senate Bill S5224B

2011-2012 Legislative Session

Relates to the ability of continuing care retirement communities to offer seniors additional service options

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Archive: Last Bill Status - Passed Senate


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 21, 2012 referred to health
delivered to assembly
passed senate
Jun 20, 2012 ordered to third reading cal.1408
committee discharged and committed to rules
Jun 18, 2012 print number 5224b
amend and recommit to health
Feb 07, 2012 print number 5224a
amend and recommit to health
Jan 04, 2012 referred to health
May 03, 2011 referred to health

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Bill Amendments

Original
A
B (Active)
Original
A
B (Active)

Co-Sponsors

S5224 - Bill Details

Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally

S5224 - Bill Texts

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Relates to the ability of continuing care retirement communities to offer seniors additional service options.

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BILL NUMBER:S5224

TITLE OF BILL:
An act
to amend the public health law, in relation to ability of
continuing care retirement communities to
offer seniors additional service options

PURPOSE OR GENERAL IDEA OF BILL: To allow continuing
care communities
to offer life care and life care at home programs to seniors.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 - amends
subdivisions 2-a,
2-b, 3, 8, 9, 10 and 10-a of section 4601 of the Public Health Law to
add life care and life care programs as options to be offered as part
of a continuing care retirement contract.

Section 2 - amends the opening paragraph of subdivision 2 of section
4602 of the Public Health Law to delete the requirement that a life
care contract mandate at least four council meetings per year.

Section 3 - amends subdivision 1 of section 4603-a of the Public
Health Law to change the name of "life care community council" to
"continuing care retirement community council."

Section 4 - amends paragraphs d and e and clause (C) of subparagraph
(iv) of paragraph j of subdivision 2 of section 4604 of the Public
Health Law to change language to reflect continuing care retirement
contracts and that clause (C) relates to facilities licensed by the
Department of Health rather than the Department of Social Services.

Section 5 - amends paragraph b of subdivision 4 and subdivisions 5 and
8 of section 4604 of the Public Health Law to provide oversight by
the Commissioner of Health rather than the Commissioner of Social
Services, and add life care at home services and amend language to
refer to continuing care retirement contracts.

Section 6 - amends paragraph g of subdivision 2 of section 4604-a of
the Public Health Law to reflect the option of life care at home
services.

Section 7 - amends paragraph d of subdivision 1 of section 4605 of the
Public Health Law to add continuing care retirement contracts.

Section 8 - amends the opening paragraph, paragraph d of subdivision
11 and subdivision 13 of section 4606 of the Public Health Law to
change language to "continuing care retirement contracts."

Section 9 - paragraphs e, f and g of subdivision 14 of section 4606 of
the Public Health Law are renumbered and a new paragraph e is added
to list the types of meal plans available.

Section 10 - amends section 4608 of the Public Health Law to include
life care, modified of life care at home contracts and limit certain
provisions to life care and modified contracts only, and set forth
certain requirements for life care at home contracts.


Section 11 - amends subdivision 1 of section 4612 of the Public Health
Law to recognize that some residents under this section may be living
at home.

Section 12 - amends subdivisions 1 and 2 of section 4614 of the Public
Health Law to reflect that the Commissioner of Health shall have
responsibility for oversight.

Section 13 - amends paragraph k of subdivision 1 of section 4615 of
the Public Health Law to reflect responsibility of the Commissioner
of Health.

Section 14 - amends the section heading of section 4623 of the Public
Health Law.

Section 15 - provides that this act shall take effect on the one
hundred eightieth day after it shall have become law, provided that
the Department of Health is authorized to immediately take such steps
as may be necessary to ensure implementation of this act

JUSTIFICATION: This bill would offer another option
for seniors --
life care at home. Existing CCRC campus providers may establish a
separate affiliated 501(c)3 corporation to offer various levels of
home care services as chosen by the contract holder, based upon the
needs of the seniors(s) in the home. This bill will expand the
continuum of services from limited services at home, through
increased services, and eventual residence, if needed, on a CCRC
campus. At home services can include, as necessary, personal health
coordination, emergency response system, health and wellness
programs, home nurse visits, companion services, home inspections,
transportation, meals, on-campus activities and cultural events.
Services are coordinated by a case manager. The program allows
planned continuity so seniors can know they will continue to receive
services over the years with the same provider as their needs change
and know they can remain at home as long as possible with such
services as they may require.

PRIOR LEGISLATIVE HISTORY: New bill

FISCAL IMPLICATIONS: May reduce costs to state if
seniors can remain
at home and not spend down their assets and seek Medicaid assistance

EFFECTIVE DATE:his act shall take effect on the one
hundred and
eightieth day after it shall have become law.

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

                                  5224

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced  by  Sen.  RANZENHOFER -- read twice and ordered printed, and
  when printed to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to ability of contin-
  uing care retirement communities to offer seniors  additional  service
  options

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

  Section 1. Subdivisions 2-a, 2-b, 3, 8, 9, 10 and 10-a of section 4601
of the public health law, subdivisions 2-a and 2-b as added and subdivi-
sions 3, 8 and 9 as amended by chapter 659 of the laws of 1997, subdivi-
sion 10 as added by chapter 689 of the laws of 1989, subdivision 10-a as
added and paragraph a of subdivision 2-b as amended by  chapter  401  of
the  laws  of 2003, are amended and two new subdivisions 7-a and 7-b are
added to read as follows:
  2-a.  "Continuing  care  retirement  contract"  shall  mean  a  single
contract  to provide a person the services provided by a continuing care
retirement community INCLUDING LIFE CARE OR LIFE CARE AT HOME.
  2-b. "Continuing care retirement community" or "community" shall  mean
a  facility  or facilities established to provide a comprehensive, cohe-
sive living arrangement for the elderly, oriented to the enhancement  of
the  quality  of life and which, pursuant to the terms of the continuing
care RETIREMENT contract OFFERED BY THE COMMUNITY, at a minimum:
  a. provides, OR SUPPORTS THROUGH LIFE CARE AT HOME, independent living
units, and [provides a] meal plan OPTIONS. The independent  living  unit
can be made available either through a non-equity arrangement or through
an  equity  arrangement  including,  but not limited to a cooperative or
condominium. For purposes of this article,  the  purchase  price  of  an
independent living unit in an equity arrangement, regardless of the form
of  the  purchase  agreement,  shall  not be considered an entry fee for
purposes of calculating reserve liabilities, but shall be considered  an
entry fee for escrow purposes;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11311-01-1

S. 5224                             2

  b.  provides  a  range  of health care and social services, subject to
such terms as may be included within the contract, which  shall  include
home  health care, nursing care, and at a minimum, sixty days of prepaid
services of an on-site or affiliated nursing facility;
  c.  provides  access  to  health  services as defined in the contract,
prescription drugs, and rehabilitation services; and
  d. nothing in this article shall eliminate the obligation of a contin-
uing care retirement community to provide at least sixty days of prepaid
nursing facility services  to  all  residents.  The  prepaid  days  must
include  the  first  sixty days of nursing facility services, whether or
not consecutive, not covered by Title XVIII of the federal social  secu-
rity act.
  3. "Contracts" or "agreements" shall mean LIFE CARE AT HOME OR contin-
uing care retirement contracts as defined in this article.
  7-A.  "LIFE CARE AT HOME" SHALL MEAN AN ESTABLISHED SEPARATE 501 (C) 3
CORPORATION AFFILIATED WITH THE EXISTING CCRC  CAMPUS  PROVIDER  THROUGH
WHICH  CONTRACT  HOLDERS  PAY AN ENTRANCE FEE AND A MONTHLY FEE, BOTH OF
WHICH WOULD CORRESPOND TO THE LEVEL OF SERVICE CHOSEN  BY  THE  CONTRACT
HOLDER.  A LIFE CARE AT HOME CONTRACT INCLUDES SERVICES COORDINATED BY A
CASE MANAGER BASED UPON INDIVIDUALS' NEEDS.  SERVICES  OFFERED  INCLUDE,
BUT ARE NOT LIMITED TO, PERSONAL HEALTH COORDINATION, EMERGENCY RESPONSE
SYSTEM,  HEALTH  AND  WELLNESS  PROGRAMS,  HOME  NURSE VISITS, COMPANION
SERVICES, HOME INSPECTIONS, TRANSPORTATION, MEALS, ON-CAMPUS  ACTIVITIES
AND  CULTURAL  EVENTS.  LIFE  CARE AT HOME SERVICES SHALL INCLUDE, BASED
UPON INDIVIDUAL CONTRACTS, SERVICES OF AN ON-SITE OR AFFILIATED  NURSING
FACILITY AND AN ON-SITE OR AFFILIATED ADULT CARE FACILITY.
  7-B.  "LIFE  CARE  AT  HOME  CONTRACT" SHALL MEAN A SINGLE CONTRACT TO
PROVIDE A PERSON, FOR THE DURATION OF SUCH PERSON'S LIFE, SUCH  SERVICES
SELECTED  BY  THE  INDIVIDUAL WHICH MAY INCLUDE SERVICES PROVIDED TO THE
INDIVIDUAL IN HIS OR HER RESIDENCE.
  8. "Life care contract" shall mean a single continuing care retirement
contract to provide a person, for the duration of  such  person's  life,
the services provided by the continuing care retirement community, which
services  shall  include  unlimited services of an on-site or affiliated
nursing facility AND UNLIMITED SERVICES  OF  AN  ON-SITE  OR  AFFILIATED
ADULT CARE FACILITY.  Such term also shall mean a single continuing care
retirement  contract  to  provide  a  person,  for  the duration of such
person's life, the services provided by the continuing  care  retirement
community  under  an  arrangement  in  which the costs of the residents'
unlimited nursing home or home health care  services  are  paid  for  in
whole  or  in  part by a long term care insurance policy approved by the
superintendent in accordance with applicable regulations or by long term
care insurance or medical assistance payments  in  accordance  with  the
partnership  for  long  term  care program pursuant to the provisions of
section three hundred sixty-seven-f of the social services law,  section
three  thousand two hundred twenty-nine of the insurance law and section
four thousand six hundred twenty-three of this chapter.
  9. "Life care" shall mean those services provided pursuant to a ["life
care contract"] "CONTINUING CARE RETIREMENT CONTRACT".
  10. "Living unit" shall mean an apartment,  room,  cottage,  or  other
area  within  a community set aside for the exclusive use of one or more
residents, OR THE CONTRACT HOLDER'S PRIVATE RESIDENCE.
  10-a. "Meal plan" shall mean an arrangement whereby the person  enter-
ing  into  the  continuing care retirement contract is provided with [no
fewer than five meals per month. Additional meals shall be available  on

