senate Bill S1109D

Vetoed By Governor
2013-2014 Legislative Session

Enacts the "people first act of 2014"

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Sponsored By

Archive: Last Bill Status Via A8452 - Vetoed by Governor


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Nov 21, 2014 tabled
vetoed memo.496
Nov 10, 2014 delivered to governor
Jun 16, 2014 returned to assembly
passed senate
3rd reading cal.1372
substituted for s1109d
Jun 16, 2014 substituted by a8452
ordered to third reading cal.1372
committee discharged and committed to rules
Feb 04, 2014 reported and committed to finance
Jan 09, 2014 print number 1109d
amend (t) and recommit to mental health and developmental disabilities
Jan 08, 2014 referred to mental health and developmental disabilities
Jun 07, 2013 print number 1109c
amend and recommit to finance
Jun 05, 2013 reported and committed to finance
May 02, 2013 print number 1109b
amend and recommit to mental health and developmental disabilities
Jan 11, 2013 print number 1109a
amend and recommit to mental health and developmental disabilities
Jan 09, 2013 referred to mental health and developmental disabilities

Votes

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Jun 16, 2014 - Rules committee Vote

S1109D
21
0
committee
21
Aye
0
Nay
2
Aye with Reservations
0
Absent
2
Excused
0
Abstained
show Rules committee vote details

Feb 5, 2014 - Mental Health and Developmental Disabilities committee Vote

S1109D
11
0
committee
11
Aye
0
Nay
0
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show Mental Health and Developmental Disabilities committee vote details

Mental Health and Developmental Disabilities Committee Vote: Feb 5, 2014

Jun 5, 2013 - Mental Health and Developmental Disabilities committee Vote

S1109B
11
0
committee
11
Aye
0
Nay
0
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show committee vote details

Committee Vote: Jun 5, 2013

Bill Amendments

Original
A
B
C
D (Active)
Original
A
B
C
D (Active)

Co-Sponsors

S1109 - Bill Details

See Assembly Version of this Bill:
A8452
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§13.15 & 16.01, Ment Hyg L
Versions Introduced in 2011-2012 Legislative Session:
S6420

S1109 - Bill Texts

view summary

Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.

view sponsor memo
BILL NUMBER:S1109

TITLE OF BILL:

An act to amend the mental hygiene law, in relation to enacting the
"people first act of 2013"

SUMMARY OF PROVISIONS:

Section one provides for the short title of the bill to be the "People
First Act of 2013."

Section two of the bill contains legislative findings.

Section three of the bill amends section 13.15 of the Mental Hygiene
Law, in order to require the Commissioner of OPWDD to conduct a
geographic analysis of the supports and services in community settings
available for individuals with developmental disabilities and to identi-
fy gaps between required supports and services by region of the state.
In addition, the Commissioner is directed to develop a web-based data-
base which will permit the prioritization of the urgency of needs
(P.D.N.S.) for supports and services for those facing emergency or imme-
diate need, those facing critical need, defined as additional services
and supports with one year and planning need, for those who will require
additional services and supports within five years or where the individ-
ual's caregiver is over sixty years old. Annual reporting requirements
will allow the Executive and the Legislature make informed policy choic-
es in the delivery of supports and services to people with developmental
disabilities .

Section four of the bill makes technical amendments.

Section five of the bill amends section 16.01 of the Mental Hygiene Law
in order to permit the Commissioner, in consultation with stakeholders,
to identify and implement a valid and reliable quality assurance instru-
ment that includes assessment of consumer and family satisfaction,
provision of service and personal outcomes. The tool must be nationally
validated, benchmarked, consistent and reliable. It must include
outcome-based measures to track health, safety, well-being, relation-
ships, interactions with people who do not have a disability, employ-
ment, quality of life, integration, choice, service and consumer satis-
faction.

Section six is the effective date of the bill.

JUSTIFICATION:

The New York State Department of Health (DOH) in partnership with the
Office of People With Developmental Disabilities (OPWDD) proposed a new
model for the financing of services for individuals with developmental
disabilities to the federal government. The federal government no longer

supports NY's current model for financing services and supports for
people with developmental disabilities. The current model is based, in
significant part, upon allowed costs for institutional placement, which
are substantially in excess of actual costs of institutional placement,
as institutional capacity has been reduced over the past 30 years, The
state and the federal government had previously agreed that as institu-
tional capacity was reduced, the funds otherwise used for institutional
placement could follow the individual into the community. The use of
these funds allowed NYS to create the current community-based service
structure.

The state was authorized in the 2011-12 Enacted Budget to submit a Medi-
caid waiver application, which OMPDD has called the "People First Waiv-
er", in order to transition the current Medicaid "fee for service" long-
term care services for individuals with developmental disabilities to a
care management model.

The state is seeking authority to transition individuals served by the
current service delivery system into mandatory enrollment in managed
long-term care services.

The core concept behind the "People First Waiver" application is an
individual budget allocation built on a standardized assessment of indi-
vidual support needs. Recognizing that people with developmental disa-
bilities want to live their lives in the community, just like everyone
else, OPWOD is racing to embrace the concept of a "self-directed"
person-centered system, where individuals and their circle of support
have considerable authority over what supports they receive, how they
are received and from whom.

At the center of any system promoting self-direction is a personal budg-
et allocation that the individual and his circle of support may apply
within the bounds of an approved service plan to secure needed supports.
The Center for Medicare and Medicaid Services (CMS) requires any "indi-
vidual budget amount" to be "a prospectively determined amount of funds
that the state makes available for the provision of (federally funded)
services to an (individual)". Implicit in this definition are two key
concepts: the state determines the budget amount for each individual,
and the individual and/or his or her circle of support is provided this
information before developing a service plan.

Essential to reforming the resource allocation system is choosing an
assessment tool that will provide sufficient information to accurately
and appropriately differentiate among service participants with respect
to their support needs. The state is considering testing the InterRAI-DD
assessment tool for this critical function. However, in order to be
successful, information must be collected on the amount of money that is
expended annually for each person's support. The support needs of indi-
viduals must be systemically analyzed in relation to cost. At the same
time, the state must have reliable and accurate information pertaining
to the number of people who have requested services and need them pres-
ently and others who would likely seek services in the near future.

Doing so requires diligent data collection over several years to examine
how demand trends behave over time.

This bill encourages the type of data-gathering initiative that has
proven successful in Pennsylvania and Illinois and will insure the accu-
racy of waitlist numbers. Combined with the expected implementation of
the InterRAI-DD assessment tool, the state can begin to make meaningful
projections regarding the budget allocations individuals will require if
they were immediately enrolled in the system and began receiving the
services their support needs justify. This information will provide the
Executive and the Legislature with more reliable estimates of the costs
associated with reducing wait lists over time, and enable OPWDD to more
purposefully plan for building system capacity.

A second critically important component of the "People First Waiver" is
to improve the quality of services delivered. Adopting an assessment-
based resource allocation approach and building individual budget allo-
cations are integral parts of a strong quality improvement process. This
approach should improve access to services because an adequate and equi-
table budget allocation will be established for each person. A person-
centered planning process builds based upon knowledge of the support
needs of individuals and is made more effective because each person
served will have his or her own budget allocation. The increased effi-
ciency and equity in resource allocation conceptualized in the People
First Waiver application should enhance provider capacity as service
rates are appropriately established based upon actual cost to provide
the necessary supports and services to a pr'operly assessed individual.
Health and safety requirements, instead of being mandated by state regu-
lators operating in a "one size fits all" model can be appropriately
established and fashioned in direct response to the nature of an indi-
vidual's support needs.

The quality of services in this new "People First Waiver" can be
improved by analyzing the impact of resource allocations on service
outcomes. While state policy makers and providers are concerned about
the health and well being of people with developmental disabilities,
there is a critical need to assess systematically the relationships
between individual budget allocations, the services delivered as a
result of this allocation, and the achievement of desired outcomes. It
is critically important in this new system redesign that we measure the
outcomes as perceived by the people receiving the supports and services,
Quality needs to be tied to individual outcomes, to their safety, to
their ability to gain employment, to have friendships and to live with
friends in settings they feel good about.

This bill provides for the type of person-centered, empirical data
collection aimed at identifying in a comprehensive, consistent and reli-
able manner the quality of services using assessments of consumer and
family satisfaction, their perspective on the provision of service and
how the new service delivery model impacts on the personal outcomes of
their lives.

PRIOR LEGISLATIVE HISTORY:
S.6420/A.9402 of 2011-12; Reported and Committed to Finance

FISCAL IMPACT:

To be determined.

LOCAL FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:

Immediately.

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

                                  1109

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on Mental Health and Developmental Disabilities

AN ACT to amend the mental hygiene law,  in  relation  to  enacting  the
  "people first act of 2013"

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

  Section 1. Short title. This act shall be known and may  be  cited  as
the "people first act of 2013".
  S  2.  Legislative  findings.  It  is the intent of the legislature to
ensure that individuals  with  developmental  disabilities  who  utilize
long-term  care  services under the medical assistance program and other
long-term care related benefit programs administered by the  state  have
meaningful  access to a reasonable array of community-based and institu-
tional program options and to ensure the well-being of individuals  with
developmental  disabilities,  taking  into  account  their  informed and
expressed choices. Furthermore, the legislature declares that it is  the
policy  of  the  state  to  ensure  that the clinical, habilitative, and
social needs of individuals with developmental disabilities  who  choose
to  reside  in  integrated community-based settings can have those needs
met in integrated community-based settings.  In  order  to  meaningfully
comply  with  this  policy,  the state must have an understanding of the
existing capacity  in  integrated-community  based  settings,  including
direct  support professionals and licensed professionals, such as physi-
cians, dentists, nurse practitioners, nurses, and psychiatrists, as well
as residential capacity to provide for these needs.
  It is further the intent of the legislature to support  the  satisfac-
tion  and  success of consumers through the delivery of quality services
and supports. Evaluation of the services that consumers receive is a key
aspect to the service system. Utilizing the information  that  consumers

