  TRANSMITTAL  TO  THE  COMMISSIONER. THE COMMISSIONER, AFTER
CONSULTATION WITH THE ADVISORY COMMITTEE, SHALL MAKE PROVISION TO  ALLOW
A  BENEFICIARY  TO  MAKE  PAYMENTS  ON  A MONTHLY OR OTHER BASIS, AT THE
OPTION OF THE BENEFICIARY.
  7. A BENEFICIARY SHALL RETAIN A PROTECTED AMOUNT OF INCOME DURING  THE
PERIOD IN WHICH THE BENEFICIARY IS RECEIVING THE COMPACT SUBSIDY, AS SET
FORTH IN THIS TITLE.
  8.  A BENEFICIARY SHALL BE ELIGIBLE TO HAVE THE ANNUAL COMPACT SUBSIDY
PAID FOR NON-INSTITUTIONAL SERVICES FROM ONE OR MORE PROVIDERS FOR UP TO
AN AMOUNT THAT IS LESS THAN OR EQUAL TO  THE  ANNUAL  REGIONAL  MEDICAID
RATE  COMPUTED  FOR  NURSING  HOME  SERVICES FOR THE REGION IN WHICH THE
BENEFICIARY RESIDES.
  S 268. PROTECTED INCOME. 1. THE COMMISSIONER, AFTER CONSULTATION  WITH
THE  ADVISORY COMMITTEE, SHALL ESTABLISH PROVISIONS TO WAIVE ALL OR PART
OF THE PARTICIPATION FEE AND ALL OR PART OF THE REQUIREMENT THAT A BENE-
FICIARY PAY ANY DIFFERENCE BETWEEN THE  COMPACT  RATE  AND  THE  COMPACT
SUBSIDY  IF  THE  BENEFICIARY'S  COUNTABLE  INCOME  IN  ANY MONTH, AFTER
DEDUCTION OF THE PARTICIPATION FEE AND PAYMENT OF THE DIFFERENCE BETWEEN
THE COMPACT RATE AND THE COMPACT SUBSIDY AMOUNT WHICH THE BENEFICIARY IS
REQUIRED TO PAY FOR SERVICES, SHALL BE LESS THAN THE FOLLOWING PROTECTED
INCOME AMOUNTS:
  (A) FOR AN UNMARRIED BENEFICIARY RECEIVING CARE  IN  AN  INSTITUTIONAL
SETTING  SUCH AS A NURSING HOME, ADULT HOME, ASSISTED LIVING FACILITY OR
OTHER SIMILAR FACILITY, AN AMOUNT EQUAL TO THE  INSTITUTIONAL  PROTECTED
AMOUNT;
  (B)  FOR  AN  UNMARRIED  BENEFICIARY RECEIVING CARE AT HOME, AN AMOUNT
EQUAL TO THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE;
  (C) FOR A MARRIED COUPLE OF WHOM ONE IS A BENEFICIARY  RECEIVING  CARE
IN AN INSTITUTIONAL SETTING SUCH AS A NURSING HOME, ADULT HOME, ASSISTED
LIVING FACILITY OR OTHER SIMILAR FACILITY, AN AMOUNT EQUAL TO THE INSTI-
TUTIONAL PROTECTED AMOUNT FOR THE BENEFICIARY AND AN AMOUNT EQUAL TO THE
MINIMUM  MONTHLY MAINTENANCE NEEDS ALLOWANCE FOR THE SPOUSE WHO IS NOT A
BENEFICIARY;
  (D) FOR A MARRIED COUPLE OF WHOM ONE IS A BENEFICIARY  RECEIVING  CARE
AT  HOME,  AN AMOUNT EQUAL TO ONE AND ONE-HALF TIMES THE MINIMUM MONTHLY
MAINTENANCE NEEDS ALLOWANCE;
  (E) FOR A MARRIED COUPLE, BOTH OF  WHOM  ARE  BENEFICIARIES  RECEIVING
CARE  IN  AN  INSTITUTIONAL  SETTING SUCH AS A NURSING HOME, ADULT HOME,