S. 5224                             3

a fee-for-service basis] OPTIONS REGARDING THE INCLUSION OF MEALS WITHIN
THE CONTRACT.
  S  2.  The  opening  paragraph of subdivision 2 of section 4602 of the
public health law, as amended by chapter 659 of the  laws  of  1997,  is
amended to read as follows:
  The  council shall meet as often as may be deemed necessary to fulfill
its responsibilities[, but in no event less than four times  per  year].
The council shall have the following powers and duties:
  S  3.  Subdivision  1  of  section 4603-a of the public health law, as
added by chapter 393 of the laws of 1991, is amended to read as follows:
  1. The commissioner, upon approval of the [life care] CONTINUING  CARE
RETIREMENT community council and the public health council shall issue a
certificate  of  incorporation  of  up  to three residential health care
demonstration facilities. Notwithstanding any provision of article twen-
ty-eight of this chapter or any other provisions of law to the contrary,
the public health council may approve without regard to the  requirement
of public need as set forth in subdivision three of section twenty-eight
hundred  one-a of this chapter, a certificate of incorporation or appli-
cation for establishment of such facilities.
  S 4. Paragraphs d and e and clause (C) of subparagraph (iv)  of  para-
graph j of subdivision 2 of section 4604 of the public health law, para-
graph  d as added by chapter 689 of the laws of 1989 and paragraph e and
clause (C) of subparagraph (iv) of paragraph j as amended by chapter 659
of the laws of 1997, are amended to read as follows:
  d. a  copy  of  the  proposed  forms  of  CONTINUING  CARE  RETIREMENT
contracts to be entered into with residents of the community;
  e. complete details of any agreements with a licensed insurer, includ-
ing copies of proposed contracts, requiring the insurer to assume, whol-
ly  or  in  part,  the  cost of medical or health related services to be
provided  to  a  resident  pursuant  to  a  continuing  care  retirement
[contract] CONTRACTUAL AGREEMENT;
  (C)  is or was subject to a currently effective injunctive or restric-
tive order or federal or state administrative order relating to business
activity or health care as a result of an action  brought  by  a  public
agency or department, including, without limitation, actions affecting a
license to operate a hospital as defined by section twenty-eight hundred
one  of this chapter, or a facility required to be licensed or certified
by the department of [social services] HEALTH.  The statement shall  set
forth  the  court or agency, date of conviction or judgment, the penalty
imposed or damages assessed, or the  date,  nature  and  issuer  of  the
order;
  S  5. Paragraph b of subdivision 4 and subdivisions 5 and 8 of section
4604 of the public health law, paragraph b of subdivision 4  as  amended
by  chapter 659 of the laws of 1997, subdivision 5 as amended by chapter
700 of the laws of 2006 and subdivision 8 as added by chapter 689 of the
laws of 1989, are amended to read as follows:
  b. the commissioner [of social services] as to those  aspects  of  the
application relating to adult care facility beds, if any;
  5.  Up  to  two  thousand  residential  health  care facility beds, as
authorized herein, that may be approved as components of continuing care
retirement communities shall not be considered by the department and the
health systems agencies in the determination of public need for residen-
tial health care facility  services;  provided,  however,  that  if  the
community seeking to construct such beds does not provide A life care OR
LIFE CARE AT HOME CONTRACT to all residents, it must adequately make the

S. 5224                             4

assurances  required  by  subdivision  two  of section forty-six hundred
twenty-four of this article.
  8.  The  operator  shall  designate  and  make knowledgeable personnel
available to prospective residents to answer questions about any  infor-
mation contained in the disclosure statement or contract. The disclosure
statement  and  the CONTINUING CARE RETIREMENT contract shall each state
on the cover or top of the first page in bold  twelve  point  print  the
following "This matter involves a substantial financial investment and a
legally binding contract. In evaluating the disclosure statement and the
contract  prior  to  any  commitment, it is recommended that you consult
with an attorney and financial advisor of your choice, if you so  elect,
who can review these documents with you."
  S  6.  Paragraph  g  of  subdivision 2 of section 4604-a of the public
health law, as added by chapter 659 of the laws of 1997, is  amended  to
read as follows:
  g.  Unless  all  residents  have EITHER life care OR LIFE CARE AT HOME
contracts, the operator has adequately made the assurances  required  by
subdivision two of section forty-six hundred twenty-four of this article
and  has  agreed to fund the liability in the event that resident assets
are insufficient to pay for nursing facility services  for  a  one  year
period.
  S 7. Paragraph d of subdivision 1 of section 4605 of the public health
law,  as  amended by chapter 659 of the laws of 1997, is amended to read
as follows:
  d. to offer and execute CONTINUING CARE RETIREMENT contracts,  includ-
ing  the  collection  of  entrance fees and deposits pursuant to section
forty-six hundred eight of this article.
  S 8. The opening paragraph, paragraph d of subdivision 11 and subdivi-
sion 13 of section 4606 of the public health law, the opening  paragraph
as  amended  by chapter 120 of the laws of 1993, paragraph d of subdivi-
sion 11 as added by chapter 689 of the laws of 1989 and  subdivision  13
as  added  by  chapter  659  of the laws of 1997, are amended to read as
follows:
  Prior to the execution of a CONTINUING CARE  RETIREMENT  contract,  or
before  the  transfer  of  any  money,  other than a refundable priority
reservation fee or non-refundable priority reservation agreement  appli-
cation  fee,  to  an operator by or on behalf of a prospective resident,
whichever occurs first, the operator shall deliver to  the  person  with
whom  the contract is to be entered into or the person's legal represen-
tative the most recent annual statement as required by section forty-six
hundred seven of this article, and an initial disclosure statement which
contains the following:
  d. an estimate of any funds which are anticipated to be  necessary  to
fund  start-up  losses and to assure full performance of the obligations
of the operator  pursuant  to  [life  care]  CONTINUING  CARE  contracts
including, but not limited to, any reserves required pursuant to section
forty-six hundred eleven of this article;
  13.  The  initial  disclosure  statement  and marketing materials of a
continuing care retirement community must clearly include a  description
of  the  services  offered  as  part of its contract, including, but not
limited to, any limitations on nursing facility  services.  The  initial
disclosure  statement  and  marketing  materials  of  a  continuing care
retirement community which offers various types of contracts, which  may
include life care, MODIFIED AND LIFE CARE AT HOME contracts, must clear-
ly  differentiate  among  the  various  types  of contracts which it may
offer.

S. 5224                             5

  S 9. Paragraphs e, f and g of subdivision 14 of section  4606  of  the
public  health  law are relettered paragraphs f, g and h and a new para-
graph e is added to read as follows:
  E. THE TYPES OF MEAL PLANS AVAILABLE;
  S  10.  Section 4608 of the public health law, as added by chapter 689
of the laws of 1989, the section  heading,  the  opening  paragraph  and
subdivision  6  as amended and subdivision 17 as added by chapter 659 of
the laws of 1997, subdivision 2 as amended by chapter 120 of the laws of
1993 and subdivision 8 as amended by chapter 66 of the laws of 1994,  is
amended to read as follows:
  S 4608. Continuing care retirement contract.  A LIFE CARE, MODIFIED OR
LIFE  CARE AT HOME continuing care retirement contract shall contain all
of the following information in no less than twelve point  type  and  in
plain  language,  in  addition  to  any  other terms or matter as may be
required by regulations adopted by the council and issued by the  super-
intendent, EXCEPT WHEN SPECIFICALLY NOTED:
  1. The amount of all money transferred, including, but not limited to,
donations,  subscriptions, deposits, fees, and any other amounts paid or
payable by, or on behalf of, the resident or residents;
  2. A description of all services which are  to  be  furnished  by  the
operator,  a description of any fees in addition to the entrance fee and
periodic charges provided for in the contract, and the conditions  under
which  the  fees  may  be  adjusted, provided that an operator shall not
charge any non-refundable application fee to a prospective resident  who
has  paid  a  non-refundable  priority reservation agreement application
fee;
  3. The procedures of the community relating to a resident's failure to
pay the required monthly fees;
  4. A statement of the figures and terms  concerning  the  entry  of  a
spouse to the community and the consequences if the spouse does not meet
the requirements for entry;
  5.  A statement of the terms and conditions under which a contract may
be cancelled by the operator or by a resident and the  conditions  under
which  all  or  any  portion of the entrance fee will be refunded by the
operator,  including  the  mandatory  refund  provisions  set  forth  in
sections  forty-six hundred nine and forty-six hundred ten of this arti-
cle;
  6. a. [The] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY  THE  procedures
and conditions under which a resident may be transferred from his or her
living  unit  including  a  statement that, at the time of transfer, the
resident will be given the reasons for  the  transfer;  the  process  by
which  a  transfer  decision  is made; the persons with the authority to
make the decision to transfer; a description of any change in charges to
be paid by the resident for services not covered by the contract fees as
a result of the transfer; and a statement regarding the  disposition  of
and  the  right  to  return to the living unit in cases of temporary and
permanent transfers.
  b. [The] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY  THE  circumstances
under  which  a  living  unit  may be considered vacant and eligible for
transfer or resale to a new resident, either due to the permanent trans-
fer of a resident to the community's nursing or other specialized facil-
ity or due to the permanent transfer of a  resident  to  a  hospital  or
other facility outside of the community; provided, however, that nothing
therein  shall relieve a community from its obligations to provide or to
insure provision of all contractually  required  care  pursuant  to  the
terms  of  a  continuing care retirement contract.   Should a resident's