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02298-01-3

S. 1109                             2

and  their  families provide about such services in a reliable and mean-
ingful way is also critical to enable the commissioner of  developmental
disabilities  to  assess  the  performance  of the state's developmental
services  system and to improve services for consumers in the future. To
that end, the commissioner of developmental disabilities shall conduct a
geographic analysis of supports and services in community  settings  and
implement  an improved, unified quality assessment system, in accordance
with this act.
  S 3. Section 13.15 of the mental hygiene law is amended  by  adding  a
new subdivision (d) to read as follows:
  (D)  (1)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL
HAVE THE FOLLOWING MEANINGS:
  (I) "DIRECT  SUPPORT  PROFESSIONALS"  MEANS  DIRECT  SUPPORT  WORKERS,
DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA-
PROFESSIONALS  THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES IN THE FORM OF DAILY LIVING, AND PROVIDE THE  HABILITATION,
REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS.
  (II)  "LICENSED  PROFESSIONALS"  MEANS,  BUT IS NOT LIMITED TO, PHYSI-
CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION-
ERS,  LICENSED  PRACTICAL  NURSES,  REGISTERED  NURSES,   PSYCHIATRISTS,
PSYCHOLOGISTS,  LICENSED  MASTER  SOCIAL  WORKERS,  OR LICENSED CLINICAL
SOCIAL WORKERS, LICENSED TO PRACTICE PURSUANT TO THE EDUCATION  LAW  AND
OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS.
  (III)  "SUPPORTS  AND  SERVICES"  MEANS  DIRECT SUPPORT PROFESSIONALS,
LICENSED PROFESSIONALS, AND RESIDENTIAL  SERVICES,  INCLUDING,  BUT  NOT
LIMITED  TO,  PRIVATE  RESIDENCES,  COMMUNITY-INTEGRATED LIVING ARRANGE-
MENTS, SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL  PROGRAMS,
OR SUPPORTIVE HOUSING PROGRAMS.
  (2)  SUBJECT  TO  AVAILABLE  APPROPRIATIONS THEREFOR, THE COMMISSIONER
SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI-
TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY-
SIS SHALL ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND  SERVICES  BY
REGION OF THE STATE.
  (3)  IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA FOR
PURPOSES OF PERFORMING THE GEOGRAPHIC  ANALYSIS,  THE  COMMISSIONER  MAY
WORK  IN  COOPERATION  AND  AGREEMENT WITH OTHER OFFICES, DEPARTMENTS OR
AGENCIES OF THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR  OTHER  ORGANIZA-
TIONS AND INDIVIDUALS.
  (4)  IN  CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT TO AVAIL-
ABLE APPROPRIATIONS THEREFOR, SHALL  DEVELOP  AND  UTILIZE  A  WEB-BASED
DATA-BASE  WHICH  PRIORITIZES  THE  URGENCY  OF  NEED  FOR  SUPPORTS AND
SERVICES. THE INFORMATION COLLECTED SHOULD  ALLOW  THE  COMMISSIONER  TO
CATEGORIZE  NEEDS  FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN A FRAME-
WORK THAT ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE  LEVEL  OF
SUPPORT  NEEDS  SHOULD  INCLUDE:  EMERGENCY NEED, FOR THOSE PERSONS WITH
DEVELOPMENTAL DISABILITIES IN  NEED  OF  IMMEDIATE  SUPPORT  EITHER  DAY
SUPPORT  OR  IN-HOME  OR  OUT-OF-HOME PLACEMENT; CRITICAL NEED FOR THOSE
INDIVIDUALS WHO WILL HAVE A NEED FOR SUPPORTS  OR  SERVICES  WITHIN  ONE
YEAR  AND  PLANNING  FOR NEED, FOR THOSE INDIVIDUALS WHOSE SUPPORT NEEDS
ARE ONE TO FIVE YEARS AWAY, OR WHERE  THE  CAREGIVER  IS  AGE  SIXTY  OR
OLDER.
  (5)  SUCH  AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER OF INDIVID-
UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE
TOTAL NUMBER OF INDIVIDUALS FROM WITHIN  EACH  DEVELOPMENTAL  DISABILITY
SERVICES  OFFICE'S  GEOGRAPHIC AREA WHO AWAIT RESIDENTIAL PLACEMENT, DAY
SERVICE SUPPORT, HOME AND  COMMUNITY-BASED  WAIVER  SUPPORT,  EMPLOYMENT

S. 1109                             3

SUPPORT,   BEHAVIORAL   HEALTH   SERVICES   AND   SUPPORTS,   OR   OTHER
COMMUNITY-BASED SUPPORT. SUCH INFORMATION SHOULD BE GROUPED BY  THE  AGE
OF  THE  INDIVIDUAL AWAITING COMMUNITY SERVICES AND SUPPORTS AND THE AGE
OF  THEIR  CAREGIVER, IF ANY. SUCH INFORMATION SHOULD ALSO INCLUDE WAIT-
LIST AND PLACEMENT INFORMATION SUCH AS:
  (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO
REQUIRE  DIVIDED  INTO  CERTIFIED  OUT-OF-HOME,  SUPERVISED,  SUPPORTIVE
PLACEMENT  NEEDS  AND  OTHER  NON-PLACEMENT NEEDS AND THE NUMBER OF SUCH
PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE;
  (II) NON-CERTIFIED RESIDENTIAL  PLACEMENTS  OUTSIDE  THE  PARENT'S  OR
PARENTS' OR OTHER CAREGIVER'S HOME;
  (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY
SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME;
  (IV)  THE  TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED AS IN
NEED OF SUPPORTS AND SERVICES  WHO  HAVE  RECEIVED  THESE  SUPPORTS  AND
SERVICES  AND  ANY  GAP  BETWEEN  REQUIRED SUPPORTS AND SERVICES AND THE
SUPPORTS AND SERVICES PROVIDED;
  (V) THE NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR  THE  PAST
YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS;
  (VI)  THE  NUMBER  OF INDIVIDUALS WHO ARE CURRENTLY RECEIVING SUPPORTS
AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU-
ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER-
NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS;
  (VII) PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS  IN
NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION;
  (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE
EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI-
DENTIAL PLACEMENTS; AND
  (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER.
  (6)  THE  COMMISSIONER  SHALL  PREPARE  ANNUALLY FOR THE GOVERNOR, THE
LEGISLATURE AND THE STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY
DISABLED A WRITTEN EVALUATION REPORT CONCERNING THE DELIVERY OF SUPPORTS
AND SERVICES IN THE COMMUNITY. ON OR BEFORE MARCH FIRST, IN  EACH  YEAR,
THE  COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH RECOMMEN-
DATION AS HE OR SHE DEEMS APPROPRIATE, TO THE  GOVERNOR,  THE  TEMPORARY
PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE RESPECTIVE
MINORITY LEADERS OF EACH SUCH HOUSE, AND THE CHAIR OF THE STATE  COMMIS-
SION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST SUCH REPORT
SHALL  BE  DUE  BY  NO LATER THAN MARCH FIRST, TWO THOUSAND FIFTEEN. THE
REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL BE PUBLISHED
ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION AT THE SAME  TIME  AS
ITS SUBMISSION TO STATE OFFICIALS.
  S  4.  Subdivision  (c) of section 16.01 of the mental hygiene law, as
added by chapter 234 of the laws of 1998,  paragraph  1  as  amended  by
chapter 37 of the laws of 2011, is amended to read as follows:
  [(c)]  (J) (1) Notwithstanding any other provision of law, the commis-
sioner, or his OR HER  designee,  may  require  from  any  hospital,  as
defined  under article twenty-eight of the public health law, any infor-
mation, report, or record necessary for the purpose of carrying out  the
functions, powers and duties of the commissioner related to the investi-
gation  of  deaths  and  complaints  of  abuse, mistreatment, or neglect
concerning persons with developmental disabilities who receive services,
or had prior to death received services, in a  facility  as  defined  in
section  1.03 of this chapter, or are receiving medicaid waiver services
from the office for people with developmental disabilities in a non-cer-
tified setting, and have been treated at such hospitals.

S. 1109                             4

  (2) Any information, report, or record requested by  the  commissioner
or  his OR HER designee pursuant to this subdivision shall be limited to
that information that the  commissioner  determines  necessary  for  the
completion of this investigation.
  (3)  The information, report or record received by the commissioner or
his OR HER designee pursuant to this subdivision  shall  be  subject  to
section two thousand eight hundred five-m, section eighteen, as added by
chapter four hundred ninety-seven of the laws of nineteen hundred eight-
y-six,  and  article  twenty-seven-F  of  the public health law, section
33.13 of this chapter, and any applicable federal statute or regulation.
  S 5. Section 16.01 of the mental hygiene  law  is  amended  by  adding
seven  new  subdivisions (c), (d), (e), (f), (g), (h) and (i) to read as
follows:
  (C) THE COMMISSIONER, IN CONSULTATION WITH STAKEHOLDERS, INCLUDING BUT
NOT LIMITED TO PROVIDERS OF  SERVICES  FOR  PERSONS  WITH  DEVELOPMENTAL
DISABILITIES,  CONSUMER  REPRESENTATIVES INCLUDING PERSONS WITH DEVELOP-
MENTAL DISABILITIES, OR THEIR PARENTS OR GUARDIANS,  CORRESPONDENTS  AND
OTHER  INTERESTED  PERSONS,  SHALL IDENTIFY A VALID AND RELIABLE QUALITY
ASSURANCE INSTRUMENT THAT INCLUDES ASSESSMENTS OF  CONSUMER  AND  FAMILY
SATISFACTION,  PROVISION OF SERVICES, AND PERSONAL OUTCOMES. THE INSTRU-
MENT SHALL DO ALL OF THE FOLLOWING:
  (1) PROVIDE NATIONALLY VALIDATED,  BENCHMARKED,  CONSISTENT,  RELIABLE
AND MEASURABLE DATA FOR THE OFFICE'S QUALITY MANAGEMENT SYSTEM.
  (2) ENABLE THE COMMISSIONER AND ENTITIES CONTRACTED BY THE COMMISSION-
ER  TO  COORDINATE  AND/OR DELIVER SUPPORTS AND SERVICES TO PERSONS WITH
DEVELOPMENTAL DISABILITIES, INCLUDING BUT NOT LIMITED  TO  HEALTH  HOMES
ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-L OF THE SOCIAL
SERVICES  LAW  OR  OTHER  MANAGED  CARE ENTITIES AS APPROVED PURSUANT TO
SECTION FOUR THOUSAND FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH  LAW  TO
COMPARE  THE  PERFORMANCE  OF  NEW  YORK'S DEVELOPMENTAL SERVICES SYSTEM
AGAINST OTHER STATES' DEVELOPMENTAL SERVICES SYSTEMS AND TO ASSESS QUAL-
ITY AND PERFORMANCE AMONG ALL  OF  THE  MANAGED  CARE  AND  SERVICE  AND
SUPPORT ENTITIES STATEWIDE.
  (3) INCLUDE OUTCOME-BASED MEASURES SUCH AS HEALTH, SAFETY, WELL-BEING,
RELATIONSHIPS,  INTERACTIONS  WITH  PEOPLE WHO DO NOT HAVE A DISABILITY,
EMPLOYMENT, QUALITY OF LIFE, INTEGRATION, CHOICE, SERVICE, AND  CONSUMER
SATISFACTION.
  (D) TO THE EXTENT THAT FUNDING IS AVAILABLE, THE INSTRUMENT IDENTIFIED
IN SUBDIVISION (C) OF THIS SECTION MAY BE EXPANDED TO COLLECT ADDITIONAL
DATA  REQUESTED  BY OTHER OFFICES, DEPARTMENTS OR AGENCIES OF THE STATE,
LOCAL OR FEDERAL GOVERNMENT.
  (E) THE COMMISSIONER SHALL CONTRACT  WITH  AN  INDEPENDENT  AGENCY  OR
ORGANIZATION  TO  IMPLEMENT BY JANUARY FIRST, TWO THOUSAND FOURTEEN, THE
QUALITY ASSURANCE  INSTRUMENT  DESCRIBED  IN  SUBDIVISION  (C)  OF  THIS
SECTION. THE CONTRACTOR SHALL BE EXPERIENCED IN ALL OF THE FOLLOWING:
  (1)  DESIGNING  VALID  QUALITY ASSURANCE INSTRUMENTS FOR DEVELOPMENTAL
SERVICE SYSTEMS.
  (2) TRACKING OUTCOME-BASED MEASURES SUCH AS HEALTH,  SAFETY,  WELL-BE-
ING, RELATIONSHIPS, INTERACTIONS WITH PEOPLE WHO DO NOT HAVE A DISABILI-
TY,  EMPLOYMENT,  QUALITY  OF  LIFE,  INTEGRATION,  CHOICE, SERVICE, AND
CONSUMER SATISFACTION.
  (3) DEVELOPING DATA SYSTEMS.
  (4) DATA ANALYSIS AND REPORT PREPARATION.
  (5) ASSESSMENTS OF THE SERVICES RECEIVED BY CONSUMERS  WHO  ARE  MOVED
FROM  DEVELOPMENTAL  CENTERS  TO  THE COMMUNITY, GIVEN THE LEGISLATURE'S