S. 2185                             9

ASSISTED LIVING FACILITY OR OTHER SIMILAR FACILITY, AN AMOUNT  EQUAL  TO
AN INSTITUTIONAL PROTECTED AMOUNT FOR EACH BENEFICIARY; AND
  (F)  FOR  A  MARRIED  COUPLE, BOTH OF WHOM ARE BENEFICIARIES RECEIVING
CARE AT HOME, AN AMOUNT EQUAL TO ONE  AND  ONE-HALF  TIMES  THE  MINIMUM
MONTHLY MAINTENANCE NEEDS ALLOWANCE.
  2. THE COMMISSIONER SHALL ANNUALLY ADJUST SUCH INSTITUTIONAL PROTECTED
AMOUNT  BY  THE  PERCENTAGE  INCREASE  OR DECREASE IN THE COST OF LIVING
INDEX, USING THE YEAR IN WHICH THIS TITLE SHALL HAVE BECOME LAW  AS  THE
BASE YEAR.
  3.  AS USED IN THIS SECTION, "MINIMUM MONTHLY MAINTENANCE NEEDS ALLOW-
ANCE" HAS THE SAME MEANING AS SUCH TERM IN PARAGRAPH (H) OF  SUBDIVISION
TWO  OF SECTION THREE HUNDRED SIXTY-SIX-C OF THE SOCIAL SERVICES LAW AND
"INSTITUTIONAL PROTECTED AMOUNT" MEANS THE SUM OF ONE  HUNDRED  DOLLARS,
WHICH  AMOUNT SHALL BE ADJUSTED BY THE COMMISSIONER ANNUALLY BY THE SAME
PERCENTAGE AS THE PERCENTAGE INCREASE  IN  THE  FEDERAL  CONSUMER  PRICE
INDEX.
  4.  WHEN MAKING THE COMPUTATION TO DETERMINE IF A BENEFICIARY'S INCOME
WOULD FALL BELOW THE APPROPRIATE PROTECTED INCOME  AMOUNT,  THE  COMMIS-
SIONER  SHALL  SUBTRACT  FROM THE BENEFICIARY'S MONTHLY COUNTABLE INCOME
THE DIFFERENCE BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY THAT THE
BENEFICIARY IS REQUIRED TO PAY, AND THEN THE PARTICIPATION FEE.  IF  THE
REMAINING  COUNTABLE  INCOME  AFTER  SUCH  SUBTRACTION  IS LESS THAN THE
PROTECTED AMOUNT  APPROPRIATE  TO  SUCH  BENEFICIARY,  THE  COMMISSIONER
SHALL,   AFTER  CONSULTATION  WITH  THE  ADVISORY  COMMITTEE,  ESTABLISH
PROVISIONS FOR:  (A) A REDUCTION IN THE AMOUNT OF THE PARTICIPATION  FEE
TO  BE  PAID BY THE BENEFICIARY, (B) A REDUCTION IN PAYMENT FOR SERVICES
BY THE BENEFICIARY OF ANY DIFFERENCE  TO  BE  PAID  BY  THE  BENEFICIARY
BETWEEN  THE COMPACT RATE AND THE COMPACT SUBSIDY, AND (C) THE PERIOD OF
TIME DURING WHICH REDUCTION OR REDUCTIONS SHALL BE EFFECTIVE,  IN  ORDER
TO  ASSURE THAT THE BENEFICIARY SHALL ALWAYS RETAIN THE PROTECTED AMOUNT
OF INCOME. ANY SUCH REDUCTION SHALL NOT BE EFFECTIVE FOR A PERIOD GREAT-
ER THAN TWELVE MONTHS IN ANY THIRTY-SIX MONTH PERIOD.
  5. ANY OTHER PROVISION OF THIS TITLE TO THE CONTRARY  NOTWITHSTANDING,
THE  COMMISSIONER  MAY  ADDITIONALLY,  AFTER  CONSULTATION WITH AND UPON
RECOMMENDATION OF THE ADVISORY COMMITTEE,  ESTABLISH  AS  AN  ADDITIONAL
BASIS  FOR A REDUCTION OF THE PAYMENT FOR SERVICES BY THE BENEFICIARY OF
ANY DIFFERENCE BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY  AND  OF
THE  PARTICIPATION  FEE  TO BE PAID BY THE BENEFICIARY, A FINDING THAT A
BENEFICIARY LACKS THE RESOURCES AFTER PAYMENT OF NECESSARY  EXPENSES  TO
REMAIN  IN  HIS  OR HER PLACE OF RESIDENCE AFTER PAYMENT OF SUCH PARTIC-
IPATION FEE AND/OR PAYMENT FOR SERVICES,  IRRESPECTIVE  OF  WHETHER  THE
BENEFICIARY'S  COUNTABLE INCOME EXCEEDS THE PROTECTED INCOME AMOUNT. THE
ADVISORY COMMITTEE SHALL PROVIDE THE COMMISSIONER WITH A  DEFINITION  OF
NECESSARY  EXPENSES  AS  USED  IN THIS SECTION PRIOR TO THE COMMISSIONER
TAKING ANY ACTION AUTHORIZED BY THIS SUBDIVISION. INSOFAR  AS  PRACTICA-
BLE,  SUCH  DEFINITION SHALL BE QUANTIFIABLE, AND THE COMMISSIONER SHALL
ESTABLISH A FORMULA BY RULE AND  REGULATION  FOR  DETERMINING  NECESSARY
EXPENSES  BASED ON SUCH DEFINITION AND FOR DETERMINING WHETHER A BENEFI-
CIARY LACKS THE RESOURCES AFTER PAYMENT OF SUCH  NECESSARY  EXPENSES  TO
REMAIN IN HIS OR HER PLACE OF RESIDENCE.
  S  269. IMPOSITION OF LIEN IN CERTAIN CASES. NOTHING CONTAINED IN THIS
TITLE SHALL PREVENT THE IMPOSITION OF A LIEN  OR  RECOVERY  AGAINST  THE
PROPERTY  OF AN INDIVIDUAL ON ACCOUNT OF EXPENSES INCORRECTLY PAID UNDER
THE COMPACT SUBSIDY.

S. 2185                            10

  S 270. PROHIBITED ACTS. NO PERSON ENGAGED IN THE DEVELOPMENT,  MARKET-
ING,  ADVERTISING  OR SALE OF ANY INSURANCE PLAN DESIGNED TO SATISFY THE
PLEDGE AMOUNT SHALL:
  1. GIVE LEGAL ADVICE OR OTHERWISE ENGAGE IN THE PRACTICE OF LAW.
  2. ASSUME, USE OR ADVERTISE THE TITLE OF LAWYER OR ATTORNEY AT LAW, OR
EQUIVALENT  TERMS  IN  THE  ENGLISH  LANGUAGE  OR ANY OTHER LANGUAGE, OR
REPRESENT OR ADVERTISE OTHER TITLES OR CREDENTIALS,  INCLUDING  BUT  NOT
LIMITED TO "NOTARY PUBLIC", "ACCREDITED REPRESENTATIVE OF THE DEPARTMENT
OF  HEALTH"  OR  "COMPACT CONSULTANT", THAT COULD CAUSE AN INDIVIDUAL TO
BELIEVE THAT THE PERSON POSSESSES  SPECIAL  PROFESSIONAL  SKILLS  OR  IS
AUTHORIZED TO PROVIDE ADVICE ON MATTERS RELATED TO THE COMPACT; PROVIDED
THAT  A  NOTARY  PUBLIC  LICENSED  BY THE SECRETARY OF STATE MAY USE THE
TITLE "NOTARY PUBLIC".
  3. STATE OR IMPLY THAT THE PERSON CAN OR WILL  OBTAIN  SPECIAL  FAVORS
FROM  OR HAS SPECIAL INFLUENCE WITH THE DEPARTMENT OF HEALTH, THE ADMIN-
ISTRATIVE ENTITY OR ANY OTHER GOVERNMENTAL ENTITY.
  4. DEMAND  OR  RETAIN  ANY  FEES  OR  COMPENSATION  FOR  SERVICES  NOT
PERFORMED OR COSTS THAT ARE NOT ACTUALLY INCURRED.
  5.  ADVISE,  DIRECT  OR  PERMIT  A  CUSTOMER  TO ANSWER QUESTIONS ON A
GOVERNMENT DOCUMENT, OR IN A DISCUSSION WITH A GOVERNMENT OFFICIAL, IN A
SPECIFIC WAY WHERE SUCH PERSON KNOWS OR HAS REASONABLE CAUSE TO  BELIEVE
THAT THE ANSWERS ARE FALSE OR MISLEADING.
  6.  DISCLOSE  ANY  INFORMATION TO, OR FILE ANY FORMS OR DOCUMENTS WITH
THE DEPARTMENT OF HEALTH, ANY OTHER STATE DEPARTMENT OR THE  ADMINISTRA-
TIVE ENTITY WITHOUT THE KNOWLEDGE OR CONSENT OF THE CUSTOMER.
  7. FAIL TO PROVIDE AN INDIVIDUAL WITH COPIES OF DOCUMENTS FILED WITH A
GOVERNMENTAL  ENTITY OR REFUSE TO RETURN ORIGINAL DOCUMENTS SUPPLIED BY,
PREPARED ON BEHALF OF OR PAID FOR BY THE INDIVIDUAL, UPON THE REQUEST OF
THE INDIVIDUAL.  ORIGINAL  DOCUMENTS  MUST  BE  RETURNED  PROMPTLY  UPON
REQUEST, EVEN IF THERE IS A FEE DISPUTE WITH THE INDIVIDUAL.
  8.  MAKE  ANY  MISREPRESENTATION OR FALSE STATEMENT, DIRECTLY OR INDI-
RECTLY.
  9. MAKE ANY GUARANTEE OR PROMISE TO AN INDIVIDUAL, UNLESS THERE  IS  A
BASIS  IN  FACT FOR SUCH REPRESENTATION, AND THE GUARANTEE OR PROMISE IS
IN WRITING.
  S 271. FRAUDULENT PRACTICES. 1. ANY APPLICANT  WHO  IS  FOUND  BY  THE
COMMISSIONER, AFTER NOTICE AND A HEARING, TO HAVE KNOWINGLY MADE A FALSE
STATEMENT OR REPRESENTATION CONCERNING A FACT MATERIAL TO THE FULFILLING
OF  A  PLEDGE  AMOUNT,  AS  PROVIDED  IN  THIS  ARTICLE, OR DELIBERATELY
CONCEALED SUCH A FACT, SHALL BE DISQUALIFIED FROM  THE  COMPACT  PROGRAM
PROVIDED  FOR IN THIS ARTICLE. SUCH INDIVIDUAL SHALL NOT BE DEEMED TO BE
A PARTICIPANT OR BENEFICIARY OR TO HAVE  FULFILLED  HIS  OR  HER  PLEDGE
AMOUNT,  BUT  SHALL  NOT  SURRENDER  HIS OR HER ELIGIBILITY TO APPLY FOR
MEDICAID.
  2. NO PERSON SHALL KNOWINGLY MAKE A FALSE STATEMENT OR  REPRESENTATION
OF  A  MATERIAL FACT, OR DELIBERATELY CONCEAL A MATERIAL FACT, OR OTHER-
WISE SEEK BENEFITS BY IMPERSONATION OR OTHER FRAUDULENT DEVICE, IN THEIR
WRITTEN APPLICATION FOR BENEFITS UNDER THIS TITLE.
  3. NO PERSON SHALL, WITH INTENT TO DEFRAUD, PRESENT FOR  ALLOWANCE  OR
PAYMENT  ANY  FRAUDULENT  CLAIM  FOR  FURNISHING SERVICES OR MERCHANDISE
UNDER THIS TITLE, OR KNOWINGLY SUBMIT FALSE INFORMATION FOR THE  PURPOSE
OF  OBTAINING GREATER COMPENSATION THAN THAT TO WHICH SUCH INDIVIDUAL IS
LEGALLY ENTITLED FOR  FURNISHING  SERVICES  OR  MERCHANDISE  UNDER  THIS
TITLE,  OR KNOWINGLY SUBMIT FALSE INFORMATION FOR THE PURPOSE OF OBTAIN-
ING AUTHORIZATION FOR FURNISHING  SERVICES  OR  MERCHANDISE  UNDER  THIS
TITLE.