S. 5224                             6

chronic condition require placement in a more specialized  chronic  care
facility that provides services beyond those provided through the commu-
nity's  nursing facility, the liability of THE community pursuant to the
terms  of  a  continuing  care retirement contract shall be equal to the
current per diem rate of the nursing facility minus the pro rata  appor-
tionment  of  the resident's monthly fee for the period of care required
by the contract.   Nothing  herein  shall  obligate  a  continuing  care
retirement  community  which  does  not have a life care contract with a
resident to provide or pay for a level of nursing facility services  nor
for any duration beyond what is specifically described in its continuing
care  retirement  contract  with  that  resident. This section shall not
affect the  operator's  obligation  under  subdivision  two  of  section
forty-six hundred twenty-four of this article;
  7.  [A] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY A statement that, if
the resident dies prior to occupancy date or, through  illness,  injury,
or  incapacity  is precluded from becoming a resident under the terms of
the contract, the contract is automatically rescinded and  the  resident
or  his  or  her legal representative shall receive a full refund of all
moneys paid  to  the  facility,  except  for  those  costs  specifically
incurred by the facility at the request of the resident and set forth in
writing in a separate addendum, signed by the parties to the contract;
  8.  FOR  LIFE CARE AT HOME CONTRACTS THE CIRCUMSTANCES UNDER WHICH THE
CONTRACT HOLDER MAY MOVE INTO A CAMPUS INDEPENDENT LIVING UNIT;
  9. A statement of the conditions under which all or any portion of the
entrance fee will be released to the operator  before  the  living  unit
becomes available for occupancy, and a statement of the conditions under
which  all  or  any portion of that fee will be refunded in the event of
the death of the resident and/or spouse following occupancy of a  living
unit,  including  the  mandatory  refund provisions set forth in section
forty-six hundred nine of this article;
  [9.] 10. A statement of the advance notice to be  provided  the  resi-
dent,  of  not less than sixty days, of any change in fees or charges or
scope of care or services;
  [10.] 11. A statement that no act,  agreement,  or  statement  of  any
resident,  or  of an individual purchasing care for a resident under any
agreement to furnish care to the  resident,  shall  constitute  a  valid
waiver  of  any  provision  of this article or of any regulation enacted
pursuant thereto intended for the benefit or protection of the  resident
or the individual purchasing care for the resident;
  [11.  A] 12. FOR LIFE CARE AND MODIFIED CONTRACTS A description of the
reinstatement policies if a resident leaves the facility or the contract
is cancelled;
  [12.] 13. FOR LIFE CARE AT HOME CONTRACTS A DESCRIPTION OF POLICIES IF
THE CONTRACT IS CANCELLED.
  14. A statement that  internal  procedures  to  resolve  disputes  and
grievances have been established, and residents notified of them;
  [13.]  15. A statement of the grace period, if any, for the payment of
periodic fees without a penalty, and the extent of any penalty  for  the
late payment thereof;
  [14.] 16. A statement that: a. the resident shall, if eligible, enroll
in  medicare parts a and b or the equivalent and shall continue to main-
tain that coverage, together with medicare supplement coverage at  least
equivalent  in  benefits  to  those established by the superintendent as
minimum benefits for medicare supplement policies;
  b. if the resident fails to maintain medicare coverage and a  medicare
supplement  coverage,  or  is  ineligible for such coverage and fails to

S. 5224                             7

purchase the equivalent of such coverage, the community  shall  purchase
the  coverage or equivalent coverage on behalf and at the expense of the
resident and shall have the authority to require an appropriate  adjust-
ment in payments by the resident to the community;
  c.  if  the  community  cannot purchase medicare coverage and medicare
supplement coverage or the equivalent,  the  community  shall  have  the
authority  to  require  an  adjustment  in  monthly fees, subject to the
approval of the superintendent, to  fund  the  additional  risk  to  the
facility; and
  d. if the resident fails to purchase or maintain medicare coverage and
medicare  supplement  coverage  or the equivalent, and the community has
not purchased such coverage, the community will be responsible  for  any
expenses  which would have been covered by medicare and medicare supple-
ment coverage.  The community may add the amount of such expenses to the
resident's monthly fees.
  [15.] 17. A statement that any  amendment  to  the  contract  and  any
change  in fees or charges, other than those within the guidelines of an
approved rating system, must be approved by the superintendent of insur-
ance; and
  [16.] 18. A statement  that  property  shall  not  be  substituted  as
payment for either the entrance fee or monthly fee.
  [17.]  19. A statement whether the continuing care retirement contract
includes any ownership, beneficial or trust interest in  the  assets  of
the operator, the assets of the facility, or both. Assets shall include,
but  are  not limited to, property, trusts, reserves, interest and other
assets.
  S 11. Subdivision 1 of section 4612 of the public health law, as added
by chapter 689 of the laws of 1989, is amended to read as follows:
  1. Residents [living] in a community authorized by this article  shall
have  the right of self-organization, the right to be represented by one
or more individuals of their own choosing, and the right  to  engage  in
concerted  activities  for the purpose of keeping informed of the opera-
tion of the community in which they live.
  S 12. Subdivisions 1 and 2 of section 4614 of the public  health  law,
as  amended  by  chapter 659 of the laws of 1997, are amended to read as
follows:
  1. The commissioner, or designee; AND the superintendent, or designee;
[and, with regard to communities for  which  the  department  of  social
services  has  regulatory  responsibility,  the  commissioner  of social
services, or designee,] may at any time, and shall at least  once  every
three years, visit each community and examine the business of any appli-
cant  for  a  certificate  of  authority and any operator engaged in the
execution of continuing care retirement  contracts  or  engaged  in  the
performance  of  obligations under such contracts.  Routine examinations
may be conducted by having documents designated by and submitted to such
commissioners or superintendent, which shall include financial documents
and records conforming to commonly accepted  accounting  principles  and
practices.  The  final written report of each such examination conducted
by such commissioners or superintendent shall be filed with the  commis-
sioner  and, when so filed, shall constitute a public record.  A copy of
each report shall be provided to members of the continuing care  retire-
ment community council. Any operator being examined shall, upon request,
give  reasonable  and timely access to all of its records. The represen-
tative or examiner designated by the  commissioners  or  superintendent,
respectively,  may,  at  any  time,  examine the records and affairs and

S. 5224                             8

inspect the community's facilities, whether in connection with a  formal
examination or not.
  2.  Any  duly  authorized  officer,  employee,  or agent of the health
department, [social services department,] or insurance  department  may,
upon presentation of proper identification, have access to, and inspect,
any records maintained by the community relevant to the respective agen-
cy's  regulatory  authority,  with  or without advance notice, to secure
compliance with, or to prevent a violation of,  any  provision  of  this
article.
  S  13.  Paragraph  k  of  subdivision  1 of section 4615 of the public
health law, as amended by chapter 659 of the laws of 1997, is amended to
read as follows:
  k. The commissioner [or the commissioner of social services] has found
violations of applicable statutes, rules or regulations  which  threaten
to  affect  directly  the  health, safety, or welfare of a resident of a
continuing care retirement community.
  S 14. The section heading of section 4623 of the public health law, as
amended by chapter 659 of the laws  of  1997,  is  amended  to  read  as
follows:
  Long   term  care  insurance  [for]  AND  continuing  care  retirement
contracts.
  S 15. This act shall take effect on  the  one  hundred  eightieth  day
after  it  shall  have  become  a law; provided, however, that effective
immediately the department of health is authorized to take such steps in
advance of such effective date, including the addition, amendment and/or
repeal of any rule or regulation as may be necessary to ensure the time-
ly implementation of this act on such effective date.

Co-Sponsors

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S5224A - Bill Details

Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally

S5224A - Bill Texts

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Relates to the ability of continuing care retirement communities to offer seniors additional service options.

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BILL NUMBER:S5224A

TITLE OF BILL:
An act
to amend the public health law, in relation to ability of
continuing care retirement communities to
offer seniors additional service options

PURPOSE OR GENERAL IDEA OF BILL:
To allow continuing care communities
to offer life care and life care at home programs to seniors.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1 - amends subdivisions 2-a, 2-b, 3, 8, 9, 10 and 10-a,
and adds new subdivisions 7-A and 7-B of
section 4601 of the Public Health Law to add life care and life
care programs as options to be offered as part of a continuing care
retirement contract.

Section 2 - amends the opening paragraph of subdivision 2 of section
4602 of the Public Health Law to delete the requirement that a life
care contract mandate at least four council meetings per year.

Section 3 - amends subdivision 1 of section 4603-a of the Public
Health Law to change the name of "life care community council" to
"continuing care retirement community council."

Section 4 - amends paragraphs d and e and clause (C) of subparagraph
(iv) of paragraph j of subdivision 2 of section 4604 of the Public
Health Law to change language to reflect continuing care retirement
contracts and that clause (C) relates to facilities licensed by the
Department of Health rather than the Department of Social Services.

Section 5 - amends paragraph b of subdivision 4 and subdivisions 5 and
8 of section 4604 of the Public Health Law to provide oversight by
the Commissioner of Health rather than the Commissioner of Social
Services, and add life care at home services and amend language to
refer to continuing care retirement contracts.

Section 6 - amends paragraph g of subdivision 2 of section 4604-a of
the Public Health Law to reflect the option of life care at home
services.

Section 7 - amends paragraph d of subdivision 1 of section 4605 of the
Public Health Law to add continuing care retirement contracts.

Section 8 - amends the opening paragraph, paragraph d of subdivision
11 and subdivision 13 of section 4606 of the Public Health Law to
change language to "continuing care retirement contracts."

Section 9 - paragraphs e, f and g of subdivision 14 of section 4606 of
the Public Health Law are renumbered and a new paragraph e is added
to list the types of meal plans available.

Section 10 - amends section 4608 of the Public Health Law to include
life care, modified life care at home contracts and limit certain
provisions to life care and modified contracts only, and set forth
certain requirements for life care at home contracts.

Section 11 - amends subdivision 1 of section 4612 of the Public Health
Law to recognize that some residents under this section may be living
at home.

Section 12 - amends subdivisions 1 and 2 of section 4614 of the Public
Health Law to reflect that the Commissioner of Health shall have
responsibility for oversight.

Section 13 - amends paragraph k of subdivision 1 of section 4615 of
the Public Health Law to reflect responsibility of the Commissioner
of Health.

Section 14 - amends the section heading of section 4623 of the Public
Health Law.

Section 15 - provides that this act shall take effect on the one
hundred eightieth day after it shall have become law, provided that
the Department of Health is authorized to immediately take such steps
as may be necessary to ensure implementation of this act

JUSTIFICATION:
This bill would offer another option for seniors --life
care at home.
Existing CCRC campus providers may establish a separate affiliated
501(c)3 corporation to offer various levels of home care services as
chosen by the contract holder, based upon the needs of the seniors(s)
in the home. This bill will expand the continuum of services from
limited services at home, through increased services, and eventual
residence, if needed, on a CCRC campus. At home services can include,
as necessary, personal health coordination, emergency response
system, health and wellness programs, home nurse visits, companion
services, home inspections, transportation, meals, on-campus
activities and cultural events. Services are coordinated by a case
manager. The program allows planned continuity so seniors can know
they will continue to receive services over the years with the same
provider as their needs change and know they can remain at home as
long as possible with such services as they may require.

PRIOR LEGISLATIVE HISTORY:
2011 - S.5224/A.8405 -- HEALTH/Health

FISCAL IMPLICATIONS:

May reduce costs to state if seniors can remain
at home and not spend down their assets and seek Medicaid assistance.

EFFECTIVE DATE:
This act shall take effect on the one hundred and
eightieth day after it shall have become law.