S. 1109                             5

HISTORIC RECOGNITION OF A SPECIAL OBLIGATION TO ENSURE THE WELL-BEING OF
THESE PERSONS.
  (F) THE COMMISSIONER, IN CONSULTATION WITH THE CONTRACTOR DESCRIBED IN
SUBDIVISION  (E)  OF  THIS  SECTION,  SHALL ESTABLISH THE METHODOLOGY BY
WHICH THE QUALITY ASSURANCE INSTRUMENT SHALL BE ADMINISTERED, INCLUDING,
BUT NOT LIMITED TO, HOW OFTEN AND TO WHOM THE QUALITY ASSURANCE WILL  BE
ADMINISTERED,  AND  THE  DESIGN OF A STRATIFIED, RANDOM SAMPLE AMONG THE
ENTIRE POPULATION OF CONSUMERS SERVED BY  SERVICE  PROVIDERS,  INCLUDING
ANY  NEWLY  APPROVED MANAGED CARE ENTITIES. THE CONTRACTOR SHALL PROVIDE
AGGREGATE INFORMATION FOR ALL SERVICE  PROVIDERS  AND  THE  STATE  AS  A
WHOLE.  AT THE REQUEST OF A CONSUMER OR THE FAMILY MEMBER OF A CONSUMER,
THE SURVEY SHALL BE CONDUCTED IN THE PRIMARY LANGUAGE OF THE CONSUMER OR
FAMILY MEMBER SURVEYED.
  (G) THE COMMISSIONER SHALL COLLECT  DATA  FOR  THE  QUALITY  ASSURANCE
INSTRUMENT  DESCRIBED IN SUBDIVISION (C) OF THIS SECTION. IF, DURING THE
DATA COLLECTION  PROCESS,  THE  COMMISSIONER  IDENTIFIES  ANY  SUSPECTED
VIOLATION OF THE LEGAL, CIVIL, OR SERVICE RIGHTS OF A CONSUMER, OR IF IT
DETERMINES  THAT  THE  HEALTH AND WELFARE OF A CONSUMER IS AT RISK, THAT
INFORMATION SHALL BE PROVIDED IMMEDIATELY TO THE CHAIR OF THE COMMISSION
ON QUALITY OF CARE FOR THE MENTALLY DISABLED  AND  ANY  REGIONAL  ENTITY
PROVIDING  CASE  MANAGEMENT  SERVICES TO THE CONSUMER. AT THE REQUEST OF
THE CONSUMER, OR FAMILY, WHEN  APPROPRIATE,  A  COPY  OF  THE  COMPLETED
SURVEY  SHALL  BE  PROVIDED TO THE COMMISSION ON QUALITY OF CARE FOR THE
MENTALLY DISABLED AND ANY  REGIONAL  ENTITY  PROVIDING  CASE  MANAGEMENT
SERVICES TO IMPROVE THE CONSUMER'S QUALITY OF SERVICES THROUGH THE INDI-
VIDUAL PLANNING PROCESS.
  (H) THE COMMISSIONER, IN CONSULTATION WITH STAKEHOLDERS, SHALL ANNUAL-
LY REVIEW THE DATA COLLECTED FROM AND THE FINDINGS OF THE QUALITY ASSUR-
ANCE  INSTRUMENT DESCRIBED IN SUBDIVISION (C) OF THIS SECTION AND ACCEPT
RECOMMENDATIONS REGARDING ADDITIONAL OR DIFFERENT CRITERIA FOR THE QUAL-
ITY ASSURANCE INSTRUMENT IN ORDER  TO  ASSESS  THE  PERFORMANCE  OF  THE
STATE'S  DEVELOPMENTAL  SERVICES SYSTEM AND IMPROVE SERVICES FOR CONSUM-
ERS.
  (I) ALL REPORTS GENERATED PURSUANT  TO  THIS  SECTION  SHALL  BE  MADE
PUBLICLY  AVAILABLE,  BUT  SHALL  NOT  CONTAIN  ANY PERSONAL IDENTIFYING
INFORMATION ABOUT ANY PERSON ASSESSED.
  S 6. This act shall take effect immediately.

Co-Sponsors

S1109A - Bill Details

See Assembly Version of this Bill:
A8452
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§13.15 & 16.01, Ment Hyg L
Versions Introduced in 2011-2012 Legislative Session:
S6420

S1109A - Bill Texts

view summary

Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.

view sponsor memo
BILL NUMBER:S1109A

TITLE OF BILL:

An act to amend the mental hygiene law, in relation to enacting the
"people first act of 2013"

SUMMARY OF PROVISIONS:

Section one provides for the short title of the bill to be the "People
First Act of 2013."

Section two of the bill contains legislative findings.

Section three of the bill amends section 13.15 of the Mental Hygiene
Law, in order to require the Commissioner of OPWDD to conduct a
geographic analysis of the supports and services in community settings
available for individuals with developmental disabilities and to
identify gaps between required supports and services by region of the
state. In addition, the Commissioner is directed to develop a
web-based database which will permit the prioritization of the urgency
of needs (P.D.N.S.) for supports and services for those facing
emergency or immediate need, those facing critical need, defined as
additional services and supports with one year and planning need, for
those who will require additional services and supports within five
years or where the individual's caregiver is over sixty years old.
Annual reporting requirements will allow the Executive and the
Legislature make informed policy choices in the delivery of supports
and services to people with developmental disabilities.

Section four of the bill makes technical amendments.

Section five of the bill amends section 16.01 of the Mental Hygiene
Law in order to permit the Commissioner, in consultation with
stakeholders, to identify and implement a valid and reliable quality
assurance instrument that includes assessment of consumer and family
satisfaction, provision of service and personal outcomes. The tool
must be nationally validated, benchmarked, consistent and reliable.
It must include outcome-based measures to track health, safety,
well-being, relationships, interactions with people who do not have a
disability, employment, quality of life, integration, choice, service
and consumer satisfaction,

Section six is the effective date of the bill.

JUSTIFICATION:

The New York State Department of Health (DOH) in partnership with the
Office of People With Developmental Disabilities (OPWDD) proposed a
new model for the financing of services for individuals with
developmental disabilities to the federal government. The federal
government no longer supports NY's current model for financing
services and supports for people with developmental disabilities. The
current model is based, in significant part, upon allowed costs for
institutional placement, which are substantially in excess of actual
costs of institutional placement, as institutional capacity has been


reduced over the past 30 years, The state and the federal government
had previously agreed that as institutional capacity was reduced, the
funds otherwise used for institutional placement could follow the
individual into the: community. The use of these funds allowed NYS to
create the current community-based service structure.

The state was authorized in the 2011-12 Enacted Budget to submit a
Medicaid waiver application, which OMPDD has called the "People First
Waiver", in order to transition the current Medicaid "fee for service"
longterm care services for individuals with developmental disabilities
to a care management model.

The state is seeking authority to transition individuals served by the
current service delivery system into mandatory enrollment in managed
long-term care services.

The core concept behind the "People First Waiver'" application is an
individual budget allocation built on a standardized assessment of
individual support needs.. Recognizing that people with developmental
disabilities want to live their lives in the community, just like
everyone else, OPWOD is racing to embrace the concept of a
"self-directed" person-centered system, where individuals and their
circle of support have considerable authority over what supports they
receive, how they are received and from whom.

At the center of any system promoting self-direction is a personal
budget allocation that the individual and his circle of support may
apply within the bounds of an approved service plan to secure needed
supports. The Center for Medicare and Medicaid Services (CMS)
requires any "individual budget amount" to be "a prospectively
determined amount of funds that the state makes available for the
provision of (federally funded) services to an (individual)". Implicit
in this definition are two key concepts: the state determines the
budget amount for each individual, and the individual and/or his or
her circle of support is provided this information before developing a
service plan.

Essential to reforming the resource allocation system is choosing an
assessment tool that will provide sufficient information to accurately
and appropriately differentiate among service participants with
respect to their support needs. The state is considering testing the
InterRAI-DD assessment tool for this critical function. However, in
order to be successful, information must be collected on the amount of
money that is expended annually for each person is support. The
support needs of individuals must be systemically analyzed in relation
to cost. At the same time, the state must have reliable and accurate
information pertaining to the number of people who have requested
services and need them presently and others who would likely seek
services in the near future. Doing so requires diligent data
collection over several years to examine how demand trends behave over
time.

This bill encourages the type of data-gathering initiative that has
proven successful in Pennsylvania and Illinois and will insure the
accuracy of waitlist numbers. Combined with the expected
implementation of the InterRAI-DD assessment tool, the state can begin
to make meaningful projections regarding the budget allocations


individuals will require if they were immediately enrolled in the
system and began receiving the services their support needs justify.
This information will provide the Executive and the Legislature with
more reliable estimates of the costs associated with reducing wait
lists over time, and enable OPWDD to more purposefully plan for
building system capacity.

A second critically important component of the "People First Waiver"
is to improve the quality of services delivered. Adopting an
assessment- based resource allocation approach and building individual
budget allocations are integral parts of a strong quality improvement
process. This approach should improve access to services because an
adequate and equitable budget allocation will be established for each
person. A personcentered planning process builds based upon knowledge
of the support needs of individuals and is made more effective because
each person served will have his or her own budget allocation. The
increased efficiency and equity in resource allocation conceptualized
in the People First Waiver application should enhance provider
capacity as service rates are appropriately established based upon
actual cost to provide the necessary supports and services to a
pr'operly assessed individual. Health and safety requirements,
instead of being mandated by state regulators operating in a "one size
fits all" model can be appropriately established and fashioned in
direct response to the nature of an individual's support needs.

The quality of services in this new "People First Waiver" can be
improved by analyzing the impact of resource allocations on service
outcomes. While state policy makers and providers are concerned about
the health and well being of people with developmental disabilities,
there is a critical need to assess systematically the relationships
between individual budget allocations, the services delivered as a
result of this allocation, and the achievement of desired outcomes. It
is critically important in this new system redesign that we measure
the outcomes as perceived by the people receiving the supports and
services, Quality needs to be tied to individual outcomes, to their'
safety, to their ability to gain employment, to have friendships and
to live with friends in settings they feel good about.

This bill provides for the type of person-centered, empirical data
collection aimed at identifying in a comprehensive, consistent and
reliable manner the quality of services using assessments of consumer
and family satisfaction, their perspective on the provision of service
and how the new service delivery model impacts on the personal
outcomes of their lives.

PRIOR LEGISLATIVE HISTORY:
S.6420/A.9402 of 2011-12; Reported and Committed to Finance

FISCAL IMPACT:

To be determined.

LOCAL FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:


Immediately.

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

                                 1109--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on  Mental  Health  and  Developmental   Disabilities   --   committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT  to  amend  the  mental hygiene law, in relation to enacting the
  "people first act of 2013"

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

  Section  1.  Short  title. This act shall be known and may be cited as
the "people first act of 2013".
  S 2. Legislative findings. It is the  intent  of  the  legislature  to
ensure  that  individuals  with  developmental  disabilities who utilize
long-term care services under the medical assistance program  and  other
long-term  care  related benefit programs administered by the state have
meaningful access to a reasonable array of community-based and  institu-
tional  program options and to ensure the well-being of individuals with
developmental disabilities,  taking  into  account  their  informed  and
expressed  choices. Furthermore, the legislature declares that it is the
policy of the state to  ensure  that  the  clinical,  habilitative,  and
social  needs  of individuals with developmental disabilities who choose
to reside in integrated community-based settings can  have  those  needs
met  in  integrated  community-based  settings. In order to meaningfully
comply with this policy, the state must have  an  understanding  of  the
existing  capacity  in  integrated-community  based  settings, including
direct support professionals and licensed professionals, such as  physi-
cians, dentists, nurse practitioners, nurses, and psychiatrists, as well
as residential capacity to provide for these needs.
  It  is  further the intent of the legislature to support the satisfac-
tion and success of consumers through the delivery of  quality  services