S. 2185                            11

  4.  ANY  PERSON  WHO  RECEIVES A BENEFIT PROVIDED FOR UNDER THIS TITLE
BASED UPON AN APPLICATION WHICH VIOLATES SUBDIVISION  TWO  OR  THREE  OF
THIS  SECTION  SHALL  BE GUILTY OF A CLASS A MISDEMEANOR. SUCH A FINDING
SHALL NOT PREVENT AN ACTION TO RECOVER THE VALUE OF THE BENEFIT PROVIDED
FOR  UNDER THIS TITLE AGAINST THE INDIVIDUAL FOUND TO HAVE VIOLATED THIS
SECTION.
  S 271-A. PAYMENTS AND DEFAULTS. 1. PAYMENTS TO SERVICE  PROVIDERS  FOR
SERVICES  PROVIDED  TO  PARTICIPANTS  SHALL  BE  MADE BY OR ON BEHALF OF
PARTICIPANTS OR A PERSON OR ENTITY ACTING ON BEHALF OF THE PARTICIPANT.
  2. PAYMENTS TO SERVICE PROVIDERS FOR SERVICES  PROVIDED  TO  BENEFICI-
ARIES  SHALL  BE  MADE  BY  THE PROGRAM MANAGEMENT ENTITY. A BENEFICIARY
SHALL BE RESPONSIBLE TO PAY ANY DIFFERENCE BETWEEN THE COMPACT RATE  AND
THE  COMPACT  SUBSIDY  TO  THE  PROGRAM  MANAGEMENT  ENTITY. PAYMENTS TO
SERVICES PROVIDERS SHALL BE MADE NO LESS  FREQUENTLY  THAN  PAYMENTS  TO
PROVIDERS  BY  MEDICAID PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN OF
THE SOCIAL SERVICES LAW.
  3. A BENEFICIARY WHO KNOWINGLY FAILS TO PAY THE DIFFERENCE BETWEEN THE
COMPACT RATE AND THE COMPACT SUBSIDY AS REQUIRED IN THIS  TITLE,  UNLESS
SUCH  BENEFICIARY IS EXCUSED PURSUANT TO THE HARDSHIP PROVISIONS OF THIS
TITLE, SHALL BE LIABLE TO THE PROGRAM MANAGEMENT ENTITY, WHICH MAY EXER-
CISE ANY AND ALL APPROPRIATE REMEDIES FOR COLLECTION OF  THE  DEBT.    A
DEBT  UNPAID  FOR  A  PERIOD OF NINETY DAYS, EXCEPT IN THE CASE IN WHICH
HARDSHIP HAS BEEN DETERMINED, SHALL RESULT  IN  SUCH  BENEFICIARY  BEING
DECLARED IN DEFAULT AND NO LONGER ENROLLED IN THE COMPACT.
  4. A PARTICIPANT WHO HAS FULFILLED HIS OR HER PLEDGE SHALL BE PRESUMED
ELIGIBLE TO RECEIVE SERVICES AS A BENEFICIARY FOR A PERIOD OF SIXTY DAYS
FROM  THE  DATE  OF  DETERMINATION.  IF  A  PARTICIPANT DETERMINED TO BE
PRESUMPTIVELY ELIGIBLE TO RECEIVE THE COMPACT SUBSIDY AS  A  BENEFICIARY
IS  SUBSEQUENTLY  DETERMINED  TO  BE INELIGIBLE FOR SUCH ASSISTANCE, THE
COMMISSIONER MAY RECOUP FROM  SUCH  INDIVIDUAL  ANY  SUMS  EXPENDED  FOR
ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
  5. A PARTICIPANT WHO KNOWINGLY DEFAULTS ON PAYMENT OF THE PLEDGE, OR A
BENEFICIARY  WHO KNOWINGLY DEFAULTS ON PAYMENT OF THE DIFFERENCE BETWEEN
THE COMPACT RATE AND THE COMPACT SUBSIDY, AND WHO IS THEREFORE NO LONGER
ENROLLED IN THE PROGRAM, SHALL NOT BE ELIGIBLE TO RECEIVE PROTECTION  OF
ASSETS  OR  INCOME  OTHERWISE AFFORDED TO PARTICIPANTS AND BENEFICIARIES
UNDER THE COMPACT. NOTHING CONTAINED IN THIS TITLE SHALL  BE  DEEMED  TO
SHIELD  OR  OTHERWISE EXCUSE A BENEFICIARY OR A PARTICIPANT FROM PAYMENT
OF A DEBT LAWFULLY INCURRED TO A SERVICE PROVIDER.
  6. UPON RECOMMENDATION OF THE ADVISORY COMMITTEE, THE COMMISSIONER MAY
ESTABLISH RULES, INCLUDING REQUIREMENTS FOR WRITTEN AGREEMENTS,  GOVERN-
ING THE PAYMENT AND COLLECTION OF DEBT BY PARTICIPANTS AND BENEFICIARIES
TO  SERVICE  PROVIDERS  AND  TO THE PROGRAM MANAGEMENT ENTITY AS WELL AS
NOTIFICATION GUIDELINES TO THE BENEFICIARY, OR A PERSON OR ENTITY ACTING
ON BEHALF OF THE BENEFICIARY TO ENSURE THAT PAYMENTS MISSED IN ERROR CAN
BE CORRECTED WITHOUT PUNISHMENT TO THE BENEFICIARY.
  S 272. APPEALS. 1. ANY PERSON OR AN INDIVIDUAL AUTHORIZED  TO  ACT  ON
BEHALF  OF ANY SUCH PERSON MAY APPEAL TO THE COMMISSIONER FROM DECISIONS
OF THE PROGRAM MANAGEMENT ENTITY UPON GROUNDS SPECIFIED IN THIS SECTION.
ANY APPEAL PURSUANT TO THIS SECTION SHALL BE REQUESTED WITHIN SIXTY DAYS
AFTER THE DATE OF THE ACTION OR FAILURE TO ACT COMPLAINED OF.
  2. THE COMMISSIONER SHALL SPECIFY THE GROUNDS AND THE FORUM  FOR  SUCH
APPEALS IN REGULATIONS.
  (A)  SUCH  GROUNDS  AND FORUMS SHALL INCLUDE PROVISION OF FAIR HEARING
FOR THE FOLLOWING AND SIMILAR ISSUES: (I) COMPUTATION OF  THE  VALUE  OF
ASSETS  OR  INCOME;  (II)  WHETHER  EXPENSES  ARE  ELIGIBLE EXPENSES FOR