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

                                 5224--A

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced  by  Sens. RANZENHOFER, DeFRANCISCO, LIBOUS -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health  --  recommitted  to the Committee on Health in accordance with
  Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the public health law, in relation to ability of contin-
  uing  care  retirement communities to offer seniors additional service
  options

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

  Section 1. Subdivisions 2-a, 2-b, 3, 8, 9, 10 and 10-a of section 4601
of the public health law, subdivision 2-a as added and subdivisions 3, 8
and  9 as amended by chapter 659 of the laws of 1997, subdivision 2-b as
amended by chapter 523 of the laws of 2011, subdivision 10 as  added  by
chapter  689 of the laws of 1989, and subdivision 10-a as added by chap-
ter 401 of the laws of 2003, are amended and two  new  subdivisions  7-a
and 7-b are added to read as follows:
  2-a.  "Continuing  care  retirement  contract"  shall  mean  a  single
contract to provide a person the services provided by a continuing  care
retirement community INCLUDING LIFE CARE OR LIFE CARE AT HOME.
  2-b.  "Continuing care retirement community" or "community" shall mean
a facility or facilities established to provide a  comprehensive,  cohe-
sive  living arrangement for the elderly, oriented to the enhancement of
the quality of life and which, pursuant to the terms of  the  continuing
care RETIREMENT contract OFFERED BY THE COMMUNITY, at a minimum:
  a. provides, OR SUPPORTS THROUGH LIFE CARE AT HOME, independent living
units,  and [provides a] meal plan OPTIONS.  The independent living unit
can be made available either through a non-equity arrangement or through
an equity arrangement including, but not limited  to  a  cooperative  or
condominium.  For  purposes  of  this  article, the purchase price of an
independent living unit in an equity arrangement, regardless of the form

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11311-02-2

S. 5224--A                          2

of the purchase agreement, shall not be  considered  an  entry  fee  for
purposes  of calculating reserve liabilities, but shall be considered an
entry fee for escrow purposes;
  b.  provides  a  range  of health care and social services, subject to
such terms as may be included within the contract, which  shall  include
adult  care  facility  services  of  an on-site or affiliated adult care
facility, and at a minimum, sixty days of prepaid services of an on-site
or affiliated nursing facility  for  residents  not  receiving  services
under a fee-for-service contract;
  c.  provides  access  to  health  services as defined in the contract,
prescription drugs, and rehabilitation services;
  d. nothing in this article shall eliminate the obligation of a contin-
uing care retirement community to provide at least sixty days of prepaid
nursing facility services to all residents, with the exception of  resi-
dents receiving services under the terms of a fee-for-service continuing
care  contract as defined in this section. The prepaid days must include
the first sixty days  of  nursing  facility  services,  whether  or  not
consecutive,  not  covered by Title XVIII of the federal social security
act; and
  e. communities established under this article  and  offering  fee-for-
service  continuing  care contracts must offer, along with such fee-for-
service continuing care contracts,  life  care  and/or  continuing  care
contracts as defined in subdivision eight-a of this section.
  3. "Contracts" or "agreements" shall mean LIFE CARE AT HOME OR contin-
uing care retirement contracts as defined in this article.
  7-A.  "LIFE CARE AT HOME" SHALL MEAN AN ESTABLISHED SEPARATE 501 (C) 3
CORPORATION AFFILIATED WITH THE EXISTING CCRC  CAMPUS  PROVIDER  THROUGH
WHICH  CONTRACT  HOLDERS  PAY AN ENTRANCE FEE AND A MONTHLY FEE, BOTH OF
WHICH WOULD CORRESPOND TO THE LEVEL OF SERVICE CHOSEN  BY  THE  CONTRACT
HOLDER.  A LIFE CARE AT HOME CONTRACT INCLUDES SERVICES COORDINATED BY A
CASE MANAGER BASED UPON INDIVIDUALS' NEEDS.  SERVICES  OFFERED  INCLUDE,
BUT ARE NOT LIMITED TO, PERSONAL HEALTH COORDINATION, EMERGENCY RESPONSE
SYSTEM,  HEALTH  AND  WELLNESS  PROGRAMS,  HOME  NURSE VISITS, COMPANION
SERVICES, HOME INSPECTIONS, TRANSPORTATION, MEALS, ON-CAMPUS  ACTIVITIES
AND  CULTURAL  EVENTS.  LIFE  CARE AT HOME SERVICES SHALL INCLUDE, BASED
UPON INDIVIDUAL CONTRACTS, SERVICES OF AN ON-SITE OR AFFILIATED  NURSING
FACILITY AND AN ON-SITE OR AFFILIATED ADULT CARE FACILITY.
  7-B.  "LIFE  CARE  AT  HOME  CONTRACT" SHALL MEAN A SINGLE CONTRACT TO
PROVIDE A PERSON, FOR THE DURATION OF SUCH PERSON'S LIFE, SUCH  SERVICES
SELECTED  BY  THE  INDIVIDUAL WHICH MAY INCLUDE SERVICES PROVIDED TO THE
INDIVIDUAL IN HIS OR HER RESIDENCE.
  8. "Life care contract" shall mean a single continuing care retirement
contract to provide a person, for the duration of  such  person's  life,
the services provided by the continuing care retirement community, which
services  shall  include  unlimited services of an on-site or affiliated
nursing facility AND UNLIMITED SERVICES  OF  AN  ON-SITE  OR  AFFILIATED
ADULT CARE FACILITY.  Such term also shall mean a single continuing care
retirement  contract  to  provide  a  person,  for  the duration of such
person's life, the services provided by the continuing  care  retirement
community  under  an  arrangement  in  which the costs of the residents'
unlimited nursing home or home health care  services  are  paid  for  in
whole  or  in  part by a long term care insurance policy approved by the
superintendent in accordance with applicable regulations or by long term
care insurance or medical assistance payments  in  accordance  with  the
partnership  for  long  term  care program pursuant to the provisions of
section three hundred sixty-seven-f of the social services law,  section

S. 5224--A                          3

three  thousand two hundred twenty-nine of the insurance law and section
four thousand six hundred twenty-three of this chapter.
  9. "Life care" shall mean those services provided pursuant to a ["life
care contract"] "CONTINUING CARE RETIREMENT CONTRACT".
  10.  "Living  unit"  shall  mean an apartment, room, cottage, or other
area within a community set aside for the exclusive use of one  or  more
residents, OR THE CONTRACT HOLDER'S PRIVATE RESIDENCE.
  10-a.  "Meal plan" shall mean an arrangement whereby the person enter-
ing into the continuing care retirement contract is  provided  with  [no
fewer  than five meals per month. Additional meals shall be available on
a fee-for-service basis] OPTIONS REGARDING THE INCLUSION OF MEALS WITHIN
THE CONTRACT.
  S 2. The opening paragraph of subdivision 2 of  section  4602  of  the
public  health  law,  as  amended by chapter 659 of the laws of 1997, is
amended to read as follows:
  The council shall meet as often as may be deemed necessary to  fulfill
its  responsibilities[,  but in no event less than four times per year].
The council shall have the following powers and duties:
  S 3. Subdivision 1 of section 4603-a of  the  public  health  law,  as
added by chapter 393 of the laws of 1991, is amended to read as follows:
  1.  The commissioner, upon approval of the [life care] CONTINUING CARE
RETIREMENT community council and the public health council shall issue a
certificate of incorporation of up  to  three  residential  health  care
demonstration facilities. Notwithstanding any provision of article twen-
ty-eight of this chapter or any other provisions of law to the contrary,
the  public health council may approve without regard to the requirement
of public need as set forth in subdivision three of section twenty-eight
hundred one-a of this chapter, a certificate of incorporation or  appli-
cation for establishment of such facilities.
  S  4.  Paragraphs d and e and clause (C) of subparagraph (iv) of para-
graph j of subdivision 2 of section 4604 of the public health law, para-
graph d as added by chapter 689 of the laws of 1989 and paragraph e  and
clause (C) of subparagraph (iv) of paragraph j as amended by chapter 659
of the laws of 1997, are amended to read as follows:
  d.  a  copy  of  the  proposed  forms  of  CONTINUING  CARE RETIREMENT
contracts to be entered into with residents of the community;
  e. complete details of any agreements with a licensed insurer, includ-
ing copies of proposed contracts, requiring the insurer to assume, whol-
ly or in part, the cost of medical or  health  related  services  to  be
provided  to  a  resident  pursuant  to  a  continuing  care  retirement
[contract] CONTRACTUAL AGREEMENT;
  (C) is or was subject to a currently effective injunctive or  restric-
tive order or federal or state administrative order relating to business
activity  or  health  care  as a result of an action brought by a public
agency or department, including, without limitation, actions affecting a
license to operate a hospital as defined by section twenty-eight hundred
one of this chapter, or a facility required to be licensed or  certified
by  the department of [social services] HEALTH.  The statement shall set
forth the court or agency, date of conviction or judgment,  the  penalty
imposed  or  damages  assessed,  or  the  date, nature and issuer of the
order;
  S 5. Paragraph b of subdivision 4 and subdivisions 5 and 8 of  section
4604  of  the public health law, paragraph b of subdivision 4 as amended
by chapter 659 of the laws of 1997, subdivision 5 as amended by  chapter
700 of the laws of 2006 and subdivision 8 as added by chapter 689 of the
laws of 1989, are amended to read as follows:

S. 5224--A                          4

  b.  the  commissioner  [of social services] as to those aspects of the
application relating to adult care facility beds, if any;
  5.  Up  to  two  thousand  residential  health  care facility beds, as
authorized herein, that may be approved as components of continuing care
retirement communities shall not be considered by the department and the
health systems agencies in the determination of public need for residen-
tial health care facility  services;  provided,  however,  that  if  the
community seeking to construct such beds does not provide A life care OR
LIFE CARE AT HOME CONTRACT to all residents, it must adequately make the
assurances  required  by  subdivision  two  of section forty-six hundred
twenty-four of this article.
  8. The operator  shall  designate  and  make  knowledgeable  personnel
available  to prospective residents to answer questions about any infor-
mation contained in the disclosure statement or contract. The disclosure
statement and the CONTINUING CARE RETIREMENT contract shall  each  state
on  the  cover  or  top of the first page in bold twelve point print the
following "This matter involves a substantial financial investment and a
legally binding contract. In evaluating the disclosure statement and the
contract prior to any commitment, it is  recommended  that  you  consult
with  an attorney and financial advisor of your choice, if you so elect,
who can review these documents with you."
  S 6. Paragraph g of subdivision 2 of  section  4604-a  of  the  public
health  law,  as added by chapter 659 of the laws of 1997, is amended to
read as follows:
  g. Unless all residents have EITHER life care OR  LIFE  CARE  AT  HOME
contracts,  the  operator has adequately made the assurances required by
subdivision two of section forty-six hundred twenty-four of this article
and has agreed to fund the liability in the event that  resident  assets
are  insufficient  to  pay  for nursing facility services for a one year
period.
  S 7. Paragraph d of subdivision 1 of section 4605 of the public health
law, as amended by chapter 659 of the laws of 1997, is amended  to  read
as follows:
  d.  to offer and execute CONTINUING CARE RETIREMENT contracts, includ-
ing the collection of entrance fees and  deposits  pursuant  to  section
forty-six hundred eight of this article.
  S 8. The opening paragraph, paragraph d of subdivision 11 and subdivi-
sion  13 of section 4606 of the public health law, the opening paragraph
as amended by chapter 120 of the laws of 1993, paragraph d  of  subdivi-
sion  11  as added by chapter 689 of the laws of 1989 and subdivision 13
as added by chapter 659 of the laws of 1997,  are  amended  to  read  as
follows:
  Prior  to  the  execution of a CONTINUING CARE RETIREMENT contract, or
before the transfer of any  money,  other  than  a  refundable  priority
reservation  fee or non-refundable priority reservation agreement appli-
cation fee, to an operator by or on behalf of  a  prospective  resident,
whichever  occurs  first,  the operator shall deliver to the person with
whom the contract is to be entered into or the person's legal  represen-
tative the most recent annual statement as required by section forty-six
hundred seven of this article, and an initial disclosure statement which
contains the following:
  d.  an  estimate of any funds which are anticipated to be necessary to
fund start-up losses and to assure full performance of  the  obligations
of  the  operator  pursuant  to  [life  care]  CONTINUING CARE contracts
including, but not limited to, any reserves required pursuant to section
forty-six hundred eleven of this article;

S. 5224--A                          5

  13. The initial disclosure statement  and  marketing  materials  of  a
continuing  care retirement community must clearly include a description
of the services offered as part of  its  contract,  including,  but  not
limited  to,  any  limitations on nursing facility services. The initial
disclosure  statement  and  marketing  materials  of  a  continuing care
retirement community which offers various types of contracts, which  may
include life care, MODIFIED AND LIFE CARE AT HOME contracts, must clear-
ly  differentiate  among  the  various  types  of contracts which it may
offer.
  S 9. Paragraphs e, f and g of subdivision 14 of section  4606  of  the
public  health  law are relettered paragraphs f, g and h and a new para-
graph e is added to read as follows:
  E. THE TYPES OF MEAL PLANS AVAILABLE;
  S 10. Section 4608 of the public health law, as added by  chapter  689
of  the  laws  of  1989,  the section heading, the opening paragraph and
subdivision 6 as amended and subdivision 17 as added by chapter  659  of
the laws of 1997, subdivision 2 as amended by chapter 120 of the laws of
1993,  subdivision  8  as  amended by chapter 66 of the laws of 1994 and
subdivision 15 as further amended by section 104 of part A of chapter 62
of the laws of 2011, is amended to read as follows:
  S 4608. Continuing care retirement contract.  A LIFE CARE, MODIFIED OR
LIFE CARE AT HOME continuing care retirement contract shall contain  all
of  the  following  information in no less than twelve point type and in
plain language, in addition to any other  terms  or  matter  as  may  be
required  by regulations adopted by the council and issued by the super-
intendent, EXCEPT WHEN SPECIFICALLY NOTED:
  1. The amount of all money transferred, including, but not limited to,
donations, subscriptions, deposits, fees, and any other amounts paid  or
payable by, or on behalf of, the resident or residents;
  2.  A  description  of  all  services which are to be furnished by the
operator, a description of any fees in addition to the entrance fee  and
periodic  charges provided for in the contract, and the conditions under
which the fees may be adjusted, provided  that  an  operator  shall  not
charge  any non-refundable application fee to a prospective resident who
has paid a non-refundable  priority  reservation  agreement  application
fee;
  3. The procedures of the community relating to a resident's failure to
pay the required monthly fees;
  4.  A  statement  of  the  figures and terms concerning the entry of a
spouse to the community and the consequences if the spouse does not meet
the requirements for entry;
  5. A statement of the terms and conditions under which a contract  may
be  cancelled  by the operator or by a resident and the conditions under
which all or any portion of the entrance fee will  be  refunded  by  the
operator,  including  the  mandatory  refund  provisions  set  forth  in
sections forty-six hundred nine and forty-six hundred ten of this  arti-
cle;
  6.  a.  [The] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY THE procedures
and conditions under which a resident may be transferred from his or her
living unit including a statement that, at the  time  of  transfer,  the
resident  will  be  given  the  reasons for the transfer; the process by
which a transfer decision is made; the persons  with  the  authority  to
make the decision to transfer; a description of any change in charges to
be paid by the resident for services not covered by the contract fees as
a  result  of the transfer; and a statement regarding the disposition of

S. 5224--A                          6

and the right to return to the living unit in  cases  of  temporary  and
permanent transfers.
  b.  [The]  FOR LIFE CARE AND MODIFIED CONTRACTS ONLY THE circumstances
under which a living unit may be  considered  vacant  and  eligible  for
transfer or resale to a new resident, either due to the permanent trans-
fer of a resident to the community's nursing or other specialized facil-
ity  or  due  to  the  permanent transfer of a resident to a hospital or
other facility outside of the community; provided, however, that nothing
therein shall relieve a community from its obligations to provide or  to
insure  provision  of  all  contractually  required care pursuant to the
terms of a continuing care retirement contract.    Should  a  resident's
chronic  condition  require placement in a more specialized chronic care
facility that provides services beyond those provided through the commu-
nity's nursing facility, the liability of THE community pursuant to  the
terms  of  a  continuing  care retirement contract shall be equal to the
current per diem rate of the nursing facility minus the pro rata  appor-
tionment  of  the resident's monthly fee for the period of care required
by the contract.   Nothing  herein  shall  obligate  a  continuing  care
retirement  community  which  does  not have a life care contract with a
resident to provide or pay for a level of nursing facility services  nor
for any duration beyond what is specifically described in its continuing
care  retirement  contract  with  that  resident. This section shall not
affect the  operator's  obligation  under  subdivision  two  of  section
forty-six hundred twenty-four of this article;
  7.  [A] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY A statement that, if
the resident dies prior to occupancy date or, through  illness,  injury,
or  incapacity  is precluded from becoming a resident under the terms of
the contract, the contract is automatically rescinded and  the  resident
or  his  or  her legal representative shall receive a full refund of all
moneys paid  to  the  facility,  except  for  those  costs  specifically
incurred by the facility at the request of the resident and set forth in
writing in a separate addendum, signed by the parties to the contract;
  8.  FOR  LIFE CARE AT HOME CONTRACTS THE CIRCUMSTANCES UNDER WHICH THE
CONTRACT HOLDER MAY MOVE INTO A CAMPUS INDEPENDENT LIVING UNIT;
  9. A statement of the conditions under which all or any portion of the
entrance fee will be released to the operator  before  the  living  unit
becomes available for occupancy, and a statement of the conditions under
which  all  or  any portion of that fee will be refunded in the event of
the death of the resident and/or spouse following occupancy of a  living
unit,  including  the  mandatory  refund provisions set forth in section
forty-six hundred nine of this article;
  [9.] 10. A statement of the advance notice to be  provided  the  resi-
dent,  of  not less than sixty days, of any change in fees or charges or
scope of care or services;
  [10.] 11. A statement that no act,  agreement,  or  statement  of  any
resident,  or  of an individual purchasing care for a resident under any
agreement to furnish care to the  resident,  shall  constitute  a  valid
waiver  of  any  provision  of this article or of any regulation enacted
pursuant thereto intended for the benefit or protection of the  resident
or the individual purchasing care for the resident;
  [11.  A] 12. FOR LIFE CARE AND MODIFIED CONTRACTS A description of the
reinstatement policies if a resident leaves the facility or the contract
is cancelled;
  [12.] 13. FOR LIFE CARE AT HOME CONTRACTS A DESCRIPTION OF POLICIES IF
THE CONTRACT IS CANCELLED.

S. 5224--A                          7

  14. A statement that  internal  procedures  to  resolve  disputes  and
grievances have been established, and residents notified of them;
  [13.]  15. A statement of the grace period, if any, for the payment of
periodic fees without a penalty, and the extent of any penalty  for  the
late payment thereof;
  [14.] 16. A statement that: a. the resident shall, if eligible, enroll
in  medicare parts a and b or the equivalent and shall continue to main-
tain that coverage, together with medicare supplement coverage at  least
equivalent  in  benefits  to  those established by the superintendent as
minimum benefits for medicare supplement policies;
  b. if the resident fails to maintain medicare coverage and a  medicare
supplement  coverage,  or  is  ineligible for such coverage and fails to
purchase the equivalent of such coverage, the community  shall  purchase
the  coverage or equivalent coverage on behalf and at the expense of the
resident and shall have the authority to require an appropriate  adjust-
ment in payments by the resident to the community;
  c.  if  the  community  cannot purchase medicare coverage and medicare
supplement coverage or the equivalent,  the  community  shall  have  the
authority  to  require  an  adjustment  in  monthly fees, subject to the
approval of the superintendent, to  fund  the  additional  risk  to  the
facility; and
  d. if the resident fails to purchase or maintain medicare coverage and
medicare  supplement  coverage  or the equivalent, and the community has
not purchased such coverage, the community will be responsible  for  any
expenses  which would have been covered by medicare and medicare supple-
ment coverage.  The community may add the amount of such expenses to the
resident's monthly fees.
  [15.] 17. A statement that any  amendment  to  the  contract  and  any
change  in fees or charges, other than those within the guidelines of an
approved rating system, must be approved by the superintendent of finan-
cial services; and
  [16.] 18. A statement  that  property  shall  not  be  substituted  as
payment for either the entrance fee or monthly fee.
  [17.]  19. A statement whether the continuing care retirement contract
includes any ownership, beneficial or trust interest in  the  assets  of
the operator, the assets of the facility, or both. Assets shall include,
but  are  not limited to, property, trusts, reserves, interest and other
assets.
  S 11. Subdivision 1 of section 4612 of the public health law, as added
by chapter 689 of the laws of 1989, is amended to read as follows:
  1. Residents [living] in a community authorized by this article  shall
have  the right of self-organization, the right to be represented by one
or more individuals of their own choosing, and the right  to  engage  in
concerted  activities  for the purpose of keeping informed of the opera-
tion of the community in which they live.
  S 12. Subdivisions 1 and 2 of section 4614 of the public  health  law,
as  amended  by  chapter  659  of  the laws of 1997 and subdivision 2 as
further amended by section 104 of part A of chapter 62 of  the  laws  of
2011, are amended to read as follows:
  1. The commissioner, or designee; AND the superintendent, or designee;
[and,  with  regard  to  communities  for which the department of social
services has  regulatory  responsibility,  the  commissioner  of  social
services,  or  designee,] may at any time, and shall at least once every
three years, visit each community and examine the business of any appli-
cant for a certificate of authority and  any  operator  engaged  in  the
execution  of  continuing  care  retirement  contracts or engaged in the