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02298-02-3

S. 1109--A                          2

and supports. Evaluation of the services that consumers receive is a key
aspect  to  the service system. Utilizing the information that consumers
and their families provide about such services in a reliable  and  mean-
ingful  way is also critical to enable the commissioner of developmental
disabilities to assess the  performance  of  the  state's  developmental
services  system and to improve services for consumers in the future. To
that end, the commissioner of developmental disabilities shall conduct a
geographic analysis of supports and services in community  settings  and
implement  an improved, unified quality assessment system, in accordance
with this act.
  S 3. Section 13.15 of the mental hygiene law is amended  by  adding  a
new subdivision (d) to read as follows:
  (D)  (1)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL
HAVE THE FOLLOWING MEANINGS:
  (I) "DIRECT  SUPPORT  PROFESSIONALS"  MEANS  DIRECT  SUPPORT  WORKERS,
DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA-
PROFESSIONALS  THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES IN THE FORM OF DAILY LIVING, AND PROVIDE THE  HABILITATION,
REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS.
  (II)  "LICENSED  PROFESSIONALS"  MEANS,  BUT IS NOT LIMITED TO, PHYSI-
CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION-
ERS,  LICENSED  PRACTICAL  NURSES,  REGISTERED  NURSES,   PSYCHIATRISTS,
PSYCHOLOGISTS,  LICENSED  MASTER  SOCIAL  WORKERS,  OR LICENSED CLINICAL
SOCIAL WORKERS, LICENSED TO PRACTICE PURSUANT TO THE EDUCATION  LAW  AND
OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS.
  (III)  "SUPPORTS  AND  SERVICES"  MEANS  DIRECT SUPPORT PROFESSIONALS,
LICENSED PROFESSIONALS, AND RESIDENTIAL  SERVICES,  INCLUDING,  BUT  NOT
LIMITED  TO,  PRIVATE  RESIDENCES,  COMMUNITY-INTEGRATED LIVING ARRANGE-
MENTS, SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL  PROGRAMS,
OR SUPPORTIVE HOUSING PROGRAMS.
  (2)  SUBJECT  TO  AVAILABLE  APPROPRIATIONS THEREFOR, THE COMMISSIONER
SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI-
TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY-
SIS SHALL ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND  SERVICES  BY
REGION OF THE STATE.
  (3)  IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA FOR
PURPOSES OF PERFORMING THE GEOGRAPHIC  ANALYSIS,  THE  COMMISSIONER  MAY
WORK  IN  COOPERATION  AND  AGREEMENT WITH OTHER OFFICES, DEPARTMENTS OR
AGENCIES OF THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR  OTHER  ORGANIZA-
TIONS AND INDIVIDUALS.
  (4)  IN  CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT TO AVAIL-
ABLE APPROPRIATIONS THEREFOR, SHALL  DEVELOP  AND  UTILIZE  A  WEB-BASED
DATA-BASE  WHICH  PRIORITIZES  THE  URGENCY  OF  NEED  FOR  SUPPORTS AND
SERVICES. THE INFORMATION COLLECTED SHOULD  ALLOW  THE  COMMISSIONER  TO
CATEGORIZE  NEEDS  FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN A FRAME-
WORK THAT ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE  LEVEL  OF
SUPPORT  NEEDS  SHOULD  INCLUDE:  EMERGENCY NEED, FOR THOSE PERSONS WITH
DEVELOPMENTAL DISABILITIES IN  NEED  OF  IMMEDIATE  SUPPORT  EITHER  DAY
SUPPORT  OR  IN-HOME  OR  OUT-OF-HOME PLACEMENT; CRITICAL NEED FOR THOSE
INDIVIDUALS WHO WILL HAVE A NEED FOR SUPPORTS  OR  SERVICES  WITHIN  ONE
YEAR  AND  PLANNING  FOR NEED, FOR THOSE INDIVIDUALS WHOSE SUPPORT NEEDS
ARE ONE TO FIVE YEARS AWAY, OR WHERE  THE  CAREGIVER  IS  AGE  SIXTY  OR
OLDER.
  (5)  SUCH  AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER OF INDIVID-
UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE
TOTAL NUMBER OF INDIVIDUALS FROM WITHIN  EACH  DEVELOPMENTAL  DISABILITY

S. 1109--A                          3

SERVICES  OFFICE'S  GEOGRAPHIC AREA WHO AWAIT RESIDENTIAL PLACEMENT, DAY
SERVICE SUPPORT, HOME AND  COMMUNITY-BASED  WAIVER  SUPPORT,  EMPLOYMENT
SUPPORT,   BEHAVIORAL   HEALTH   SERVICES   AND   SUPPORTS,   OR   OTHER
COMMUNITY-BASED  SUPPORT.  SUCH INFORMATION SHOULD BE GROUPED BY THE AGE
OF THE INDIVIDUAL AWAITING COMMUNITY SERVICES AND SUPPORTS AND  THE  AGE
OF  THEIR  CAREGIVER, IF ANY. SUCH INFORMATION SHOULD ALSO INCLUDE WAIT-
LIST AND PLACEMENT INFORMATION SUCH AS:
  (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO
REQUIRE  DIVIDED  INTO  CERTIFIED  OUT-OF-HOME,  SUPERVISED,  SUPPORTIVE
PLACEMENT  NEEDS  AND  OTHER  NON-PLACEMENT NEEDS AND THE NUMBER OF SUCH
PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE;
  (II) NON-CERTIFIED RESIDENTIAL  PLACEMENTS  OUTSIDE  THE  PARENT'S  OR
PARENTS' OR OTHER CAREGIVER'S HOME;
  (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY
SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME;
  (IV)  THE  TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED AS IN
NEED OF SUPPORTS AND SERVICES  WHO  HAVE  RECEIVED  THESE  SUPPORTS  AND
SERVICES  AND  ANY  GAP  BETWEEN  REQUIRED SUPPORTS AND SERVICES AND THE
SUPPORTS AND SERVICES PROVIDED;
  (V) THE NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR  THE  PAST
YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS;
  (VI)  THE  NUMBER  OF INDIVIDUALS WHO ARE CURRENTLY RECEIVING SUPPORTS
AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU-
ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER-
NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS;
  (VII) PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS  IN
NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION;
  (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE
EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI-
DENTIAL PLACEMENTS; AND
  (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER.
  (6)  THE  COMMISSIONER  SHALL  PREPARE  ANNUALLY FOR THE GOVERNOR, THE
LEGISLATURE AND THE STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY
DISABLED A WRITTEN EVALUATION REPORT CONCERNING THE DELIVERY OF SUPPORTS
AND SERVICES IN THE COMMUNITY. ON OR BEFORE MARCH FIRST, IN  EACH  YEAR,
THE  COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH RECOMMEN-
DATION AS HE OR SHE DEEMS APPROPRIATE, TO THE  GOVERNOR,  THE  TEMPORARY
PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE RESPECTIVE
MINORITY LEADERS OF EACH SUCH HOUSE, AND THE CHAIR OF THE STATE  COMMIS-
SION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST SUCH REPORT
SHALL  BE  DUE  BY  NO LATER THAN MARCH FIRST, TWO THOUSAND FIFTEEN. THE
REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL BE PUBLISHED
ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION AT THE SAME  TIME  AS
ITS SUBMISSION TO STATE OFFICIALS.
  S  4.  Subdivision  (c) of section 16.01 of the mental hygiene law, as
added by chapter 234 of the laws of 1998,  paragraph  1  as  amended  by
chapter 37 of the laws of 2011, is amended to read as follows:
  [(c)]  (J) (1) Notwithstanding any other provision of law, the commis-
sioner, or his OR HER  designee,  may  require  from  any  hospital,  as
defined  under article twenty-eight of the public health law, any infor-
mation, report, or record necessary for the purpose of carrying out  the
functions, powers and duties of the commissioner related to the investi-
gation  of  deaths  and  complaints  of  abuse, mistreatment, or neglect
concerning persons with developmental disabilities who receive services,
or had prior to death received services, in a  facility  as  defined  in
section  1.03 of this chapter, or are receiving medicaid waiver services

S. 1109--A                          4

from the office for people with developmental disabilities in a non-cer-
tified setting, and have been treated at such hospitals.
  (2)  Any  information, report, or record requested by the commissioner
or his OR HER designee pursuant to this subdivision shall be limited  to
that  information  that  the  commissioner  determines necessary for the
completion of this investigation.
  (3) The information, report or record received by the commissioner  or
his  OR  HER  designee  pursuant to this subdivision shall be subject to
section two thousand eight hundred five-m, section eighteen, as added by
chapter four hundred ninety-seven of the laws of nineteen hundred eight-
y-six, and article twenty-seven-F of  the  public  health  law,  section
33.13 of this chapter, and any applicable federal statute or regulation.
  S  5.  Section  16.01  of  the mental hygiene law is amended by adding
seven new subdivisions (c), (d), (e), (f), (g), (h) and (i) to  read  as
follows:
  (C) THE COMMISSIONER, IN CONSULTATION WITH STAKEHOLDERS, INCLUDING BUT
NOT  LIMITED  TO  PROVIDERS  OF  SERVICES FOR PERSONS WITH DEVELOPMENTAL
DISABILITIES, REPRESENTATIVES FROM EMPLOYEE  ORGANIZATIONS  REPRESENTING
DIRECT  CARE  WORKERS,  CONSUMER  REPRESENTATIVES INCLUDING PERSONS WITH
DEVELOPMENTAL DISABILITIES, OR THEIR PARENTS OR  GUARDIANS,  CORRESPOND-
ENTS  AND  OTHER INTERESTED PERSONS, SHALL IDENTIFY A VALID AND RELIABLE
QUALITY ASSURANCE INSTRUMENT THAT INCLUDES ASSESSMENTS OF  CONSUMER  AND
FAMILY  SATISFACTION,  PROVISION OF SERVICES, AND PERSONAL OUTCOMES. THE
INSTRUMENT SHALL DO ALL OF THE FOLLOWING:
  (1) PROVIDE NATIONALLY VALIDATED,  BENCHMARKED,  CONSISTENT,  RELIABLE
AND MEASURABLE DATA FOR THE OFFICE'S QUALITY MANAGEMENT SYSTEM.
  (2) ENABLE THE COMMISSIONER AND ENTITIES CONTRACTED BY THE COMMISSION-
ER  TO  COORDINATE  AND/OR DELIVER SUPPORTS AND SERVICES TO PERSONS WITH
DEVELOPMENTAL DISABILITIES, INCLUDING BUT NOT LIMITED  TO  HEALTH  HOMES
ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-L OF THE SOCIAL
SERVICES  LAW  OR  OTHER  MANAGED  CARE ENTITIES AS APPROVED PURSUANT TO
SECTION FOUR THOUSAND FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH  LAW  TO
COMPARE  THE  PERFORMANCE  OF  NEW  YORK'S DEVELOPMENTAL SERVICES SYSTEM
AGAINST OTHER STATES' DEVELOPMENTAL SERVICES SYSTEMS AND TO ASSESS QUAL-
ITY AND PERFORMANCE AMONG ALL  OF  THE  MANAGED  CARE  AND  SERVICE  AND
SUPPORT ENTITIES STATEWIDE.
  (3) INCLUDE OUTCOME-BASED MEASURES SUCH AS HEALTH, SAFETY, WELL-BEING,
RELATIONSHIPS,  INTERACTIONS  WITH  PEOPLE WHO DO NOT HAVE A DISABILITY,
EMPLOYMENT, QUALITY OF LIFE, INTEGRATION, CHOICE, SERVICE, AND  CONSUMER
SATISFACTION.
  (D) TO THE EXTENT THAT FUNDING IS AVAILABLE, THE INSTRUMENT IDENTIFIED
IN SUBDIVISION (C) OF THIS SECTION MAY BE EXPANDED TO COLLECT ADDITIONAL
DATA  REQUESTED  BY OTHER OFFICES, DEPARTMENTS OR AGENCIES OF THE STATE,
LOCAL OR FEDERAL GOVERNMENT.
  (E) THE COMMISSIONER SHALL CONTRACT  WITH  AN  INDEPENDENT  AGENCY  OR
ORGANIZATION  TO  IMPLEMENT BY JANUARY FIRST, TWO THOUSAND FOURTEEN, THE
QUALITY ASSURANCE  INSTRUMENT  DESCRIBED  IN  SUBDIVISION  (C)  OF  THIS
SECTION. THE CONTRACTOR SHALL BE EXPERIENCED IN ALL OF THE FOLLOWING:
  (1)  DESIGNING  VALID  QUALITY ASSURANCE INSTRUMENTS FOR DEVELOPMENTAL
SERVICE SYSTEMS.
  (2) TRACKING OUTCOME-BASED MEASURES SUCH AS HEALTH,  SAFETY,  WELL-BE-
ING, RELATIONSHIPS, INTERACTIONS WITH PEOPLE WHO DO NOT HAVE A DISABILI-
TY,  EMPLOYMENT,  QUALITY  OF  LIFE,  INTEGRATION,  CHOICE, SERVICE, AND
CONSUMER SATISFACTION.
  (3) DEVELOPING DATA SYSTEMS.
  (4) DATA ANALYSIS AND REPORT PREPARATION.