S. 2185                            12

PAYMENT OF THE PLEDGE, AND  WHETHER  THE  PLEDGE  WAS  FULFILLED;  (III)
AMOUNT  OF  PARTICIPATION  FEE  OR  CO-PAY; (IV) DENIAL OF PAYMENT FOR A
SERVICE PROVIDED TO A BENEFICIARY.
  (B)  SUCH  GROUNDS  AND  FORUMS SHALL ALSO INCLUDE PROVISION FOR THIRD
PARTY REVIEW AND ARBITRATION FOR SUCH ISSUES AS: (I) THE ASSESSMENT  AND
PLAN  OF CARE; (II) PAYMENTS TO PROVIDERS; AND (III) QUALITY OF PROVIDER
SERVICES.
  3. DECISIONS OF THE COMMISSIONER PURSUANT TO  THIS  SECTION  SHALL  BE
BINDING  UPON  THE  PROGRAM  MANAGEMENT  ENTITY. SUCH GROUNDS FOR APPEAL
SHALL NOT INCLUDE DENIALS FOR ISSUES AND CIRCUMSTANCES  RELATED  TO  THE
LANGUAGE,  PROCESSING  OR  APPROVAL  OF  COVERAGE UNDER A LONG TERM CARE
INSURANCE POLICY WHICH ARE OTHERWISE THE SUBJECT OF EXTERNAL APPEALS  OF
ADVERSE  DETERMINATIONS  OF  HEALTH  CARE PLANS PURSUANT TO SECTIONS TWO
HUNDRED ONE, THREE HUNDRED ONE, ELEVEN HUNDRED NINE, THIRTY-TWO  HUNDRED
ONE,   THIRTY-TWO   HUNDRED   SIXTEEN,   THIRTY-TWO  HUNDRED  SEVENTEEN,
THIRTY-TWO HUNDRED SEVENTEEN-A, THIRTY-TWO HUNDRED TWENTY-ONE, FORTY-TWO
HUNDRED THIRTY-FIVE,  FORTY-THREE  HUNDRED  THREE,  FORTY-THREE  HUNDRED
FOUR,   FORTY-THREE   HUNDRED   FIVE,  FORTY-THREE  HUNDRED  TWENTY-ONE,
FORTY-THREE HUNDRED  TWENTY-TWO  AND  FORTY-THREE  HUNDRED  TWENTY-FOUR,
ARTICLE  FORTY-SEVEN  AND  ARTICLE  FORTY-NINE  OF THE INSURANCE LAW AND
CHAPTER FIVE HUNDRED EIGHTY-SIX OF THE LAWS OF NINETEEN HUNDRED  NINETY-
EIGHT.
  4. ANY AGGRIEVED PARTY TO AN APPEAL, OTHER THAN THE PROGRAM MANAGEMENT
ENTITY, MAY APPLY FOR REVIEW AS PROVIDED IN ARTICLE SEVENTY-EIGHT OF THE
CIVIL PRACTICE LAW AND RULES.
  S  273. TREATMENT OF ASSETS. 1. A PARTICIPANT'S HOMESTEAD SHALL NOT BE
DEEMED A COUNTABLE ASSET IF THE HOMESTEAD WAS PURCHASED MORE  THAN  FIVE
YEARS  PRIOR  TO THE DATE THAT AN INDIVIDUAL APPLIES TO BECOME A PARTIC-
IPANT IN THE COMPACT. A HOMESTEAD PURCHASED WITHIN FIVE  YEARS  OF  SUCH
DATE  SHALL  BE  DEEMED  A  COUNTABLE  ASSET, UNLESS SUCH HOMESTEAD IS A
REPLACEMENT FOR A HOMESTEAD SOLD WITHIN ONE YEAR PRIOR TO  THE  PURCHASE
DATE,  IN  WHICH CASE AN AMOUNT EQUAL TO THE DIFFERENCE BETWEEN THE SALE
PRICE OF THE OLD HOMESTEAD AND THE PURCHASE PRICE OF THE  NEW  HOMESTEAD
SHALL  BE DEEMED A COUNTABLE ASSET. AS USED IN THIS SECTION, "HOMESTEAD"
MEANS THE PRIMARY RESIDENCE OCCUPIED BY  A  BENEFICIARY  OR  PARTICIPANT
AND/OR  MEMBERS  OF  HIS  OR  HER FAMILY. FAMILY MEMBERS MAY INCLUDE THE
BENEFICIARY'S OR PARTICIPANT'S SPOUSE, MINOR CHILDREN,  CERTIFIED  BLIND
OR  CERTIFIED  DISABLED CHILDREN, A CARETAKER CHILD, AND OTHER DEPENDENT
RELATIVES.  HOMESTEAD SHALL BE DEEMED TO MEAN AND INCLUDE THE HOME, LAND
AND INTEGRAL PARTS SUCH AS GARAGES AND OUTBUILDINGS, AND MAY BE A CONDO-
MINIUM, COOPERATIVE APARTMENT OR MANUFACTURED HOME.  HOMESTEAD SHALL NOT
BE DEEMED TO MEAN AND INCLUDE VACATION  HOMES,  SUMMER  HOMES  OR  OTHER
PREMISES  NOT USED AS A PRIMARY RESIDENCE. THE FOREGOING TO THE CONTRARY
NOTWITHSTANDING, TO THE EXTENT THAT A HOMESTEAD PURCHASED MORE THAN FIVE
YEARS PRIOR TO THE DATE THAT AN INDIVIDUAL APPLIES TO BECOME  A  PARTIC-
IPANT  IN  THE COMPACT IS DEEMED A RESOURCE UNDER THE RULES OF THE PART-
NERSHIP FOR LONG-TERM CARE ESTABLISHED PURSUANT TO SECTION THREE HUNDRED
SIXTY-SEVEN-F OF THE SOCIAL SERVICES LAW, IT  SHALL  ALSO  BE  DEEMED  A
RESOURCE UNDER THE COMPACT.
  2.  ANY  OTHER  PROVISION  OF  ANY  OTHER  LAW OR OF THIS TITLE TO THE
CONTRARY NOTWITHSTANDING, THE COMMISSIONER, ACTING ON RECOMMENDATION  OF
THE  ADVISORY  COMMITTEE,  MAY EXEMPT CERTAIN INCOME AND RESOURCES OF AN
INDIVIDUAL AND OF THE INDIVIDUAL'S SPOUSE FROM INCLUSION AS A  COUNTABLE
ASSET.
  3.  (A)  WITH  RESPECT  TO  ANNUITIES, (I) THE PRINCIPAL AMOUNT OF ANY
ANNUITY SHALL BE DEEMED A COUNTABLE ASSET IF SUCH ANNUITY  IN  PERMANENT