S. 5224--A                          8

performance of obligations under such contracts.   Routine  examinations
may be conducted by having documents designated by and submitted to such
commissioners or superintendent, which shall include financial documents
and  records  conforming  to commonly accepted accounting principles and
practices. The final written report of each such  examination  conducted
by  such commissioners or superintendent shall be filed with the commis-
sioner and, when so filed, shall constitute a public record.  A copy  of
each  report shall be provided to members of the continuing care retire-
ment community council. Any operator being examined shall, upon request,
give reasonable and timely access to all of its records.  The  represen-
tative  or  examiner  designated by the commissioners or superintendent,
respectively, may, at any time, examine  the  records  and  affairs  and
inspect  the community's facilities, whether in connection with a formal
examination or not.
  2. Any duly authorized officer,  employee,  or  agent  of  the  health
department,  [social  services  department,]  or department of financial
services may, upon presentation of proper  identification,  have  access
to, and inspect, any records maintained by the community relevant to the
respective  agency's  regulatory  authority,  with  or  without  advance
notice, to secure compliance with, or to prevent  a  violation  of,  any
provision of this article.
  S  13.  Paragraph  k  of  subdivision  1 of section 4615 of the public
health law, as amended by chapter 659 of the laws of 1997, is amended to
read as follows:
  k. The commissioner [or the commissioner of social services] has found
violations of applicable statutes, rules or regulations  which  threaten
to  affect  directly  the  health, safety, or welfare of a resident of a
continuing care retirement community.
  S 14. The section heading of section 4623 of the public health law, as
amended by chapter 659 of the laws  of  1997,  is  amended  to  read  as
follows:
  Long   term  care  insurance  [for]  AND  continuing  care  retirement
contracts.
  S 15. This act shall take effect on  the  one  hundred  eightieth  day
after  it  shall  have  become  a law; provided, however, that effective
immediately the department of health is authorized to take such steps in
advance of such effective date, including the addition, amendment and/or
repeal of any rule or regulation as may be necessary to ensure the time-
ly implementation of this act on such effective date.

Co-Sponsors

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S5224B (ACTIVE) - Bill Details

Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally

S5224B (ACTIVE) - Bill Texts

view summary

Relates to the ability of continuing care retirement communities to offer seniors additional service options.

view sponsor memo
BILL NUMBER:S5224B

TITLE OF BILL:
An act
to amend the public health law, in relation to ability of
continuing care retirement communities to
offer seniors additional service options

PURPOSE OR GENERAL IDEA OF BILL:
To allow continuing care communities
to offer life care and life care at home programs to seniors.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1- amends
subdivisions a, 2-b, 3, 8,9, 10 and 10-a, and adds new subdivisions
7-A, 7-B and 7-C of
section 4601 of the Public Health Law to add life care and life care
programs as options to be offered as part of a continuing care
retirement contract.

Section 2 - amends the opening paragraph of subdivision 2 of section
4602 of the Public Health Law to delete the requirement that a life
care contract mandate at least four council meetings per year.

Section 3 - amends subdivision 1 of section 4603-a of the Public
Health Law to change the name of "life care community council" to
"continuing care retirement community council."

Section 4 - amends paragraphs d and e and clause (C) of subparagraph
(iv) of par graph j of subdivision 2 of section 4604 of the Public
Health Law to change language to reflect continuing care retirement
contracts and that clause (C) relates to facilities licensed by the
Department of Health rather than the Department of Social Services.

Section 5 - amends paragraph b of subdivision 4 and subdivisions 5 and
8 of section 4604 of the Public Health Law to provide oversight by
the Commissioner of Health rather than the Commissioner of Social
Services, and add life care at home services and amend language to
refer to continuing care retirement contracts.

Section 6 - amends paragraph g of subdivision 2 of section 4604-a of
the Public Health Law to reflect the option of life care at home
services.

Section 7 - amends paragraph d of subdivision 1 of section 4605 of the
Public Health Law to add continuing care retirement contracts.

Section 8 - amends the opening paragraph, paragraph d of subdivision
11 and subdivision 13 of section 4606 of the Public Health Law to
change language to "continuing care retirement contracts."

Section 9 - paragraphs e, f and g of subdivision 14 of section 4606 of
the Public Health Law are renumbered and a new paragraph e is added to
list the types of meal plans available.


Section 10 - amends section 4608 of the Public Health Law to include
life care modified life care at home contracts and limit certain
provisions to life care and modified co tracts only, and set forth
certain requirements for life care at home contracts.

Section 11 - amends subdivision 1 of section 4612 of the Public Health
Law to recognize that some residents under this section may be living
at home.

Section 12 - amends subdivisions 1 and 2 of section 4614 of the Public
Health Law to reflect that the Commissioner of Health shall have
responsibility for oversight.

Section 13 - amends paragraph k of subdivision 1 of section 4615 of
the Public Health Law to reflect
responsibility of the Commissioner of Health.

Section 14 - amends the section heading of section 4623 of the Public
Health

Section 15 - provides that this act shall take effect on the one
hundred eightieth day after it shall have become law, provided that
the Department of Health is authorized to immediately take such steps
as may be necessary to ensure implementation of this act

JUSTIFICATION:
This bill would offer another option for seniors
--life care at home.
Existing CCRC campus providers may establish a separate affiliated
501(c)3 corporation to offer various levels of home care services as
chosen by the contract holder, based upon the needs of the seniors(s)
in the home. This bill will expand the continuum of services from
limited services at home, through increased services, and eventual
residence, if needed, on a CCRC campus. At home services can include,
as necessary, personal health coordination, emergency response
system, health and wellness programs, home nurse visits, companion
services, home inspections, transportation, meals, on-campus
activities and cultural events. Services are coordinated by a case
manager. The program allows planned continuity so seniors can know
they will continue to receive services over the years with the same
provider as their needs change an know they can remain at home as
long as possible with such services as they may require.

PRIOR LEGISLATIVE HISTORY:
2011 - S.5224/A.8405 -- HEALTH/Health

FISCAL IMPLICATIONS:
May reduce costs to state if seniors can remain
at home and not spend down their assets and seek Medicaid assistance.

EFFECTIVE DATE:
This act shall take effect on the one hundred and
eightieth day after it shall have become law.

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

                                 5224--B

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced  by Sens. RANZENHOFER, DeFRANCISCO, LAVALLE, LIBOUS, STEWART-
  COUSINS, ZELDIN -- read twice and ordered printed, and when printed to
  be committed to the Committee on Health -- recommitted to the  Commit-
  tee  on  Health  in accordance with Senate Rule 6, sec. 8 -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the public health law, in relation to ability of contin-
  uing  care  retirement communities to offer seniors additional service
  options

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

  Section 1. Subdivisions 2-a, 2-b, 3, 8, 9, 10 and 10-a of section 4601
of the public health law, subdivision 2-a as added and subdivisions 3, 8
and  9 as amended by chapter 659 of the laws of 1997, subdivision 2-b as
amended by chapter 523 of the laws of 2011, subdivision 10 as  added  by
chapter  689 of the laws of 1989, and subdivision 10-a as added by chap-
ter 401 of the laws of 2003, are amended and three new subdivisions 7-a,
7-b and 7-c are added to read as follows:
  2-a.  "Continuing  care  retirement  contract"  shall  mean  a  single
contract  to provide a person the services provided by a continuing care
retirement community INCLUDING LIFE CARE OR LIFE CARE AT HOME.
  2-b. "Continuing care retirement community" or "community" shall  mean
a  facility  or facilities established to provide a comprehensive, cohe-
sive living arrangement for the elderly, oriented to the enhancement  of
the  quality  of life and which, pursuant to the terms of the continuing
care RETIREMENT contract OFFERED BY THE COMMUNITY, at a minimum:
  a. provides, OR SUPPORTS THROUGH LIFE CARE AT HOME, independent living
units, and [provides a] meal plan OPTIONS.  The independent living  unit
can be made available either through a non-equity arrangement or through
an  equity  arrangement  including,  but not limited to a cooperative or