S. 1109--A                          5

  (5) ASSESSMENTS OF THE SERVICES RECEIVED BY CONSUMERS  WHO  ARE  MOVED
FROM  DEVELOPMENTAL  CENTERS  TO  THE COMMUNITY, GIVEN THE LEGISLATURE'S
HISTORIC RECOGNITION OF A SPECIAL OBLIGATION TO ENSURE THE WELL-BEING OF
THESE PERSONS.
  (F) THE COMMISSIONER, IN CONSULTATION WITH THE CONTRACTOR DESCRIBED IN
SUBDIVISION  (E)  OF  THIS  SECTION,  SHALL ESTABLISH THE METHODOLOGY BY
WHICH THE QUALITY ASSURANCE INSTRUMENT SHALL BE ADMINISTERED, INCLUDING,
BUT NOT LIMITED TO, HOW OFTEN AND TO WHOM THE QUALITY ASSURANCE WILL  BE
ADMINISTERED,  AND  THE  DESIGN OF A STRATIFIED, RANDOM SAMPLE AMONG THE
ENTIRE POPULATION OF CONSUMERS SERVED BY  SERVICE  PROVIDERS,  INCLUDING
ANY  NEWLY  APPROVED MANAGED CARE ENTITIES. THE CONTRACTOR SHALL PROVIDE
AGGREGATE INFORMATION FOR ALL SERVICE  PROVIDERS  AND  THE  STATE  AS  A
WHOLE.  AT THE REQUEST OF A CONSUMER OR THE FAMILY MEMBER OF A CONSUMER,
THE SURVEY SHALL BE CONDUCTED IN THE PRIMARY LANGUAGE OF THE CONSUMER OR
FAMILY MEMBER SURVEYED.
  (G) THE COMMISSIONER SHALL COLLECT  DATA  FOR  THE  QUALITY  ASSURANCE
INSTRUMENT  DESCRIBED IN SUBDIVISION (C) OF THIS SECTION. IF, DURING THE
DATA COLLECTION  PROCESS,  THE  COMMISSIONER  IDENTIFIES  ANY  SUSPECTED
VIOLATION OF THE LEGAL, CIVIL, OR SERVICE RIGHTS OF A CONSUMER, OR IF IT
DETERMINES  THAT  THE  HEALTH AND WELFARE OF A CONSUMER IS AT RISK, THAT
INFORMATION SHALL BE PROVIDED IMMEDIATELY TO THE CHAIR OF THE COMMISSION
ON QUALITY OF CARE FOR THE MENTALLY DISABLED  AND  ANY  REGIONAL  ENTITY
PROVIDING  CASE  MANAGEMENT  SERVICES TO THE CONSUMER. AT THE REQUEST OF
THE CONSUMER, OR FAMILY, WHEN  APPROPRIATE,  A  COPY  OF  THE  COMPLETED
SURVEY  SHALL  BE  PROVIDED TO THE COMMISSION ON QUALITY OF CARE FOR THE
MENTALLY DISABLED AND ANY  REGIONAL  ENTITY  PROVIDING  CASE  MANAGEMENT
SERVICES TO IMPROVE THE CONSUMER'S QUALITY OF SERVICES THROUGH THE INDI-
VIDUAL PLANNING PROCESS.
  (H) THE COMMISSIONER, IN CONSULTATION WITH STAKEHOLDERS, SHALL ANNUAL-
LY REVIEW THE DATA COLLECTED FROM AND THE FINDINGS OF THE QUALITY ASSUR-
ANCE  INSTRUMENT DESCRIBED IN SUBDIVISION (C) OF THIS SECTION AND ACCEPT
RECOMMENDATIONS REGARDING ADDITIONAL OR DIFFERENT CRITERIA FOR THE QUAL-
ITY ASSURANCE INSTRUMENT IN ORDER  TO  ASSESS  THE  PERFORMANCE  OF  THE
STATE'S  DEVELOPMENTAL  SERVICES SYSTEM AND IMPROVE SERVICES FOR CONSUM-
ERS.
  (I) ALL REPORTS GENERATED PURSUANT  TO  THIS  SECTION  SHALL  BE  MADE
PUBLICLY  AVAILABLE,  BUT  SHALL  NOT  CONTAIN  ANY PERSONAL IDENTIFYING
INFORMATION ABOUT ANY PERSON ASSESSED.
  S 6. This act shall take effect immediately.

Co-Sponsors

S1109B - Bill Details

See Assembly Version of this Bill:
A8452
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§13.15 & 16.01, Ment Hyg L
Versions Introduced in 2011-2012 Legislative Session:
S6420

S1109B - Bill Texts

view summary

Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.

view sponsor memo
BILL NUMBER:S1109B

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
enacting the "people first act of 2013"

SUMMARY OF PROVISIONS:

Section one provides for the short title of the bill to be the "People
First Act of 2013."

Section two of the bill contains legislative findings.

Section three of the bill amends section 13.15 of the Mental Hygiene
Law, in order to require the Commissioner of OPWDD to conduct a
geographic analysis of the supports and services in community settings
available for individuals ,with developmental disabilities and to
identify gaps between required supports and services by region of the
state. In addition, the Commissioner is directed to develop a
web-based database which will permit the prioritization of the urgency
of needs (P.D.N.S.) for supports and services for those facing
emergency or immediate need, those facing critical need, defined as
additional services and supports with one year and planning need, for
those who will require additional services and supports within five
years or where the Individual's caregiver is over sixty years old.
Annual reporting requirements will allow the Executive and the
Legislature make informed policy choices in the delivery of supports
and services to people with developmental disabilities.

Section four, of the bill makes technical, amendments. Section five is
the effective date of the bill.

JUSTIFICATION:

The New York State Department of Health (DOH) in partnership with the
Office of People with Developmental Disabilities (OPWDD) proposed a
new model for the financing of services for individuals with
developmental disabilities to the federal government. The federal
government no longer supports NY's current model for financing
services and supports for people with developmental disabilities. The
current model is based, in significant part, upon allowed costs for
institutional placement, which are substantially in excess of actual
costs of institutional placement, as institutional capacity has been
reduced over the past 30 years. The state and the federal government
had previously agreed that as institutional capacity was reduced, the
funds otherwise used for institutional placement could follow the
individual into the community. The use of these funds allowed NYS to
create the current community-based service structure.

The state was authorized in the 2011-12 Enacted. Budget to submit a
Medicaid waiver application, which OPWDD has called the "People First
Waiver", in order to transition the current Medicaid "fee for service"
longterm care services for individuals with developmental disabilities
to a case management model.

The state is seeking authority to transition individuals served by the
current service delivery system into mandatory enrollment in managed
long-term care services. The core concept behind the "People First


Waiver" application is an individual budget allocation built on a
standardized assessment of individual support needs. Recognizing that
people with developmental disabilities want to live their lives in the
community, just like everyone else, OPWDD is racing to embrace the
concept of a "selfdirected person-cantered system, where individuals
and their circle of support have considerable authority over what
supports they receive, how they are received and from whom.

At the center of any system promoting self-direction is a personal
budget allocation that the individual and his circle of support may
apply within the bounds of an approved service plan to secure needed
supports. The Center for Medicare and Medicaid Services (CMS) requires
any "individual budget amount" to be "a prospectively determined
amount of funds that the state makes available for the provision of
federally funded services to an (individual)". Implicit in this
definition are two key concepts: the state determines the budget
amount for each individual, and the individual and/or his or her
circle of support is provided this information before developing a
service plan.

LEGISLATIVE HISTORY:

S.6420/A.9402 of 2011-12; Reported and Committed to Finance

FISCAL IMPACT:

To be determined.

EFFECTIVE DATE:

Immediately.

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

                                 1109--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on  Mental  Health  and  Developmental   Disabilities   --   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 mental hygiene law,  in  relation  to  enacting  the
  "people first act of 2013"

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

  Section 1. Short title. This act shall be known and may  be  cited  as
the "people first act of 2013".
  S  2.  Legislative  findings.  It  is the intent of the legislature to
ensure that individuals  with  developmental  disabilities  who  utilize
long-term  care  services under the medical assistance program and other
long-term care related benefit programs administered by the  state  have
meaningful  access to a reasonable array of community-based and institu-
tional program options and to ensure the well-being of individuals  with
developmental  disabilities,  taking  into  account  their  informed and
expressed choices. Furthermore, the legislature declares that it is  the
policy  of  the  state  to  ensure  that the clinical, habilitative, and
social needs of individuals with developmental disabilities  who  choose
to  reside  in  integrated community-based settings can have those needs
met in integrated community-based settings.  In  order  to  meaningfully
comply  with  this  policy,  the state must have an understanding of the
existing capacity  in  integrated-community  based  settings,  including
direct  support professionals and licensed professionals, such as physi-
cians, dentists, nurse practitioners, nurses, and psychiatrists, as well
as residential capacity to provide for these needs.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02298-05-3