S. 2185                            13

PAYOUT  STATUS WAS PURCHASED WITHIN FIVE YEARS OF THE DATE AN INDIVIDUAL
APPLIES TO BECOME  A  PARTICIPANT,  PROVIDED  HOWEVER  THAT  ANY  PAYOUT
AMOUNTS SHALL NOT BE TREATED AS INCOME FOR PURPOSES OF THE INCOME CALCU-
LATION;  (II)  THE PRINCIPAL AMOUNT OF ANY ANNUITY SHALL NOT BE DEEMED A
COUNTABLE ASSET IF A LEVEL PAYMENT SCHEDULE HAS BEEN IN FORCE FOR  THREE
YEARS  OR  MORE  PRIOR  TO  THE  DATE  AN INDIVIDUAL APPLIES TO BECOME A
PARTICIPANT, AND NEITHER THE INDIVIDUAL NOR  A  PERSON  ACTING  ON  SUCH
INDIVIDUAL'S  BEHALF  HAS  THE  ABILITY TO WITHDRAW AMOUNTS IN EXCESS OF
SCHEDULED PAYMENTS, PROVIDED HOWEVER  THAT  IN  SUCH  CASE,  ANY  PAYOUT
AMOUNTS  SHALL  BE  COUNTED  AS INCOME FOR PURPOSES OF THE INCOME CALCU-
LATION; AND (III) AN ANNUITY NOT IN PERMANENT  PAYOUT  STATUS  FOR  FIVE
YEARS PRIOR TO THE DATE AN INDIVIDUAL APPLIES TO BECOME A PARTICIPANT IN
THE COMPACT PROGRAM SHALL BE DEEMED A COUNTABLE ASSET.
  (B)  THE  VALUE  OF AN ASSET TRANSFERRED INTO AN IRREVOCABLE TRUST FOR
LESS THAN FULL CONSIDERATION WITHIN FIVE YEARS  PRIOR  TO  THE  DATE  OF
APPLICATION TO THE COMPACT PROGRAM SHALL BE DEEMED A COUNTABLE ASSET.
  (C)  PRE-PAID  FUNERALS  PURCHASED  FOR  AN  INDIVIDUAL  WHO BECOMES A
PARTICIPANT OR A BENEFICIARY, A SPOUSE OR FOR CHILDREN WITH DISABILITIES
SHALL NOT BE INCLUDED AS A COUNTABLE ASSET, IF MADE PRIOR TO THE DATE ON
WHICH THE PARTICIPANT FULFILLS THE PLEDGE AMOUNT.
  (D) THE VALUE OF ANY DEBTS, INCLUDING BUT NOT LIMITED  TO  OUTSTANDING
DEBT  ON  CREDIT  CARDS,  AUTO PAYMENTS, MONTHLY MORTGAGE PAYMENTS, HOME
EQUITY LOANS, REVERSE MORTGAGES AND ANY OTHER SUCH SIMILAR DEBT  INSTRU-
MENTS  SHALL  BE  DEDUCTED WHEN CALCULATING THE TOTAL VALUE OF COUNTABLE
ASSETS.
  (E) THE PRINCIPAL AMOUNT OF A MORTGAGE ON A  HOMESTEAD  SHALL  NOT  BE
DEDUCTED  IF  THE  HOMESTEAD  IS  NOT DEEMED A COUNTABLE ASSET, PROVIDED
HOWEVER THAT PAYMENTS MADE TO REDUCE  OR  ELIMINATE  ANY  SUCH  MORTGAGE
SHALL  BE DEDUCTED WHEN CALCULATING THE TOTAL VALUE OF COUNTABLE ASSETS.
IF THE HOMESTEAD IS DEEMED A COUNTABLE ASSET, THE  PRINCIPAL  AMOUNT  OF
THE  MORTGAGE  SHALL  BE  DEDUCTED  WHEN  CALCULATING THE TOTAL VALUE OF
COUNTABLE ASSETS.
  (F) IN ADDITION TO THE FOREGOING, THE FOLLOWING SHALL NOT  BE  CONSID-
ERED AS INCOME OR ASSETS:
  (I)  ANY GIFT OR GIFTS MADE BY AN INDIVIDUAL OR AN INDIVIDUAL'S SPOUSE
THAT TOTAL LESS THAN TWELVE THOUSAND DOLLARS IN ANY CALENDAR  YEAR.  THE
COMMISSIONER SHALL ANNUALLY ADJUST SUCH AMOUNT BY THE SAME PERCENTAGE AS
THE PERCENTAGE INCREASE IN THE FEDERAL CONSUMER PRICE INDEX;
  (II) EXPENDITURES TO AN EDUCATIONAL INSTITUTION OR MEDICAL FACILITY ON
BEHALF  OF  A  SPOUSE  OR  CHILD,  PROVIDED  HOWEVER THAT THESE SHALL BE
REASONABLE EXPENDITURES FOR THE PURPOSE OF MEDICAL TREATMENT  OR  EDUCA-
TION;
  (III) GIFTS THAT QUALIFY AS A CHARITABLE DEDUCTION ON THE INDIVIDUAL'S
FEDERAL INCOME TAX RETURN; AND
  (IV)  THE  AMOUNT  RECEIVED FROM A REVERSE MORTGAGE IF EXPENDED WITHIN
THIRTY DAYS OF THE TIME IN WHICH RECEIVED.  AN  AMOUNT  FROM  A  REVERSE
MORTGAGE  THAT  IS  HELD FOR LONGER THAN SUCH THIRTY DAY PERIOD SHALL BE
CONSIDERED AS COUNTABLE INCOME, UNLESS USED FOR  THE  PURCHASE  OF  LONG
TERM CARE SERVICES AS DEFINED IN THIS TITLE.
  (G)  THE  COMMISSIONER,  AFTER CONSULTING WITH THE ADVISORY COMMITTEE,
SHALL ESTABLISH CRITERIA TO DETERMINE  WHETHER  EXPENDITURES  AND  GIFTS
MADE PURSUANT TO THIS SUBDIVISION ARE DISALLOWABLE TRANSACTIONS.
  S  274.  SPECIAL  PROVISIONS REGARDING COUPLES. 1. THE REQUIREMENTS OF
THIS TITLE CONCERNING DISCLOSURE OF ASSETS SHALL BE DEEMED TO  MEAN  AND
INCLUDE  DISCLOSURE  OF  ALL  ASSETS,  INCLUDING ALL ASSETS OF A MARRIED
COUPLE, WITHOUT DISTINCTION AS  TO  OWNERSHIP  BY  OR  BETWEEN  SPOUSES.