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11311-04-2

S. 5224--B                          2

condominium. For purposes of this article,  the  purchase  price  of  an
independent living unit in an equity arrangement, regardless of the form
of  the  purchase  agreement,  shall  not be considered an entry fee for
purposes  of calculating reserve liabilities, but shall be considered an
entry fee for escrow purposes;
  b. provides a range of health care and  social  services,  subject  to
such  terms  as may be included within the contract, which shall include
adult care facility services of an  on-site  or  affiliated  adult  care
facility, and at a minimum, sixty days of prepaid services of an on-site
or  affiliated  nursing  facility  for  residents not receiving services
under a fee-for-service contract;
  c. provides access to health services  as  defined  in  the  contract,
prescription drugs, and rehabilitation services;
  d. nothing in this article shall eliminate the obligation of a contin-
uing care retirement community to provide at least sixty days of prepaid
nursing  facility services to all residents, with the exception of resi-
dents receiving services under the terms of a fee-for-service continuing
care contract as defined in this section. The prepaid days must  include
the  first  sixty  days  of  nursing  facility  services, whether or not
consecutive, not covered by Title XVIII of the federal  social  security
act; and
  e.  communities  established  under this article and offering fee-for-
service continuing care contracts must offer, along with  such  fee-for-
service  continuing  care  contracts,  life  care and/or continuing care
contracts as defined in subdivision eight-a of this section.
  3. "Contracts" or "agreements" shall mean LIFE CARE AT HOME OR contin-
uing care retirement contracts as defined in this article.
  7-A. "LIFE CARE AT HOME" SHALL MEAN AN ESTABLISHED SEPARATE 501 (C)  3
CORPORATION  AFFILIATED  WITH  THE EXISTING CCRC CAMPUS PROVIDER THROUGH
WHICH CONTRACT HOLDERS PAY AN ENTRANCE FEE AND A MONTHLY  FEE,  BOTH  OF
WHICH  WOULD  CORRESPOND  TO THE LEVEL OF SERVICE CHOSEN BY THE CONTRACT
HOLDER. A LIFE CARE AT HOME CONTRACT INCLUDES SERVICES COORDINATED BY  A
CASE  MANAGER  BASED  UPON INDIVIDUALS' NEEDS. SERVICES OFFERED INCLUDE,
BUT ARE NOT LIMITED TO, PERSONAL HEALTH COORDINATION, EMERGENCY RESPONSE
SYSTEM, HEALTH AND  WELLNESS  PROGRAMS,  HOME  NURSE  VISITS,  COMPANION
SERVICES,  HOME INSPECTIONS, TRANSPORTATION, MEALS, ON-CAMPUS ACTIVITIES
AND CULTURAL EVENTS. LIFE CARE AT HOME  SERVICES  SHALL  INCLUDE,  BASED
UPON  INDIVIDUAL CONTRACTS, SERVICES OF AN ON-SITE OR AFFILIATED NURSING
FACILITY AND AN ON-SITE OR AFFILIATED ADULT CARE FACILITY.
  7-B. "LIFE CARE AT HOME CONTRACT" SHALL  MEAN  A  SINGLE  CONTRACT  TO
PROVIDE  A PERSON, FOR THE DURATION OF SUCH PERSON'S LIFE, SUCH SERVICES
SELECTED BY THE INDIVIDUAL WHICH MAY INCLUDE SERVICES  PROVIDED  TO  THE
INDIVIDUAL IN HIS OR HER RESIDENCE.
  7-C.  A.  "LIFE  CARE AT HOME" CORPORATIONS PROVIDING HOSPITAL CARE AS
DEFINED IN SECTION TWENTY-EIGHT HUNDRED ONE  OF  THIS  CHAPTER  MUST  BE
LICENSED  UNDER  ARTICLE  TWENTY-EIGHT  AND  SHALL  BE  SUBJECT  TO  THE
PROVISIONS AND STANDARDS OF SUCH ARTICLE.
  B. "LIFE CARE AT HOME" CORPORATIONS PROVIDING HOME  CARE  SERVICES  AS
DEFINED  IN  SECTION  THIRTY-SIX  HUNDRED  TWO  OF  THIS CHAPTER MUST BE
LICENSED UNDER ARTICLE THIRTY-SIX AND SHALL BE SUBJECT TO THE PROVISIONS
AND STANDARDS OF SUCH ARTICLE.
  8. "Life care contract" shall mean a single continuing care retirement
contract to provide a person, for the duration of  such  person's  life,
the services provided by the continuing care retirement community, which
services  shall  include  unlimited services of an on-site or affiliated
nursing facility AND UNLIMITED SERVICES  OF  AN  ON-SITE  OR  AFFILIATED

S. 5224--B                          3

ADULT CARE FACILITY.  Such term also shall mean a single continuing care
retirement  contract  to  provide  a  person,  for  the duration of such
person's life, the services provided by the continuing  care  retirement
community  under  an  arrangement  in  which the costs of the residents'
unlimited nursing home or home health care  services  are  paid  for  in
whole  or  in  part by a long term care insurance policy approved by the
superintendent in accordance with applicable regulations or by long term
care insurance or medical assistance payments  in  accordance  with  the
partnership  for  long  term  care program pursuant to the provisions of
section three hundred sixty-seven-f of the social services law,  section
three  thousand two hundred twenty-nine of the insurance law and section
four thousand six hundred twenty-three of this chapter.
  9. "Life care" shall mean those services provided pursuant to a ["life
care contract"] "CONTINUING CARE RETIREMENT CONTRACT".
  10. "Living unit" shall mean an apartment,  room,  cottage,  or  other
area  within  a community set aside for the exclusive use of one or more
residents, OR THE CONTRACT HOLDER'S PRIVATE RESIDENCE.
  10-a. "Meal plan" shall mean an arrangement whereby the person  enter-
ing  into  the  continuing care retirement contract is provided with [no
fewer than five meals per month. Additional meals shall be available  on
a fee-for-service basis] OPTIONS REGARDING THE INCLUSION OF MEALS WITHIN
THE CONTRACT.
  S  2.  The  opening  paragraph of subdivision 2 of section 4602 of the
public health law, as amended by chapter 659 of the  laws  of  1997,  is
amended to read as follows:
  The  council shall meet as often as may be deemed necessary to fulfill
its responsibilities[, but in no event less than four times  per  year].
The council shall have the following powers and duties:
  S  3.  Subdivision  1  of  section 4603-a of the public health law, as
added by chapter 393 of the laws of 1991, is amended to read as follows:
  1. The commissioner, upon approval of the [life care] CONTINUING  CARE
RETIREMENT community council and the public health council shall issue a
certificate  of  incorporation  of  up  to three residential health care
demonstration facilities. Notwithstanding any provision of article twen-
ty-eight of this chapter or any other provisions of law to the contrary,
the public health council may approve without regard to the  requirement
of public need as set forth in subdivision three of section twenty-eight
hundred  one-a of this chapter, a certificate of incorporation or appli-
cation for establishment of such facilities.
  S 4. Paragraphs d and e and clause (C) of subparagraph (iv)  of  para-
graph j of subdivision 2 of section 4604 of the public health law, para-
graph  d as added by chapter 689 of the laws of 1989 and paragraph e and
clause (C) of subparagraph (iv) of paragraph j as amended by chapter 659
of the laws of 1997, are amended to read as follows:
  d. a  copy  of  the  proposed  forms  of  CONTINUING  CARE  RETIREMENT
contracts to be entered into with residents of the community;
  e. complete details of any agreements with a licensed insurer, includ-
ing copies of proposed contracts, requiring the insurer to assume, whol-
ly  or  in  part,  the  cost of medical or health related services to be
provided  to  a  resident  pursuant  to  a  continuing  care  retirement
[contract] CONTRACTUAL AGREEMENT;
  (C)  is or was subject to a currently effective injunctive or restric-
tive order or federal or state administrative order relating to business
activity or health care as a result of an action  brought  by  a  public
agency or department, including, without limitation, actions affecting a
license to operate a hospital as defined by section twenty-eight hundred

S. 5224--B                          4

one  of this chapter, or a facility required to be licensed or certified
by the department of [social services] HEALTH.  The statement shall  set
forth  the  court or agency, date of conviction or judgment, the penalty
imposed  or  damages  assessed,  or  the  date, nature and issuer of the
order;
  S 5. Paragraph b of subdivision 4 and subdivisions 5 and 8 of  section
4604  of  the public health law, paragraph b of subdivision 4 as amended
by chapter 659 of the laws of 1997, subdivision 5 as amended by  chapter
700 of the laws of 2006 and subdivision 8 as added by chapter 689 of the
laws of 1989, are amended to read as follows:
  b.  the  commissioner  [of social services] as to those aspects of the
application relating to adult care facility beds, if any;
  5. Up to two  thousand  residential  health  care  facility  beds,  as
authorized herein, that may be approved as components of continuing care
retirement communities shall not be considered by the department and the
health systems agencies in the determination of public need for residen-
tial  health  care  facility  services;  provided,  however, that if the
community seeking to construct such beds does not provide A life care OR
LIFE CARE AT HOME CONTRACT to all residents, it must adequately make the
assurances required by subdivision  two  of  section  forty-six  hundred
twenty-four of this article.
  8.  The  operator  shall  designate  and  make knowledgeable personnel
available to prospective residents to answer questions about any  infor-
mation contained in the disclosure statement or contract. The disclosure
statement  and  the CONTINUING CARE RETIREMENT contract shall each state
on the cover or top of the first page in bold  twelve  point  print  the
following "This matter involves a substantial financial investment and a
legally binding contract. In evaluating the disclosure statement and the
contract  prior  to  any  commitment, it is recommended that you consult
with an attorney and financial advisor of your choice, if you so  elect,
who can review these documents with you."
  S  6.  Paragraph  g  of  subdivision 2 of section 4604-a of the public
health law, as added by chapter 659 of the laws of 1997, is  amended  to
read as follows:
  g.  Unless  all  residents  have EITHER life care OR LIFE CARE AT HOME
contracts, the operator has adequately made the assurances  required  by
subdivision two of section forty-six hundred twenty-four of this article
and  has  agreed to fund the liability in the event that resident assets
are insufficient to pay for nursing facility services  for  a  one  year
period.
  S 7. Paragraph d of subdivision 1 of section 4605 of the public health
law,  as  amended by chapter 659 of the laws of 1997, is amended to read
as follows:
  d. to offer and execute CONTINUING CARE RETIREMENT contracts,  includ-
ing  the  collection  of  entrance fees and deposits pursuant to section
forty-six hundred eight of this article.
  S 8. The opening paragraph, paragraph d of subdivision 11 and subdivi-
sion 13 of section 4606 of the public health law, the opening  paragraph
as  amended  by chapter 120 of the laws of 1993, paragraph d of subdivi-
sion 11 as added by chapter 689 of the laws of 1989 and  subdivision  13
as  added  by  chapter  659  of the laws of 1997, are amended to read as
follows:
  Prior to the execution of a CONTINUING CARE  RETIREMENT  contract,  or
before  the  transfer  of  any  money,  other than a refundable priority
reservation fee or non-refundable priority reservation agreement  appli-
cation  fee,  to  an operator by or on behalf of a prospective resident,

