senate Bill S2118A

Signed By Governor
2013-2014 Legislative Session

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

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Archive: Last Bill Status Via A4611 - Signed by Governor


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Dec 29, 2014 approval memo.34
signed chap.549
Dec 17, 2014 delivered to governor
May 28, 2014 returned to assembly
passed senate
May 20, 2014 3rd reading cal.557
substituted for s2118b
May 20, 2014 substituted by a4611b
May 12, 2014 advanced to third reading
May 07, 2014 2nd report cal.
May 06, 2014 1st report cal.557
Feb 27, 2014 print number 2118b
amend and recommit to health
Jan 08, 2014 referred to health
Jun 21, 2013 committed to rules
Jun 18, 2013 amended on third reading 2118a
vote reconsidered - restored to third reading
Jun 18, 2013 returned to senate
recalled from assembly
Mar 04, 2013 referred to health
delivered to assembly
passed senate
Feb 12, 2013 advanced to third reading
Feb 11, 2013 2nd report cal.
Feb 05, 2013 1st report cal.50
Jan 11, 2013 referred to health

Votes

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May 6, 2014 - Health committee Vote

S2118B
17
0
committee
17
Aye
0
Nay
0
Aye with Reservations
0
Absent
0
Excused
0
Abstained
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Feb 5, 2013 - Health committee Vote

S2118
16
0
committee
16
Aye
0
Nay
1
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show committee vote details

Bill Amendments

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

Co-Sponsors

S2118 - Bill Details

See Assembly Version of this Bill:
A4611A
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally
Versions Introduced in 2011-2012 Legislative Session:
S5224B

S2118 - Bill Texts

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

view sponsor memo
BILL NUMBER:S2118

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

PRIOR LEGISLATIVE HISTORY: 2012 - S.5224-B PASSED SENATE

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

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

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

                                  2118

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 11, 2013
                               ___________

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

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

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

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05244-01-3

S. 2118                             2

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

S. 2118                             3

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

S. 2118                             4

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

S. 2118                             5

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

S. 2118                             6

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

S. 2118                             7

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

S. 2118                             8

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

Co-Sponsors

S2118A - Bill Details

See Assembly Version of this Bill:
A4611A
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally
Versions Introduced in 2011-2012 Legislative Session:
S5224B

S2118A - Bill Texts

view summary

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

view sponsor memo
BILL NUMBER:S2118A

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

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

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 - Amends and adds a new subdivision to section 4601 of the
Public Health Law to allow for continuing care at home as continuing
care retirement community contract option.

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

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

Section 4 - Amends paragraphs d and e and clause (C) of subparagraph

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

Section 5 - Amends paragraph b of subdivision 4 of section 4604 of the
Public Health Law to provide oversight by the Commissioner of Health
rather than the Commissioner of Social Services.

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

Section 7 Amends subdivision 13 of section 4606 of the Public Health
Law to change language to reflect the option of continuing care at
home contracts.

Section 8 - Paragraphs e, f and g of subdivision 14 of section 4606 of
the Public Health Law are renumbered and a new paragraph e is added
to list the types of meal plans available.

Section 9 - Amends section 4608 of the Public Health Law to include
Continuing care retirement community or continuing care at home
contracts and limit certain provisions to life care and modified

contracts only, and set forth certain requirements for life care at
home contracts.

Section 10 - Amends subdivision 1 of section 4612 of the Public Health
Law to recognize that some residents under this section may be living
at home.

Section 11 - Amends subdivisions land 2 of section 4614 of the Public
Health Law to reflect that the Commissioner of Health shall have
responsibility for oversight.

Section 12 - Amends paragraph k of subdivision 1 of section 4615 of
the Public Health Law to reflect responsibility of the Commissioner
of Health.

Section 14 - Provides that this act shall take effect on the one
hundred eightieth day after it shall have become law, provided that
the Department of Health is authorized to immediately take such steps
as may be necessary to ensure implementation of this act.