S. 1109--B                          2

  It is further the intent of the legislature to support  the  satisfac-
tion  and  success of consumers through the delivery of quality services
and supports. Evaluation of the services that consumers receive is a key
aspect to the service system. Utilizing the information  that  consumers
and  their  families provide about such services in a reliable and mean-
ingful way is also critical to enable the commissioner of  developmental
disabilities  to  assess  the  performance  of the state's developmental
services system and to improve services for consumers in the future.  To
that end, the commissioner of developmental disabilities shall conduct a
geographic  analysis  of supports and services in community settings and
implement an improved, unified quality assessment system, in  accordance
with this act.
  S  3.  Section  13.15 of the mental hygiene law is amended by adding a
new subdivision (d) to read as follows:
  (D) (1) FOR PURPOSES OF THIS SUBDIVISION, THE  FOLLOWING  TERMS  SHALL
HAVE THE FOLLOWING MEANINGS:
  (I)  "DIRECT  SUPPORT  PROFESSIONALS"  MEANS  DIRECT  SUPPORT WORKERS,
DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA-
PROFESSIONALS THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH  DEVELOPMENTAL
DISABILITIES  IN THE FORM OF DAILY LIVING, AND PROVIDE THE HABILITATION,
REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS.
  (II) "LICENSED PROFESSIONALS" MEANS, BUT IS  NOT  LIMITED  TO,  PHYSI-
CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION-
ERS,   LICENSED  PRACTICAL  NURSES,  REGISTERED  NURSES,  PSYCHIATRISTS,
PSYCHOLOGISTS, LICENSED MASTER  SOCIAL  WORKERS,  OR  LICENSED  CLINICAL
SOCIAL  WORKERS,  LICENSED TO PRACTICE PURSUANT TO THE EDUCATION LAW AND
OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS.
  (III) "SUPPORTS AND  SERVICES"  MEANS  DIRECT  SUPPORT  PROFESSIONALS,
LICENSED  PROFESSIONALS,  AND  RESIDENTIAL  SERVICES, INCLUDING, BUT NOT
LIMITED TO, PRIVATE  RESIDENCES,  COMMUNITY-INTEGRATED  LIVING  ARRANGE-
MENTS,  SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL PROGRAMS,
OR SUPPORTIVE HOUSING PROGRAMS.
  (2) SUBJECT TO AVAILABLE  APPROPRIATIONS  THEREFOR,  THE  COMMISSIONER
SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI-
TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY-
SIS  SHALL  ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND SERVICES BY
REGION OF THE STATE.
  (3) IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA  FOR
PURPOSES  OF  PERFORMING  THE  GEOGRAPHIC ANALYSIS, THE COMMISSIONER MAY
WORK IN COOPERATION AND AGREEMENT WITH  OTHER  OFFICES,  DEPARTMENTS  OR
AGENCIES  OF  THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR OTHER ORGANIZA-
TIONS AND INDIVIDUALS.
  (4) IN CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT  TO  AVAIL-
ABLE  APPROPRIATIONS  THEREFOR,  SHALL  DEVELOP  AND UTILIZE A WEB-BASED
DATA-BASE WHICH  PRIORITIZES  THE  URGENCY  OF  NEED  FOR  SUPPORTS  AND
SERVICES.  THE  INFORMATION  COLLECTED  SHOULD ALLOW THE COMMISSIONER TO
CATEGORIZE NEEDS FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN  A  FRAME-
WORK  THAT  ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE LEVEL OF
SUPPORT NEEDS SHOULD INCLUDE: EMERGENCY NEED,  FOR  THOSE  PERSONS  WITH
DEVELOPMENTAL  DISABILITIES  IN  NEED  OF  IMMEDIATE  SUPPORT EITHER DAY
SUPPORT OR IN-HOME OR OUT-OF-HOME PLACEMENT;  CRITICAL  NEED  FOR  THOSE
INDIVIDUALS  WHO  WILL  HAVE  A NEED FOR SUPPORTS OR SERVICES WITHIN ONE
YEAR; AND PLANNING FOR NEED, FOR THOSE INDIVIDUALS WHOSE  SUPPORT  NEEDS
ARE  ONE  TO  FIVE  YEARS  AWAY,  OR WHERE THE CAREGIVER IS AGE SIXTY OR
OLDER.

S. 1109--B                          3

  (5) SUCH AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER  OF  INDIVID-
UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE
TOTAL  NUMBER OF INDIVIDUALS FROM WITHIN EACH REGIONAL SERVICES OFFICE'S
GEOGRAPHIC AREA WHO AWAIT RESIDENTIAL PLACEMENT,  DAY  SERVICE  SUPPORT,
HOME  AND COMMUNITY-BASED WAIVER SUPPORT, EMPLOYMENT SUPPORT, BEHAVIORAL
HEALTH SERVICES AND SUPPORTS, OR  OTHER  COMMUNITY-BASED  SUPPORT.  SUCH
INFORMATION  SHOULD  BE  GROUPED  BY  THE AGE OF THE INDIVIDUAL AWAITING
COMMUNITY SERVICES AND SUPPORTS AND THE AGE OF THEIR CAREGIVER, IF  ANY.
SUCH  INFORMATION SHOULD ALSO INCLUDE WAITLIST AND PLACEMENT INFORMATION
SUCH AS:
  (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO
REQUIRE  DIVIDED  INTO  CERTIFIED  OUT-OF-HOME,  SUPERVISED,  SUPPORTIVE
PLACEMENT  NEEDS  AND  OTHER  NON-PLACEMENT NEEDS AND THE NUMBER OF SUCH
PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE;
  (II) NON-CERTIFIED RESIDENTIAL  PLACEMENTS  OUTSIDE  THE  PARENT'S  OR
PARENTS' OR OTHER CAREGIVER'S HOME;
  (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY
SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME;
  (IV)  THE  TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED AS IN
NEED OF SUPPORTS AND SERVICES  WHO  HAVE  RECEIVED  THESE  SUPPORTS  AND
SERVICES  AND  ANY  GAP  BETWEEN  REQUIRED SUPPORTS AND SERVICES AND THE
SUPPORTS AND SERVICES PROVIDED;
  (V) THE NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR  THE  PAST
YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS;
  (VI)  THE  NUMBER  OF INDIVIDUALS WHO ARE CURRENTLY RECEIVING SUPPORTS
AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU-
ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER-
NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS;
  (VII) PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS  IN
NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION;
  (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE
EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI-
DENTIAL PLACEMENTS; AND
  (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER.
  (6)  THE  COMMISSIONER  SHALL  PREPARE  ANNUALLY FOR THE GOVERNOR, THE
LEGISLATURE AND THE JUSTICE CENTER FOR THE  PROTECTION  OF  PEOPLE  WITH
SPECIAL  NEEDS  A  WRITTEN  EVALUATION REPORT CONCERNING THE DELIVERY OF
SUPPORTS AND SERVICES IN THE COMMUNITY. ON OR  BEFORE  MARCH  FIRST,  IN
EACH YEAR, THE COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH
RECOMMENDATION  AS  HE  OR  SHE  DEEMS APPROPRIATE, TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE, THE  SPEAKER  OF  THE  ASSEMBLY,  THE
RESPECTIVE  MINORITY  LEADERS  OF  EACH SUCH HOUSE, AND THE CHAIR OF THE
STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST
SUCH REPORT SHALL BE DUE BY NO LATER  THAN  MARCH  FIRST,  TWO  THOUSAND
FIFTEEN. THE REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL
BE  PUBLISHED  ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION AT THE
SAME TIME AS ITS SUBMISSION TO STATE OFFICIALS.
  S 4. Subdivision (c) of section 16.01 of the mental  hygiene  law,  as
added  by  chapter  234  of  the laws of 1998, paragraph 1 as amended by
chapter 37 of the laws of 2011, is amended to read as follows:
  [(c)] (J) (1) Notwithstanding any other provision of law, the  commis-
sioner,  or  his  OR  HER  designee,  may  require from any hospital, as
defined under article twenty-eight of the public health law, any  infor-
mation,  report, or record necessary for the purpose of carrying out the
functions, powers and duties of the commissioner related to the investi-
gation of deaths and  complaints  of  abuse,  mistreatment,  or  neglect

S. 1109--B                          4

concerning persons with developmental disabilities who receive services,
or  had  prior  to  death received services, in a facility as defined in
section 1.03 of this chapter, or are receiving medicaid waiver  services
from the office for people with developmental disabilities in a non-cer-
tified setting, and have been treated at such hospitals.
  (2)  Any  information, report, or record requested by the commissioner
or his OR HER designee pursuant to this subdivision shall be limited  to
that  information  that  the  commissioner  determines necessary for the
completion of this investigation.
  (3) The information, report or record received by the commissioner  or
his  OR  HER  designee  pursuant to this subdivision shall be subject to
section two thousand eight hundred five-m, section eighteen, as added by
chapter four hundred ninety-seven of the laws of nineteen hundred eight-
y-six, and article twenty-seven-F of  the  public  health  law,  section
33.13 of this chapter, and any applicable federal statute or regulation.
  S 5. This act shall take effect immediately.

Co-Sponsors

S1109C - Bill Details

See Assembly Version of this Bill:
A8452
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§13.15 & 16.01, Ment Hyg L
Versions Introduced in 2011-2012 Legislative Session:
S6420

S1109C - Bill Texts

view summary

Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.

view sponsor memo
BILL NUMBER:S1109C

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
enacting the "people first act of 2013"

SUMMARY OF PROVISIONS:

Section one provides for the short title of the bill to be the "People
First Act of 2013."

Section two of the bill contains legislative findings.

Section three of the bill amends section 13.15 of the Mental Hygiene
Law, in order to require the Commissioner of OPWDD to conduct a
geographic analysis of the supports and services in community settings
available for individuals ,with developmental disabilities and to
identify gaps between required supports and services by region of the
state. In addition, the Commissioner is directed to develop a
web-based database which will permit the prioritization of the urgency
of needs (P.D.N.S.) for supports and services for those facing
emergency or immediate need, those facing critical need, defined as
additional services and supports with one year and planning need, for
those who will require additional services and supports within five
years or where the Individual's caregiver is over sixty years old.
Annual reporting requirements will allow the Executive and the
Legislature make informed policy choices in the delivery of supports
and services to people with developmental disabilities.

Section four, of the bill makes technical, amendments. Section five is
the effective date of the bill.

JUSTIFICATION: The New York State Department of Health (DOH) in
partnership with the Office of People with Developmental Disabilities
(OPWDD) proposed a new model for the financing of services for
individuals with developmental disabilities to the federal government.
The federal government no longer supports NY's current model for
financing services and supports for people with developmental
disabilities, The current model is based, in significant part, upon
allowed costs for institutional placement, which are substantially in
excess of actual costs of institutional placement, as institutional
capacity has been reduced over the past 30 years, The state and the
federal government had previously agreed that as institutional
capacity was reduced, the funds otherwise used for institutional
placement could follow the individual into the community. The use of
these funds allowed NYS to create the current community-based service
structure.

The state was authorized in the 2011-12 Enacted. Budget to submit a
Medicaid waiver application, which OPWDD has called the "People First
Waiver", in order to transition the current Medicaid "fee for service"
longterm care services for individuals with developmental disabilities
to a case management model.

The state is seeking authority to transition individuals served by the
current service delivery system into mandatory enrollment in managed
long-term care services. The core concept behind the "People First
Waiver" application is an individual budget allocation built on a


standardized assessment of individual support needs. Recognizing that
people with developmental disabilities want to live their lives in the
community, just like everyone else, OPWDD is racing to embrace the
concept of a "self-directed person-cantered system, where individuals
and their circle of support have considerable authority over what
supports they receive, how they are received and from whom.

At the center of any system promoting self-direction is a personal
budget allocation that the individual and his circle of support may
apply within the bounds of an approved service plan to secure needed
supports. The Center for Medicare and Medicaid Services (CMS) requires
any "individual budget amount" to be "a prospectively determined
amount of funds that the state makes available for the provision of
federally funded services to an (individual)". Implicit in this
definition are two key concepts: the state determines the budget
amount for each individual, and the individual and/or his or her
circle of support is provided this information before developing a
service plan.

LEGISLATIVE HISTORY: S.6420/A.9402 of 2011-12; Reported and Committed
to Finance

FISCAL IMPACT: To be determined.