S. 5224--B                          5

whichever occurs first, the operator shall deliver to  the  person  with
whom  the contract is to be entered into or the person's legal represen-
tative the most recent annual statement as required by section forty-six
hundred seven of this article, and an initial disclosure statement which
contains the following:
  d.  an  estimate of any funds which are anticipated to be necessary to
fund start-up losses and to assure full performance of  the  obligations
of  the  operator  pursuant  to  [life  care]  CONTINUING CARE contracts
including, but not limited to, any reserves required pursuant to section
forty-six hundred eleven of this article;
  13. The initial disclosure statement  and  marketing  materials  of  a
continuing  care retirement community must clearly include a description
of the services offered as part of  its  contract,  including,  but  not
limited  to,  any  limitations on nursing facility services. The initial
disclosure statement  and  marketing  materials  of  a  continuing  care
retirement  community which offers various types of contracts, which may
include life care, MODIFIED AND LIFE CARE AT HOME contracts, must clear-
ly differentiate among the various  types  of  contracts  which  it  may
offer.
  S  9.  Paragraphs  e, f and g of subdivision 14 of section 4606 of the
public health law are relettered paragraphs f, g and h and a  new  para-
graph e is added to read as follows:
  E. THE TYPES OF MEAL PLANS AVAILABLE;
  S  10.  Section 4608 of the public health law, as added by chapter 689
of the laws of 1989, the section  heading,  the  opening  paragraph  and
subdivision  6  as amended and subdivision 17 as added by chapter 659 of
the laws of 1997, subdivision 2 as amended by chapter 120 of the laws of
1993, subdivision 8 as amended by chapter 66 of the  laws  of  1994  and
subdivision 15 as further amended by section 104 of part A of chapter 62
of the laws of 2011, is amended to read as follows:
  S 4608. Continuing care retirement contract.  A LIFE CARE, MODIFIED OR
LIFE  CARE AT HOME continuing care retirement contract shall contain all
of the following information in no less than twelve point  type  and  in
plain  language,  in  addition  to  any  other terms or matter as may be
required by regulations adopted by the council and issued by the  super-
intendent, EXCEPT WHEN SPECIFICALLY NOTED:
  1. The amount of all money transferred, including, but not limited to,
donations,  subscriptions, deposits, fees, and any other amounts paid or
payable by, or on behalf of, the resident or residents;
  2. A description of all services which are  to  be  furnished  by  the
operator,  a description of any fees in addition to the entrance fee and
periodic charges provided for in the contract, and the conditions  under
which  the  fees  may  be  adjusted, provided that an operator shall not
charge any non-refundable application fee to a prospective resident  who
has  paid  a  non-refundable  priority reservation agreement application
fee;
  3. The procedures of the community relating to a resident's failure to
pay the required monthly fees;
  4. A statement of the figures and terms  concerning  the  entry  of  a
spouse to the community and the consequences if the spouse does not meet
the requirements for entry;
  5.  A statement of the terms and conditions under which a contract may
be cancelled by the operator or by a resident and the  conditions  under
which  all  or  any  portion of the entrance fee will be refunded by the
operator,  including  the  mandatory  refund  provisions  set  forth  in

S. 5224--B                          6

sections  forty-six hundred nine and forty-six hundred ten of this arti-
cle;
  6.  a.  [The] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY THE procedures
and conditions under which a resident may be transferred from his or her
living unit including a statement that, at the  time  of  transfer,  the
resident  will  be  given  the  reasons for the transfer; the process by
which a transfer decision is made; the persons  with  the  authority  to
make the decision to transfer; a description of any change in charges to
be paid by the resident for services not covered by the contract fees as
a  result  of the transfer; and a statement regarding the disposition of
and the right to return to the living unit in  cases  of  temporary  and
permanent transfers.
  b.  [The]  FOR LIFE CARE AND MODIFIED CONTRACTS ONLY THE circumstances
under which a living unit may be  considered  vacant  and  eligible  for
transfer or resale to a new resident, either due to the permanent trans-
fer of a resident to the community's nursing or other specialized facil-
ity  or  due  to  the  permanent transfer of a resident to a hospital or
other facility outside of the community; provided, however, that nothing
therein shall relieve a community from its obligations to provide or  to
insure  provision  of  all  contractually  required care pursuant to the
terms of a continuing care retirement contract.    Should  a  resident's
chronic  condition  require placement in a more specialized chronic care
facility that provides services beyond those provided through the commu-
nity's nursing facility, the liability of THE community pursuant to  the
terms  of  a  continuing  care retirement contract shall be equal to the
current per diem rate of the nursing facility minus the pro rata  appor-
tionment  of  the resident's monthly fee for the period of care required
by the contract.   Nothing  herein  shall  obligate  a  continuing  care
retirement  community  which  does  not have a life care contract with a
resident to provide or pay for a level of nursing facility services  nor
for any duration beyond what is specifically described in its continuing
care  retirement  contract  with  that  resident. This section shall not
affect the  operator's  obligation  under  subdivision  two  of  section
forty-six hundred twenty-four of this article;
  7.  [A] FOR LIFE CARE AND MODIFIED CONTRACTS ONLY A statement that, if
the resident dies prior to occupancy date or, through  illness,  injury,
or  incapacity  is precluded from becoming a resident under the terms of
the contract, the contract is automatically rescinded and  the  resident
or  his  or  her legal representative shall receive a full refund of all
moneys paid  to  the  facility,  except  for  those  costs  specifically
incurred by the facility at the request of the resident and set forth in
writing in a separate addendum, signed by the parties to the contract;
  8.  FOR  LIFE CARE AT HOME CONTRACTS THE CIRCUMSTANCES UNDER WHICH THE
CONTRACT HOLDER MAY MOVE INTO A CAMPUS INDEPENDENT LIVING UNIT;
  9. A statement of the conditions under which all or any portion of the
entrance fee will be released to the operator  before  the  living  unit
becomes available for occupancy, and a statement of the conditions under
which  all  or  any portion of that fee will be refunded in the event of
the death of the resident and/or spouse following occupancy of a  living
unit,  including  the  mandatory  refund provisions set forth in section
forty-six hundred nine of this article;
  [9.] 10. A statement of the advance notice to be  provided  the  resi-
dent,  of  not less than sixty days, of any change in fees or charges or
scope of care or services;
  [10.] 11. A statement that no act,  agreement,  or  statement  of  any
resident,  or  of an individual purchasing care for a resident under any

S. 5224--B                          7

agreement to furnish care to the  resident,  shall  constitute  a  valid
waiver  of  any  provision  of this article or of any regulation enacted
pursuant thereto intended for the benefit or protection of the  resident
or the individual purchasing care for the resident;
  [11.  A] 12. FOR LIFE CARE AND MODIFIED CONTRACTS A description of the
reinstatement policies if a resident leaves the facility or the contract
is cancelled;
  [12.] 13. FOR LIFE CARE AT HOME CONTRACTS A DESCRIPTION OF POLICIES IF
THE CONTRACT IS CANCELLED.
  14. A statement that  internal  procedures  to  resolve  disputes  and
grievances have been established, and residents notified of them;
  [13.]  15. A statement of the grace period, if any, for the payment of
periodic fees without a penalty, and the extent of any penalty  for  the
late payment thereof;
  [14.] 16. A statement that: a. the resident shall, if eligible, enroll
in  medicare parts a and b or the equivalent and shall continue to main-
tain that coverage, together with medicare supplement coverage at  least
equivalent  in  benefits  to  those established by the superintendent as
minimum benefits for medicare supplement policies;
  b. if the resident fails to maintain medicare coverage and a  medicare
supplement  coverage,  or  is  ineligible for such coverage and fails to
purchase the equivalent of such coverage, the community  shall  purchase
the  coverage or equivalent coverage on behalf and at the expense of the
resident and shall have the authority to require an appropriate  adjust-
ment in payments by the resident to the community;
  c.  if  the  community  cannot purchase medicare coverage and medicare
supplement coverage or the equivalent,  the  community  shall  have  the
authority  to  require  an  adjustment  in  monthly fees, subject to the
approval of the superintendent, to  fund  the  additional  risk  to  the
facility; and
  d. if the resident fails to purchase or maintain medicare coverage and
medicare  supplement  coverage  or the equivalent, and the community has
not purchased such coverage, the community will be responsible  for  any
expenses  which would have been covered by medicare and medicare supple-
ment coverage.  The community may add the amount of such expenses to the
resident's monthly fees.
  [15.] 17. A statement that any  amendment  to  the  contract  and  any
change  in fees or charges, other than those within the guidelines of an
approved rating system, must be approved by the superintendent of finan-
cial services; and
  [16.] 18. A statement  that  property  shall  not  be  substituted  as
payment for either the entrance fee or monthly fee.
  [17.]  19. A statement whether the continuing care retirement contract
includes any ownership, beneficial or trust interest in  the  assets  of
the operator, the assets of the facility, or both. Assets shall include,
but  are  not limited to, property, trusts, reserves, interest and other
assets.
  S 11. Subdivision 1 of section 4612 of the public health law, as added
by chapter 689 of the laws of 1989, is amended to read as follows:
  1. Residents [living] in a community authorized by this article  shall
have  the right of self-organization, the right to be represented by one
or more individuals of their own choosing, and the right  to  engage  in
concerted  activities  for the purpose of keeping informed of the opera-
tion of the community in which they live.
  S 12. Subdivisions 1 and 2 of section 4614 of the public  health  law,
as  amended  by  chapter  659  of  the laws of 1997 and subdivision 2 as

S. 5224--B                          8

further amended by section 104 of part A of chapter 62 of  the  laws  of
2011, are amended to read as follows:
  1. The commissioner, or designee; AND the superintendent, or designee;
[and,  with  regard  to  communities  for which the department of social
services has  regulatory  responsibility,  the  commissioner  of  social
services,  or  designee,] may at any time, and shall at least once every
three years, visit each community and examine the business of any appli-
cant for a certificate of authority and  any  operator  engaged  in  the
execution  of  continuing  care  retirement  contracts or engaged in the
performance of obligations under such contracts.   Routine  examinations
may be conducted by having documents designated by and submitted to such
commissioners or superintendent, which shall include financial documents
and  records  conforming  to commonly accepted accounting principles and
practices. The final written report of each such  examination  conducted
by  such commissioners or superintendent shall be filed with the commis-
sioner and, when so filed, shall constitute a public record.  A copy  of
each  report shall be provided to members of the continuing care retire-
ment community council. Any operator being examined shall, upon request,
give reasonable and timely access to all of its records.  The  represen-
tative  or  examiner  designated by the commissioners or superintendent,
respectively, may, at any time, examine  the  records  and  affairs  and
inspect  the community's facilities, whether in connection with a formal
examination or not.
  2. Any duly authorized officer,  employee,  or  agent  of  the  health
department,  [social  services  department,]  or department of financial
services may, upon presentation of proper  identification,  have  access
to, and inspect, any records maintained by the community relevant to the
respective  agency's  regulatory  authority,  with  or  without  advance
notice, to secure compliance with, or to prevent  a  violation  of,  any
provision of this article.
  S  13.  Paragraph  k  of  subdivision  1 of section 4615 of the public
health law, as amended by chapter 659 of the laws of 1997, is amended to
read as follows:
  k. The commissioner [or the commissioner of social services] has found
violations of applicable statutes, rules or regulations  which  threaten
to  affect  directly  the  health, safety, or welfare of a resident of a
continuing care retirement community.
  S 14. The section heading of section 4623 of the public health law, as
amended by chapter 659 of the laws  of  1997,  is  amended  to  read  as
follows:
  Long   term  care  insurance  [for]  AND  continuing  care  retirement
contracts.
  S 15. This act shall take effect on  the  one  hundred  eightieth  day
after  it  shall  have  become  a law; provided, however, that effective
immediately the department of health is authorized to take such steps in
advance of such effective date, including the addition, amendment and/or
repeal of any rule or regulation as may be necessary to ensure the time-
ly implementation of this act on such effective date.

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