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

PRIOR LEGISLATIVE HISTORY: 2011-2012:
A.8405-A/S.5224-B.

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

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

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

                                 2118--A
    Cal. No. 50

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 11, 2013
                               ___________

Introduced  by  Sens. RANZENHOFER, DeFRANCISCO, LIBOUS -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health -- reported favorably from said committee, ordered to first and
  second report, ordered to a third reading, passed by Senate and deliv-
  ered  to  the Assembly, recalled, vote reconsidered, restored to third
  reading, amended and ordered reprinted, retaining  its  place  in  the
  order of third reading

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

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

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05244-03-3

S. 2118--A                          2

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

S. 2118--A                          3

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

S. 2118--A                          4

imposed or damages assessed, or the  date,  nature  and  issuer  of  the
order;
  S 5. Paragraph b of subdivision 4 of section 4604 of the public health
law,  as  amended by chapter 659 of the laws of 1997, is amended to read
as follows:
  b. the commissioner [of social services] as to those  aspects  of  the
application relating to adult care facility beds, if any;
  S  6.  Paragraph  g  of  subdivision 2 of section 4604-a of the public
health law, as added by chapter 659 of the laws of 1997, is  amended  to
read as follows:
  g.  Unless  all  residents OR CONTINUING CARE AT HOME CONTRACT HOLDERS
have life care contracts, the operator has adequately  made  the  assur-
ances  required  by subdivision two of section forty-six hundred twenty-
four of this article and has agreed to fund the liability in  the  event
that [resident] SUCH RESIDENT'S OR CONTRACT HOLDER'S assets are insuffi-
cient to pay for nursing facility services for a one year period.
  S 7. Subdivision 13 of section 4606 of the public health law, as added
by chapter 659 of the laws of 1997, is amended to read as follows:
  13.  The  initial  disclosure  statement  and marketing materials of a
continuing care retirement community AND CONTINUING CARE AT HOME  CORPO-
RATION  must  clearly  include  a description of the services offered as
part of its contract, including, but not limited to, any limitations  on
nursing  facility services. The initial disclosure statement and market-
ing materials of a continuing care retirement  community  OR  CONTINUING
CARE  AT HOME CORPORATION which offers various types of contracts, which
may include life care contracts, must clearly  differentiate  among  the
various types of contracts which it may offer.
  S  8.  Paragraphs  e, f and g of subdivision 14 of section 4606 of the
public health law are relettered paragraphs f, g and h and a  new  para-
graph e is added to read as follows:
  E. THE TYPES OF MEAL PLANS AVAILABLE;
  S 9. Section 4608 of the public health law, as added by chapter 689 of
the  laws of 1989, the section heading, the opening paragraph and subdi-
vision 6 as amended and subdivision 17 as added by chapter  659  of  the
laws  of  1997,  subdivision  2 as amended by chapter 120 of the laws of
1993, subdivision 8 as amended by chapter 66 of the  laws  of  1994  and
subdivision 15 as further amended by section 104 of part A of chapter 62
of the laws of 2011, is amended to read as follows:
  S  4608.  Continuing care retirement COMMUNITY contract.  A continuing
care retirement COMMUNITY OR CONTINUING  CARE  AT  HOME  contract  shall
contain  all  of  the following information in no less than twelve point
type and in plain language, in addition to any other terms or matter  as
may  be required by regulations adopted by the council and issued by the
superintendent, EXCEPT WHEN SPECIFICALLY NOTED:
  1. The amount of all money transferred, including, but not limited to,
donations, subscriptions, deposits, fees, and any other amounts paid  or
payable  by,  or  on  behalf of, the resident or residents OR CONTINUING
CARE AT HOME CONTRACT HOLDER OR HOLDERS;
  2. A description of all services which are  to  be  furnished  by  the
operator,  a description of any fees in addition to the entrance fee and
periodic charges provided for in the contract, and the conditions  under
which  the  fees  may  be  adjusted, provided that an operator shall not
charge any non-refundable application fee to a prospective resident  who
has  paid  a  non-refundable  priority reservation agreement application
fee;