EFFECTIVE DATE: Immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 1109--C

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on  Mental  Health  and  Developmental   Disabilities   --   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  --  reported
  favorably  from  said  committee  and  committed  to  the Committee on
  Finance -- committee discharged, bill amended,  ordered  reprinted  as
  amended and recommitted to said committee

AN  ACT  to  amend  the  mental hygiene law, in relation to enacting the
  "people first act of 2013"

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

  Section  1.  Short  title. This act shall be known and may be cited as
the "people first act of 2013".
  S 2. Legislative findings. It is the  intent  of  the  legislature  to
ensure  that  individuals  with  developmental  disabilities who utilize
long-term care services under the medical assistance program  and  other
long-term  care  related benefit programs administered by the state have
meaningful access to a reasonable array of community-based and  institu-
tional  program options and to ensure the well-being of individuals with
developmental disabilities,  taking  into  account  their  informed  and
expressed  choices. Furthermore, the legislature declares that it is the
policy of the state to  ensure  that  the  clinical,  habilitative,  and
social  needs  of individuals with developmental disabilities who choose
to reside in integrated community-based settings can  have  those  needs
met  in  integrated  community-based  settings. In order to meaningfully
comply with this policy, the state must have  an  understanding  of  the
existing  capacity  in  integrated-community  based  settings, including
direct support professionals and licensed professionals, such as  physi-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02298-08-3

S. 1109--C                          2

cians, dentists, nurse practitioners, nurses, and psychiatrists, as well
as residential capacity to provide for these needs.
  It  is  further the intent of the legislature to support the satisfac-
tion and success of consumers through the delivery of  quality  services
and supports. Evaluation of the services that consumers receive is a key
aspect  to  the service system. Utilizing the information that consumers
and their families provide about such services in a reliable  and  mean-
ingful  way is also critical to enable the commissioner of developmental
disabilities to assess the  performance  of  the  state's  developmental
services  system and to improve services for consumers in the future. To
that end, the commissioner of developmental disabilities shall conduct a
geographic analysis of supports and services in community  settings  and
implement  an improved, unified quality assessment system, in accordance
with this act.
  S 3. Section 13.15 of the mental hygiene law is amended  by  adding  a
new subdivision (d) to read as follows:
  (D)  (1)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL
HAVE THE FOLLOWING MEANINGS:
  (I) "DIRECT  SUPPORT  PROFESSIONALS"  MEANS  DIRECT  SUPPORT  WORKERS,
DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA-
PROFESSIONALS  THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES IN THE FORM OF DAILY LIVING, AND PROVIDE THE  HABILITATION,
REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS.
  (II)  "LICENSED  PROFESSIONALS"  MEANS,  BUT IS NOT LIMITED TO, PHYSI-
CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION-
ERS,  LICENSED  PRACTICAL  NURSES,  REGISTERED  NURSES,   PSYCHIATRISTS,
PSYCHOLOGISTS,  LICENSED  MASTER  SOCIAL  WORKERS,  OR LICENSED CLINICAL
SOCIAL WORKERS, LICENSED TO PRACTICE PURSUANT TO THE EDUCATION  LAW  AND
OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS.
  (III)  "SUPPORTS  AND  SERVICES"  MEANS  DIRECT SUPPORT PROFESSIONALS,
LICENSED PROFESSIONALS, AND RESIDENTIAL  SERVICES,  INCLUDING,  BUT  NOT
LIMITED  TO,  PRIVATE  RESIDENCES,  COMMUNITY-INTEGRATED LIVING ARRANGE-
MENTS, SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL  PROGRAMS,
OR SUPPORTIVE HOUSING PROGRAMS.
  (2)  SUBJECT  TO  AVAILABLE  APPROPRIATIONS THEREFOR, THE COMMISSIONER
SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI-
TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY-
SIS SHALL ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND  SERVICES  BY
REGION OF THE STATE.
  (3)  IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA FOR
PURPOSES OF PERFORMING THE GEOGRAPHIC  ANALYSIS,  THE  COMMISSIONER  MAY
WORK  IN  COOPERATION  AND  AGREEMENT WITH OTHER OFFICES, DEPARTMENTS OR
AGENCIES OF THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR  OTHER  ORGANIZA-
TIONS  AND  INDIVIDUALS,  WHICH  MAY  INCLUDE  PROVIDERS OF SERVICES FOR
PERSONS WITH DEVELOPMENTAL DISABILITIES, REPRESENTATIVES  FROM  EMPLOYEE
ORGANIZATIONS REPRESENTING DIRECT CARE WORKERS, CONSUMER REPRESENTATIVES
INCLUDING  PERSONS  WITH DEVELOPMENTAL DISABILITIES, OR THEIR PARENTS OR
GUARDIANS.
  (4) IN CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT  TO  AVAIL-
ABLE  APPROPRIATIONS  THEREFOR,  SHALL  DEVELOP  AND UTILIZE A WEB-BASED
DATA-BASE WHICH  PRIORITIZES  THE  URGENCY  OF  NEED  FOR  SUPPORTS  AND
SERVICES.  THE  INFORMATION  COLLECTED  SHOULD ALLOW THE COMMISSIONER TO
CATEGORIZE NEEDS FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN  A  FRAME-
WORK  THAT  ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE LEVEL OF
SUPPORT NEEDS SHOULD INCLUDE: EMERGENCY NEED,  FOR  THOSE  PERSONS  WITH
DEVELOPMENTAL  DISABILITIES  IN  NEED  OF  IMMEDIATE  SUPPORT EITHER DAY

S. 1109--C                          3

SUPPORT OR IN-HOME OR OUT-OF-HOME PLACEMENT;  CRITICAL  NEED  FOR  THOSE
INDIVIDUALS  WHO  WILL  HAVE  A NEED FOR SUPPORTS OR SERVICES WITHIN ONE
YEAR; AND PLANNING FOR NEED, FOR THOSE INDIVIDUALS WHOSE  SUPPORT  NEEDS
ARE  ONE  TO  FIVE  YEARS  AWAY,  OR WHERE THE CAREGIVER IS AGE SIXTY OR
OLDER.
  (5) SUCH AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER  OF  INDIVID-
UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE
TOTAL  NUMBER OF INDIVIDUALS FROM WITHIN EACH REGIONAL SERVICES OFFICE'S
GEOGRAPHIC AREA WHO AWAIT RESIDENTIAL PLACEMENT,  DAY  SERVICE  SUPPORT,
HOME  AND COMMUNITY-BASED WAIVER SUPPORT, EMPLOYMENT SUPPORT, BEHAVIORAL
HEALTH SERVICES AND SUPPORTS, OR  OTHER  COMMUNITY-BASED  SUPPORT.  SUCH
INFORMATION  SHOULD  BE  GROUPED  BY  THE AGE OF THE INDIVIDUAL AWAITING
COMMUNITY SERVICES AND SUPPORTS AND THE AGE OF THEIR CAREGIVER, IF  ANY.
SUCH  INFORMATION SHOULD ALSO INCLUDE WAITLIST AND PLACEMENT INFORMATION
SUCH AS:
  (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO
REQUIRE  DIVIDED  INTO  CERTIFIED  OUT-OF-HOME,  SUPERVISED,  SUPPORTIVE
PLACEMENT  NEEDS  AND  OTHER  NON-PLACEMENT NEEDS AND THE NUMBER OF SUCH
PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE;
  (II) NON-CERTIFIED RESIDENTIAL  PLACEMENTS  OUTSIDE  THE  PARENT'S  OR
PARENTS' OR OTHER CAREGIVER'S HOME;
  (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY
SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME;
  (IV)  THE  TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED AS IN
NEED OF SUPPORTS AND SERVICES  WHO  HAVE  RECEIVED  THESE  SUPPORTS  AND
SERVICES  AND  ANY  GAP  BETWEEN  REQUIRED SUPPORTS AND SERVICES AND THE
SUPPORTS AND SERVICES PROVIDED;
  (V) THE NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR  THE  PAST
YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS;
  (VI)  THE  NUMBER  OF INDIVIDUALS WHO ARE CURRENTLY RECEIVING SUPPORTS
AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU-
ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER-
NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS;
  (VII) PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS  IN
NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION;
  (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE
EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI-
DENTIAL PLACEMENTS; AND
  (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER.
  (6)  THE  COMMISSIONER  SHALL  PREPARE  ANNUALLY FOR THE GOVERNOR, THE
LEGISLATURE AND THE JUSTICE CENTER FOR THE  PROTECTION  OF  PEOPLE  WITH
SPECIAL  NEEDS  A  WRITTEN  EVALUATION REPORT CONCERNING THE DELIVERY OF
SUPPORTS AND SERVICES IN THE COMMUNITY. ON OR  BEFORE  MARCH  FIRST,  IN
EACH YEAR, THE COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH
RECOMMENDATION  AS  HE  OR  SHE  DEEMS APPROPRIATE, TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE, THE  SPEAKER  OF  THE  ASSEMBLY,  THE
RESPECTIVE  MINORITY  LEADERS  OF  EACH SUCH HOUSE, AND THE CHAIR OF THE
STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST
SUCH REPORT SHALL BE DUE BY NO LATER  THAN  MARCH  FIRST,  TWO  THOUSAND
FIFTEEN. THE REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL
BE  PUBLISHED  ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION AT THE
SAME TIME AS ITS SUBMISSION TO STATE OFFICIALS.
  S 4. Subdivision (c) of section 16.01 of the mental  hygiene  law,  as
added  by  chapter  234  of  the laws of 1998, paragraph 1 as amended by
chapter 37 of the laws of 2011, is amended to read as follows:

S. 1109--C                          4

  (c) (1) Notwithstanding any other provision of law, the  commissioner,
or  his OR HER designee, may require from any hospital, as defined under
article twenty-eight of the public health law, any information,  report,
or  record  necessary  for  the  purpose  of carrying out the functions,
powers  and  duties  of the commissioner related to the investigation of
deaths and complaints of  abuse,  mistreatment,  or  neglect  concerning
persons  with  developmental  disabilities  who receive services, or had
prior to death received services, in a facility as  defined  in  section
1.03 of this chapter, or are receiving medicaid waiver services from the
office  for  people  with  developmental disabilities in a non-certified
setting, and have been treated at such hospitals.
  (2) Any information, report, or record requested by  the  commissioner
or  his OR HER designee pursuant to this subdivision shall be limited to
that information that the  commissioner  determines  necessary  for  the
completion of this investigation.
  (3)  The information, report or record received by the commissioner or
his OR HER designee pursuant to this subdivision  shall  be  subject  to
section two thousand eight hundred five-m, section eighteen, as added by
chapter four hundred ninety-seven of the laws of nineteen hundred eight-
y-six,  and  article  twenty-seven-F  of  the public health law, section
33.13 of this chapter, and any applicable federal statute or regulation.
  S 5. This act shall take effect immediately.

Co-Sponsors

S1109D (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A8452
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§13.15 & 16.01, Ment Hyg L
Versions Introduced in 2011-2012 Legislative Session:
S6420

S1109D (ACTIVE) - Bill Texts

view summary

Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.

view sponsor memo
BILL NUMBER:S1109D

TITLE OF BILL: An act to amend the mental hygiene law, in relation to
enacting the "people first act of 2014"

SUMMARY OF PROVISIONS:

Section one provides for the short title of the bill to be the "People
First Act of 2014."

Section two of the bill contains legislative findings.

Section three of the bill amends section 13.15 of the Mental Hygiene
Law, in order to require the Commissioner of OPWDD to conduct a
geographic analysis of the supports and services in community settings
available for individuals ,with developmental disabilities and to
identify gaps between required supports and services by region of the
state. In addition, the Commissioner is directed to develop a
web-based database which will permit the prioritization of the urgency
of needs (P.D.N.S.) for supports and services for those facing
emergency or immediate need, those facing critical need, defined as
additional services and supports with one year and planning need, for
those who will require additional services and supports within five
years or where the Individual's caregiver is over sixty years old.
Annual reporting requirements will allow the Executive and the
Legislature make informed Policy choices in the delivery of supports
and services to people with developmental disabilities.

Section four, of the bill makes technical, amendments. Section five is
the effective date of the bill.

JUSTIFICATION: The New York State Department of Health (DOH) in
partnership with the Office of People with Developmental Disabilities
(OPWDD) proposed a new model for the financing of services for
individuals with developmental disabilities to the federal government.
The federal government no longer supports NY's current model for
financing services and supports for people with developmental
disabilities, The current model is based, in significant part, upon
allowed costs for institutional placement, which are substantially in
excess of actual costs of institutional placement, as institutional
capacity has been reduced over the past 30 years, The state and the
federal government had previously agreed that as institutional
capacity was reduced, the funds otherwise used for institutional
placement could follow the individual into the community. The use of
these funds allowed NYS to create the current community-based service
structure.

The state was authorized in the 2011-12 Enacted. Budget to submit a
Medicaid waiver application, which OPWDD has called the "People First
Waiver", in order to transition the current Medicaid "fee for service"
longterm care services for individuals with developmental disabilities
to a case management model.

The state is seeking authority to transition individuals served by the
current service delivery system into mandatory enrollment in managed
long-term care services. The core concept behind the "People First
Waiver" application is an individual budget allocation built on a


standardized assessment of individual support needs. Recognizing that
people with developmental disabilities want to live their lives in the
community, just like everyone else, OPWDD is racing to embrace the
concept of a "self-directed person-cantered system, where individuals
and their circle of support have considerable authority over what
supports they receive, how they are received and from whom.