S. 2185                            14

NOTWITHSTANDING  THE FOREGOING, IF THERE IS A PRE OR POST-NUPTIAL AGREE-
MENT WHICH HAS BEEN EFFECTIVE THREE OR MORE YEARS PRIOR TO THE  DATE  OF
ENROLLMENT IN THE COMPACT PROGRAM, THE VALUE OF THE ASSETS OF THE SPOUSE
NOT  ENROLLED  IN  THE COMPACT SHALL NOT BE DEEMED A COUNTABLE ASSET AND
SHALL NOT REQUIRE DISCLOSURE TO THE COMMISSIONER OR  PROGRAM  MANAGEMENT
ENTITY.
  2.  IF  ONE  SPOUSE  ENROLLS IN THE COMPACT PROGRAM AND THE OTHER DOES
NOT, AND
  (A) THE ENROLLING SPOUSE BECOMES A BENEFICIARY AFTER MEETING THE MAXI-
MUM PLEDGE AMOUNT, THE COUPLE'S ASSETS SHALL BE  EXEMPT  FROM  CONSIDER-
ATION AS A COUNTABLE ASSET.
  (B)  THE  ENROLLING  SPOUSE  BECOMES  A  PARTICIPANT PLEDGING A DOLLAR
PLEDGE AMOUNT, ONE-HALF OF THE TOTAL VALUE OF THE COUPLE'S ASSETS  SHALL
BE  EXCLUDED  FROM  CONSIDERATION  AS A COUNTABLE ASSET BEFORE ANY OTHER
CALCULATIONS AS TO THE AMOUNT REQUIRED TO MEET A DOLLAR PLEDGE AMOUNT.
  (C) THE NON-ENROLLING SPOUSE SUBSEQUENTLY APPLIES TO BECOME A  PARTIC-
IPANT  IN  THE  COMPACT,  SUCH  INDIVIDUAL MAY PLEDGE EITHER THE MAXIMUM
PLEDGE AMOUNT OR THE DOLLAR PLEDGE AMOUNT. FOR PURPOSES  OF  DETERMINING
THE  DOLLAR  PLEDGE  AMOUNT  IN  SUCH CASE, THE COUNTABLE ASSETS OF SUCH
INDIVIDUAL SHALL MEAN, BEFORE ANY OTHER CALCULATIONS AS  TO  THE  AMOUNT
REQUIRED  TO  MEET  A  DOLLAR  PLEDGE  AMOUNT,  AN AMOUNT EQUAL TO FIFTY
PERCENT OF THE REMAINING ASSETS OF THE  COUPLE  LESS  ANY  AMOUNT  STILL
REQUIRED TO MEET THE PLEDGE AMOUNT OF THE INITIAL ENROLLING SPOUSE.
  3.  A  TRANSFER OR BEQUEST OF A PROTECTED AMOUNT SHALL NOT BE DEEMED A
COUNTABLE ASSET OF THE NON-ENROLLING SPOUSE, NOR SHALL INCOME OR  GROWTH
ON  SUCH INCOME BE COUNTED IF SUCH INCOME WAS PART OF A PROTECTED AMOUNT
AND HAS BEEN KEPT IN A SEPARATE ACCOUNT. FOR PURPOSES OF THIS SECTION, A
PROTECTED AMOUNT IS THE AMOUNT REMAINING AFTER A PLEDGE HAS BEEN MET.
  4. A SURVIVING SPOUSE WHO APPLIES TO BECOME A PARTICIPANT, OR WHO IS A
PARTICIPANT OR BENEFICIARY IN THE COMPACT PROGRAM SHALL NOT BE  REQUIRED
TO  EXERCISE  A  RIGHT OF ELECTION UNDER SECTION 5-1.1-A OF THE ESTATES,
POWERS AND TRUSTS LAW.
  S 275. ADVISORY COMMITTEE. 1. THE COMMISSIONER SHALL CONVENE AN  ADVI-
SORY  COMMITTEE  TO THE COMPACT PROGRAM, CONSISTING OF ELEVEN PERSONS AS
FOLLOWS: TWO FROM THE ELDER LAW SECTION OF THE NEW YORK STATE BAR  ASSO-
CIATION  TO INCLUDE THE CHAIR OF SUCH SECTION OR A DESIGNEE APPOINTED BY
THE CHAIR WHO SHALL SERVE EX OFFICIO; TWO FROM STATEWIDE ADVOCACY GROUPS
PRIMARILY CONCERNED WITH SENIOR ISSUES; FOUR FROM PROVIDERS OF SERVICES,
INCLUDING TWO REPRESENTING INSTITUTIONAL PROVIDERS OF SERVICES  AND  TWO
REPRESENTING NON-INSTITUTIONAL PROVIDERS; TWO FROM INSURERS SELLING LONG
TERM CARE INSURANCE IN THE STATE WHO SHALL BE PERSONS WITH AT LEAST FIVE
YEARS EXPERIENCE IN THE DEVELOPMENT OF LONG TERM CARE INSURANCE PRODUCTS
AND  WHO  ARE OR WHO SHALL HAVE BEEN, SO FAR AS SHALL BE PRACTICABLE, IN
EXECUTIVE POSITIONS; AND ONE WITH AT LEAST FIVE YEARS ACTUARIAL  EXPERI-
ENCE  IN  LONG  TERM  CARE  INSURANCE  MATTERS. MEMBERS SHALL RECEIVE NO
COMPENSATION FOR THEIR SERVICES, BUT SHALL BE ALLOWED THEIR  ACTUAL  AND
NECESSARY EXPENSES INCURRED IN PERFORMANCE OF THEIR DUTIES HEREUNDER.
  2.  THE PURPOSE OF SUCH ADVISORY COMMITTEE SHALL BE TO PROVIDE ADVICE,
CONSULTATION AND  RECOMMENDATIONS  ON  SPECIFIC  ISSUES  CONCERNING  THE
COMPACT PROGRAM AND ON THE FURTHER DEVELOPMENT OF THE PROGRAM, INCLUDING
BUT  NOT  LIMITED  TO  SUCH ISSUES AS THE DEFINITION OF HARDSHIP AND THE
TREATMENT OF PERSONS EXPERIENCING HARDSHIP UNDER THE COMPACT, THE TREAT-
MENT OF ASSETS OF PERSONS WHO ARE LIVING SEPARATELY  BUT  NOT  DIVORCED,
LOSS  OF  INCOME  OR  ASSETS  AFTER A PARTICIPANT HAS AGREED TO A PLEDGE
AMOUNT, SPOUSAL PROTECTIONS, AND ANY OTHER ISSUES WHICH THE COMMISSIONER
OR THE ADVISORY COMMITTEE SHALL DEEM NECESSARY  OR  APPROPRIATE  TO  THE