S. 2118--A                          5

  3. The procedures of the community OR CONTINUING CARE AT  HOME  CORPO-
RATION  relating to a resident's OR CONTRACT HOLDER'S failure to pay the
required monthly fees;
  4.  A  statement  of  the  figures and terms concerning the entry of a
spouse to the community and the consequences if the spouse does not meet
the requirements for entry;
  5. A statement of the terms and conditions under which a contract  may
be cancelled by the operator or by a resident OR CONTRACT HOLDER and the
conditions  under  which  all or any portion of the entrance fee will be
refunded by the operator, including the mandatory refund provisions  set
forth  in  sections  forty-six hundred nine and forty-six hundred ten of
this article;
  6. a. The procedures and conditions under  which  a  resident  may  be
transferred  from  his  or her living unit OR HOME including a statement
that, at the time of transfer, the resident will be  given  the  reasons
for  the transfer; the process by which a transfer decision is made; the
persons  with  the  authority  to  make  the  decision  to  transfer;  a
description  of  any  change  in  charges to be paid by the resident for
services not covered by the contract fees as a result of  the  transfer;
and  a statement regarding the disposition of and the right to return to
the living unit in cases of temporary and permanent transfers.
  b. [The] FOR CONTINUING CARE RETIREMENT COMMUNITY CONTRACTS  ONLY  THE
circumstances  under  which  a  living unit may be considered vacant and
eligible for transfer or resale to a new resident,  either  due  to  the
permanent  transfer  of  a  resident to the community's nursing or other
specialized facility or due to the permanent transfer of a resident to a
hospital or other facility outside of the community; provided,  however,
that  nothing  therein shall relieve a community from its obligations to
provide or to insure provision of all contractually required care pursu-
ant to the terms of a continuing care retirement  contract.    Should  a
resident's  chronic  condition  require  placement in a more specialized
chronic care facility  that  provides  services  beyond  those  provided
through the community's nursing facility, the liability of THE community
pursuant  to the terms of a continuing care retirement contract shall be
equal to the current per diem rate of the nursing facility minus the pro
rata apportionment of the resident's monthly fee for the period of  care
required  by  the contract.   Nothing herein shall obligate a continuing
care retirement community which does not have a life care contract  with
a  resident  to  provide or pay for a level of nursing facility services
nor for any duration  beyond  what  is  specifically  described  in  its
continuing  care  retirement  contract  with that resident. This section
shall not affect the operator's  obligation  under  subdivision  two  of
section forty-six hundred twenty-four of this article;
  7.  [A]  FOR  CONTINUING  CARE  RETIREMENT  COMMUNITY CONTRACTS ONLY A
statement that, if the resident dies prior to occupancy date or, through
illness, injury, or incapacity is precluded  from  becoming  a  resident
under the terms of the contract, the contract is automatically rescinded
and the resident or his or her legal representative shall receive a full
refund  of  all  moneys  paid  to  the  facility, except for those costs
specifically incurred by the facility at the request of the resident and
set forth in writing in a separate addendum, signed by  the  parties  to
the contract;
  8. FOR CONTINUING CARE AT HOME CONTRACTS THE CIRCUMSTANCES UNDER WHICH
THE  CONTRACT  HOLDER  MAY  MOVE  INTO A CAMPUS INDEPENDENT LIVING UNIT,
ADULT CARE FACILITY OR NURSING HOME;