At the center of any system promoting self-direction is a personal
budget allocation that the individual and his circle of support may
apply within the bounds of an approved service plan to secure needed
supports. The Center for Medicare and Medicaid Services (CMS) requires
any "individual budget amount" to be "a prospectively determined
amount of funds that the state makes available for the provision of
federally funded services to an (individual)". Implicit in this
definition are two key concepts: the state determines the budget
amount for each individual, and the individual and/or his or her
circle of support is provided this information before developing a
service plan.

LEGISLATIVE HISTORY: S.6420/A.9402 of 2011-12; Reported and Committed
to Finance

FISCAL IMPACT: To be determined.

EFFECTIVE DATE: Immediately.

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

                                 1109--D

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice
  and ordered printed, and when printed to be committed to the Committee
  on  Mental  Health  and  Developmental   Disabilities   --   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  --  reported
  favorably  from  said  committee  and  committed  to  the Committee on
  Finance -- committee discharged, bill amended,  ordered  reprinted  as
  amended  and  recommitted  to  said  committee  --  recommitted to the
  Committee on Mental Health and Developmental Disabilities  in  accord-
  ance with Senate Rule 6, sec. 8 -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN  ACT  to  amend  the  mental hygiene law, in relation to enacting the
  "people first act of 2014"

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

  Section  1.  Short  title. This act shall be known and may be cited as
the "people first act of 2014".
  S 2. Legislative findings. It is the  intent  of  the  legislature  to
ensure  that  individuals  with  developmental  disabilities who utilize
long-term care services under the medical assistance program  and  other
long-term  care  related benefit programs administered by the state have
meaningful and reliable access to a reasonable array of  community-based
and  institutional program options and to ensure the well-being of indi-
viduals with  developmental  disabilities,  taking  into  account  their
informed  and  expressed  choices. Furthermore, the legislature declares
that it is the policy of the state to ensure that the clinical,  habili-
tative,  and social needs of individuals with developmental disabilities
who choose to reside in integrated  community-based  settings  can  have
those  needs  met  in  integrated  community-based settings. In order to

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02298-10-3

S. 1109--D                          2

meaningfully comply with this policy, the state must have an understand-
ing of the existing capacity  in  integrated  community-based  settings,
including  direct support professionals and licensed professionals, such
as physicians, dentists, nurse practitioners, nurses, and psychiatrists,
as well as residential capacity to provide for these needs.
  It  is  further the intent of the legislature to support the satisfac-
tion and success of consumers through the delivery of  quality  services
and supports. Evaluation of the services that consumers receive is a key
aspect  to  the service system. Utilizing the information that consumers
and their families provide about such services in a reliable  and  mean-
ingful  way is also critical to enable the commissioner of developmental
disabilities to assess the  performance  of  the  state's  developmental
services  system and to improve services for consumers in the future. To
that end, the commissioner of developmental disabilities shall conduct a
geographic analysis of supports and services in community  settings  and
implement  an improved, unified quality assessment system, in accordance
with this act.
  S 3. Section 13.15 of the mental hygiene law is amended  by  adding  a
new subdivision (c) to read as follows:
  (C)  (1)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL
HAVE THE FOLLOWING MEANINGS:
  (I) "DIRECT  SUPPORT  PROFESSIONALS"  MEANS  DIRECT  SUPPORT  WORKERS,
DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA-
PROFESSIONALS  THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES IN THE FORM OF DAILY LIVING, AND PROVIDE THE  HABILITATION,
REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS.
  (II)  "LICENSED  PROFESSIONALS"  MEANS,  BUT IS NOT LIMITED TO, PHYSI-
CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION-
ERS,  LICENSED  PRACTICAL  NURSES,  REGISTERED  NURSES,   PSYCHIATRISTS,
PSYCHOLOGISTS,  LICENSED  MASTER  SOCIAL  WORKERS,  OR LICENSED CLINICAL
SOCIAL WORKERS, LICENSED TO PRACTICE PURSUANT TO THE EDUCATION  LAW  AND
OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS.
  (III)  "SUPPORTS  AND  SERVICES"  MEANS  DIRECT SUPPORT PROFESSIONALS,
LICENSED PROFESSIONALS, AND RESIDENTIAL  SERVICES,  INCLUDING,  BUT  NOT
LIMITED  TO,  PRIVATE  RESIDENCES,  COMMUNITY-INTEGRATED LIVING ARRANGE-
MENTS, SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL  PROGRAMS,
OR SUPPORTIVE HOUSING PROGRAMS.
  (2)  SUBJECT  TO  AVAILABLE  APPROPRIATIONS THEREFOR, THE COMMISSIONER
SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI-
TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY-
SIS SHALL ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND  SERVICES  BY
REGION OF THE STATE.
  (3)  IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA FOR
PURPOSES OF PERFORMING THE GEOGRAPHIC  ANALYSIS,  THE  COMMISSIONER  MAY
WORK  IN  COOPERATION  AND  AGREEMENT WITH OTHER OFFICES, DEPARTMENTS OR
AGENCIES OF THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR  OTHER  ORGANIZA-
TIONS  AND  INDIVIDUALS,  WHICH  MAY  INCLUDE  PROVIDERS OF SERVICES FOR
PERSONS WITH DEVELOPMENTAL DISABILITIES, REPRESENTATIVES  FROM  EMPLOYEE
ORGANIZATIONS REPRESENTING DIRECT CARE WORKERS, CONSUMER REPRESENTATIVES
INCLUDING  PERSONS  WITH DEVELOPMENTAL DISABILITIES, OR THEIR PARENTS OR
GUARDIANS.
  (4) IN CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT  TO  AVAIL-
ABLE  APPROPRIATIONS  THEREFOR,  SHALL  DEVELOP  AND UTILIZE A WEB-BASED
DATA-BASE WHICH  PRIORITIZES  THE  URGENCY  OF  NEED  FOR  SUPPORTS  AND
SERVICES.  THE  INFORMATION  COLLECTED  SHOULD ALLOW THE COMMISSIONER TO
CATEGORIZE NEEDS FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN  A  FRAME-

S. 1109--D                          3

WORK  THAT  ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE LEVEL OF
SUPPORT NEEDS SHOULD INCLUDE: EMERGENCY NEED,  FOR  THOSE  PERSONS  WITH
DEVELOPMENTAL  DISABILITIES  IN  NEED  OF  IMMEDIATE  SUPPORT EITHER DAY
SUPPORT  OR  IN-HOME  OR  OUT-OF-HOME PLACEMENT; CRITICAL NEED FOR THOSE
INDIVIDUALS WHO WILL HAVE A NEED FOR SUPPORTS  OR  SERVICES  WITHIN  ONE
YEAR;  AND  PLANNING FOR NEED, FOR THOSE INDIVIDUALS WHOSE SUPPORT NEEDS
ARE ONE TO FIVE YEARS AWAY, OR WHERE  THE  CAREGIVER  IS  AGE  SIXTY  OR
OLDER.
  (5)  SUCH  AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER OF INDIVID-
UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE
TOTAL NUMBER OF INDIVIDUALS FROM WITHIN EACH REGIONAL SERVICES  OFFICE'S
GEOGRAPHIC  AREA  WHO  AWAIT RESIDENTIAL PLACEMENT, DAY SERVICE SUPPORT,
HOME AND COMMUNITY-BASED WAIVER SUPPORT, EMPLOYMENT SUPPORT,  BEHAVIORAL
HEALTH  SERVICES  AND  SUPPORTS,  OR OTHER COMMUNITY-BASED SUPPORT. SUCH
INFORMATION SHOULD BE GROUPED BY THE  AGE  OF  THE  INDIVIDUAL  AWAITING
COMMUNITY  SERVICES AND SUPPORTS AND THE AGE OF THEIR CAREGIVER, IF ANY.
SUCH INFORMATION SHOULD ALSO INCLUDE WAITLIST AND PLACEMENT  INFORMATION
SUCH AS:
  (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO
REQUIRE  DIVIDED  INTO  CERTIFIED  OUT-OF-HOME,  SUPERVISED,  SUPPORTIVE
PLACEMENT NEEDS AND OTHER NON-PLACEMENT NEEDS AND  THE  NUMBER  OF  SUCH
PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE;
  (II)  NON-CERTIFIED  RESIDENTIAL  PLACEMENTS  OUTSIDE  THE PARENT'S OR
PARENTS' OR OTHER CAREGIVER'S HOME;
  (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY
SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME;
  (IV) THE TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED  AS  IN
NEED  OF  SUPPORTS  AND  SERVICES  WHO  HAVE RECEIVED THESE SUPPORTS AND
SERVICES AND ANY GAP BETWEEN REQUIRED  SUPPORTS  AND  SERVICES  AND  THE
SUPPORTS AND SERVICES PROVIDED;
  (V)  THE  NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR THE PAST
YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS;
  (VI) THE NUMBER OF INDIVIDUALS WHO ARE  CURRENTLY  RECEIVING  SUPPORTS
AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU-
ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER-
NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS;
  (VII)  PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS IN
NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION;
  (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE
EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI-
DENTIAL PLACEMENTS; AND
  (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER.
  (6) THE COMMISSIONER SHALL PREPARE  ANNUALLY  FOR  THE  GOVERNOR,  THE
LEGISLATURE  AND  THE  JUSTICE  CENTER FOR THE PROTECTION OF PEOPLE WITH
SPECIAL NEEDS A WRITTEN EVALUATION REPORT  CONCERNING  THE  DELIVERY  OF
SUPPORTS  AND  SERVICES  IN  THE COMMUNITY. ON OR BEFORE MARCH FIRST, IN
EACH YEAR, THE COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH
RECOMMENDATION AS HE OR SHE DEEMS  APPROPRIATE,  TO  THE  GOVERNOR,  THE
TEMPORARY  PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE
RESPECTIVE MINORITY LEADERS OF EACH SUCH HOUSE, AND  THE  CHAIR  OF  THE
STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST
SUCH  REPORT  SHALL  BE  DUE  BY NO LATER THAN MARCH FIRST, TWO THOUSAND
FIFTEEN. THE REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL
BE PUBLISHED ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION  AT  THE
SAME TIME AS ITS SUBMISSION TO STATE OFFICIALS.

S. 1109--D                          4

  S  4.  Subdivision  (c) of section 16.01 of the mental hygiene law, as
added by chapter 234 of the laws of 1998,  paragraph  1  as  amended  by
chapter 37 of the laws of 2011, is amended to read as follows:
  (c)  (1) Notwithstanding any other provision of law, the commissioner,
or his OR HER designee, may require from any hospital, as defined  under
article  twenty-eight of the public health law, any information, report,
or record necessary for the  purpose  of  carrying  out  the  functions,
powers  and  duties  of the commissioner related to the investigation of
deaths and complaints of  abuse,  mistreatment,  or  neglect  concerning
persons  with  developmental  disabilities  who receive services, or had
prior to death received services, in a facility as  defined  in  section
1.03 of this chapter, or are receiving medicaid waiver services from the
office  for  people  with  developmental disabilities in a non-certified
setting, and have been treated at such hospitals.
  (2) Any information, report, or record requested by  the  commissioner
or  his OR HER designee pursuant to this subdivision shall be limited to
that information that the  commissioner  determines  necessary  for  the
completion of this investigation.
  (3)  The information, report or record received by the commissioner or
his OR HER designee pursuant to this subdivision  shall  be  subject  to
section two thousand eight hundred five-m, section eighteen, as added by
chapter four hundred ninety-seven of the laws of nineteen hundred eight-
y-six,  and  article  twenty-seven-F  of  the public health law, section
33.13 of this chapter, and any applicable federal statute or regulation.
  S 5. This act shall take effect immediately.

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