S. 2185                            15

OPERATION  OF  THE  COMPACT.  THE  ADVISORY COMMITTEE SHALL ADDITIONALLY
CONSIDER ISSUES RELATED TO CONTINUITY  OF  CARE  BY  PROVIDERS  AND  ANY
ISSUES  RELATED  TO  SHIFTING OR FAILING TO PROVIDE SERVICES OR DROPPING
PARTICIPANTS FROM COVERAGE WHEN THEY BECOME BENEFICIARIES. IN PROMULGAT-
ING  REGULATIONS  PURSUANT TO THIS TITLE, THE COMMISSIONER SHALL CONSULT
THE ADVISORY COMMITTEE, PROVIDED HOWEVER THAT FAILURE TO RESPOND  TIMELY
BY  THE ADVISORY COMMITTEE SHALL NOT BE DEEMED A DEFECT IN THE PROMULGA-
TION OF SUCH REGULATIONS. THE ADVISORY COMMITTEE MAY REQUEST  AND  SHALL
RECEIVE  FROM  THE COMMISSIONER SUCH DATA AND ANALYSIS, OR MAY MAKE SUCH
ANALYSIS OF SUCH DATA, AS SHALL ENABLE IT TO FULFILL ITS MISSION  PURSU-
ANT TO THIS TITLE.
  3.  THE COMMITTEE SHALL ANNUALLY, OR MORE OFTEN IF THE COMMITTEE SHALL
SO DECIDE, REVIEW THE METHODOLOGY FOR SETTING THE AMOUNT OF THE  COMPACT
SUBSIDY  AND  SHALL  MAKE SUCH RECOMMENDATIONS FOR CHANGE TO THE COMMIS-
SIONER AS IT SHALL DEEM APPROPRIATE AND IN KEEPING WITH THE  SPIRIT  AND
INTENT OF THIS TITLE.
  4.  THE COMMITTEE SHALL ANNUALLY, OR MORE OFTEN IF THE COMMITTEE SHALL
SO DECIDE, REVIEW THE CONDUCT OF PROVIDERS OF  SERVICE  TO  PARTICIPANTS
AND  BENEFICIARIES  AND MAY RECOMMEND TO THE COMMISSIONER THE ESTABLISH-
MENT OF REQUIREMENTS CONCERNING SUCH CONDUCT TO PREVENT ABUSES.  IF  THE
COMMITTEE  SHALL  MAKE  SUCH  RECOMMENDATION, THE COMMISSIONER IS HEREBY
AUTHORIZED TO AND SHALL PRESCRIBE SUCH REQUIREMENTS BY  RULE  AND  REGU-
LATION.
  5.  IN  ADDITION  TO  THE  ADVISORY  COMMITTEE, THE COMMISSIONER AFTER
CONSULTATION WITH THE DIRECTOR SHALL ESTABLISH  A  TEN  MEMBER  CONSUMER
ISSUES  AND  INTEGRITY  COMMITTEE, WHOSE PURPOSE SHALL BE TO EXAMINE THE
IMPLEMENTATION AND EFFECTIVENESS OF THE COMPACT WITH RESPECT TO CONSUMER
ISSUES.  MEMBERS OF THE COMMITTEE SHALL INCLUDE PERSONS  WITH  DISABILI-
TIES,  SENIORS, ADVOCATES FOR PERSONS WITH DISABILITIES AND SENIORS, AND
INDIVIDUALS FROM THE ACADEMIC COMMUNITY WITH EXPERTISE IN LONG TERM CARE
POLICY, HEALTH POLICY AND SOCIAL POLICY.  THE  COMMITTEE  SHALL  ADDRESS
ISSUES  REFERRED TO IT BY THE COMMISSIONER OR BY THE ADVISORY COMMITTEE,
AND MAY ENGAGE IN STUDIES OF ISSUES AT ITS OWN DISCRETION.  THE  COMMIS-
SIONER  SHALL  DESIGNATE  A CHAIR FOR THE COMMITTEE. THE CONSUMER ISSUES
AND INTEGRITY COMMITTEE SHALL MEET IN A PUBLIC  SETTING  AT  LEAST  FOUR
TIMES  PER YEAR AND AT SUCH OTHER TIMES AS THE COMMISSIONER OR THE CHAIR
OF THE COMMITTEE SHALL DEEM APPROPRIATE.
  S 276. REQUIREMENT FOR CONFIDENTIALITY. EXCEPT AS  OTHERWISE  PROVIDED
IN  THIS  SECTION,  ALL  INFORMATION GATHERED FROM AN INDIVIDUAL SEEKING
ENROLLMENT IN THE  COMPACT  PROGRAM  SHALL  BE  CONFIDENTIAL,  WITH  THE
FOLLOWING EXCEPTIONS:
  1.  REQUESTS  FOR  INFORMATION  BASED UPON LEGITIMATE CRIMINAL JUSTICE
PURPOSES, AS SUCH TERM SHALL BE DEFINED IN REGULATION BY THE COMMISSION-
ER;
  2. JUDICIAL SUBPOENAS;
  3. REQUESTS FOR INFORMATION BY THE VICTIM OR CLAIMANT OR  HIS  OR  HER
AUTHORIZED REPRESENTATIVE; AND
  4.  FOR  PURPOSES  NECESSARY AND PROPER FOR THE ADMINISTRATION OF THIS
TITLE.
  ANY PERSON WHO KNOWINGLY AND INTENTIONALLY PERMITS THE RELEASE OF  ANY
SUCH DATA AND INFORMATION NOT PERMITTED BY THIS TITLE SHALL BE GUILTY OF
A CLASS A MISDEMEANOR. THE COMMISSIONER SHALL PROMULGATE RULES AND REGU-
LATIONS  INSURING  THE  TIMELINESS,  COMPLETENESS,  CONFIDENTIALITY  AND
DISPOSITION OF SUCH DATA AND INFORMATION.
  S 277. EDUCATION AND INFORMATION. THE PROGRAM  MANAGEMENT  ENTITY,  IN
CONSULTATION  WITH THE SUPERINTENDENT OF INSURANCE, THE DIRECTOR AND THE

S. 2185                            16

COMMISSIONER, IS HEREBY AUTHORIZED AND DIRECTED, WITHIN  AMOUNTS  APPRO-
PRIATED  THEREFOR  AND  OTHER  FUNDS  MADE  AVAILABLE  PURSUANT  TO THIS
SECTION, TO ESTABLISH AN EDUCATION AND OUTREACH PROGRAM  CONCERNING  THE
COMPACT  PROGRAM  OR  TO  COORDINATE SUCH EDUCATION AND OUTREACH PROGRAM
WITH ANY SIMILAR PUBLICLY SPONSORED PROGRAM FOR THE PURPOSE OF INFORMING
AND EDUCATING THE GENERAL PUBLIC OF THE AVAILABILITY AND  ADVANTAGES  OF
THE COMPACT PROGRAM BY MEANS INCLUDING BUT NOT LIMITED TO THE FOLLOWING:
EDUCATIONAL  AND  INFORMATIONAL MATERIALS IN PRINT, AUDIO, VISUAL, ELEC-
TRONIC OR OTHER MEDIA;  PUBLIC  SERVICE  ANNOUNCEMENTS,  ADVERTISEMENTS,
MEDIA CAMPAIGNS, WORKSHOPS, MASS MAILINGS, CONFERENCES OR PRESENTATIONS;
ESTABLISHMENT  OF  A TOLL-FREE TELEPHONE HOTLINE AND ELECTRONIC SERVICES
TO PROVIDE INFORMATION; AND MEETINGS CONDUCTED BY ARRANGEMENT  WITH  THE
COMMISSIONER  AND THE DIRECTOR WITH ESTATE PLANNERS, ELDER LAW ATTORNEYS
AND OTHER PROFESSIONALS CONCERNING LONG TERM CARE  INSURANCE,  INCLUDING
THOSE  POLICIES  AVAILABLE  THROUGH  THE  PARTNERSHIP FOR LONG TERM CARE
PROGRAM. IN EXERCISING  ANY  POWERS  UNDER  THIS  SECTION,  THE  PROGRAM
MANAGEMENT  ENTITY MAY CONSULT WITH APPROPRIATE AGENCIES, ORGANIZATIONS,
CONSUMERS AND PROVIDERS OF LONG TERM  CARE  INSURANCE  OR  ORGANIZATIONS
REPRESENTING  THEM. IN ADDITION TO STATE FUNDS APPROPRIATED FOR PROGRAMS
UNDER THIS SECTION, THE COMMISSIONER AND THE DIRECTOR MAY ACCEPT FUNDING
FROM PUBLIC SOURCES FOR PROGRAMS UNDER THIS SECTION  AND  MAY  UNDERTAKE
JOINT  OR  COOPERATIVE  PROGRAMS  WITH  OTHER PUBLIC AGENCIES OR PRIVATE
NOT-FOR-PROFIT CORPORATIONS WHICH ARE NEITHER PROVIDERS  NOR  REGULATORS
OF  LONG  TERM CARE INSURANCE OR AFFILIATES OR UNITS OF SUCH AGENCIES OR
CORPORATIONS.
  S 2. The insurance law is amended by adding a new  section  3229-a  to
read as follows:
  S  3229-A. LONG TERM CARE INSURANCE PLANS QUALIFYING TO PROVIDE COVER-
AGE UNDER THE NEW YORK STATE COMPACT  FOR  LONG  TERM  CARE.  ANY  OTHER
PROVISION  OF  ANY  OTHER  LAW  TO THE CONTRARY NOTWITHSTANDING, ANY TAX
QUALIFIED LONG TERM CARE INSURANCE PLANS MAY BE USED  TO  MAKE  PAYMENTS
FOR  SERVICES  PROVIDED  TO  ALLOW  PARTICIPANTS  TO MEET PLEDGE AMOUNTS
PURSUANT TO THE NEW YORK STATE COMPACT FOR LONG TERM CARE PROGRAM ESTAB-
LISHED PURSUANT TO TITLE FOUR OF ARTICLE  TWO  OF  THE  ELDER  LAW.  THE
SUPERINTENDENT  SHALL  ADDITIONALLY APPROVE INSURANCE PLANS THAT PROVIDE
OR INCLUDE TOTAL BENEFITS IN AN AMOUNT WHICH WILL ALLOW  THE  INDIVIDUAL
TO  MEET  THE  PARTICIPATION  FEE  AND  THE  CO-PAY  REQUIREMENTS OF THE
COMPACT. FOR PURPOSES OF THIS SECTION, THE TERM "TAX QUALIFIED" HAS  THE
SAME  MEANING  AS UNDER SECTION 7702B(B) OF THE INTERNAL REVENUE CODE OF
1986, AS AMENDED.
  S 3. Severability. If any clause, sentence, paragraph, section or part
of this act shall be adjudged by any court of competent jurisdiction  to
be  invalid,  such  judgment  shall not affect, impair or invalidate the
remainder thereof, but shall be confined in its operation to the clause,
sentence, paragraph, section or part thereof directly  involved  in  the
controversy in which such judgment shall have been rendered.
  S  4.  This  act shall take effect on the ninetieth day after it shall
have become a law.

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