S. 2118--A                          6

  9. [A] FOR CONTINUING CARE  RETIREMENT  COMMUNITY  CONTRACTS  ONLY,  A
statement  of  the  conditions  under  which  all  or any portion of the
entrance fee will be released to the operator  before  the  living  unit
becomes available for occupancy, and a statement of the conditions under
which  all  or  any portion of that fee will be refunded in the event of
the death of the resident and/or spouse following occupancy of a  living
unit,  including  the  mandatory  refund provisions set forth in section
forty-six hundred nine of this article;
  [9.] 10. A statement of the advance notice to be provided the resident
OR CONTRACT HOLDER, of not less than sixty days, of any change  in  fees
or charges or scope of care or services;
  [10.]  11.  A  statement  that  no act, agreement, or statement of any
resident OR CONTRACT HOLDER, or of an individual purchasing care  for  a
resident  OR  CONTRACT HOLDER under any agreement to furnish care to the
resident OR CONTRACT HOLDER, shall constitute  a  valid  waiver  of  any
provision  of this article or of any regulation enacted pursuant thereto
intended for the benefit or protection of the resident OR CONTRACT HOLD-
ER or the individual  purchasing  care  for  the  resident  OR  CONTRACT
HOLDER;
  [11.  A]  12.  FOR  CONTINUING  CARE  RETIREMENT COMMUNITY CONTRACTS A
description of the reinstatement  policies  if  a  resident  leaves  the
facility or the contract is cancelled;
  [12.] 13. FOR CONTINUING CARE AT HOME CONTRACTS A DESCRIPTION OF POLI-
CIES IF THE CONTRACT IS CANCELLED.
  14.  A  statement  that  internal  procedures  to resolve disputes and
grievances have been established, and  residents  AND  CONTRACT  HOLDERS
notified of them;
  [13.]  15. A statement of the grace period, if any, for the payment of
periodic fees without a penalty, and the extent of any penalty  for  the
late payment thereof;
  [14.]  16.  A  statement  that: a. the resident OR CONTRACT HOLDER, AS
APPLICABLE shall, if eligible, enroll in medicare parts a and b  or  the
equivalent  and  shall continue to maintain that coverage, together with
medicare supplement coverage at least equivalent in  benefits  to  those
established  by  the  superintendent  as  minimum  benefits for medicare
supplement policies;
  b. if the resident OR  CONTRACT  HOLDER  fails  to  maintain  medicare
coverage  and  a medicare supplement coverage, or is ineligible for such
coverage and fails to purchase the  equivalent  of  such  coverage,  the
community  OR  CONTINUING  CARE  AT  HOME CORPORATION shall purchase the
coverage or equivalent coverage on behalf and  at  the  expense  of  the
resident  OR  CONTRACT HOLDER and shall have the authority to require an
appropriate adjustment in payments by the resident OR CONTRACT HOLDER to
the community OR CONTINUING CARE AT HOME CORPORATION;
  c. if the community OR CONTINUING  CARE  AT  HOME  CORPORATION  cannot
purchase  medicare  coverage  and  medicare  supplement  coverage or the
equivalent, the community shall have the authority to require an adjust-
ment in monthly fees, subject to the approval of the superintendent,  to
fund the additional risk to the facility OR CORPORATION; and
  d.  if  the  resident OR CONTRACT HOLDER fails to purchase or maintain
medicare coverage and medicare supplement coverage  or  the  equivalent,
and  the  community  OR  CONTINUING  CARE  AT  HOME  CORPORATION has not
purchased such coverage, the community OR CORPORATION will be  responsi-
ble for any expenses which would have been covered by medicare and medi-
care  supplement  coverage.    The  community OR CORPORATION may add the

S. 2118--A                          7

amount of such expenses to the resident's OR CONTRACT  HOLDER'S  monthly
fees.
  [15.]  17.  A  statement  that  any  amendment to the contract and any
change in fees or charges, other than those within the guidelines of  an
approved rating system, must be approved by the superintendent of finan-
cial services; and
  [16.]  18.  A  statement  that  property  shall  not be substituted as
payment for either the entrance fee or monthly fee.
  [17.] 19. [A] FOR CONTINUING CARE RETIREMENT  COMMUNITY  CONTRACTS,  A
statement  whether  the  continuing  care  retirement COMMUNITY contract
includes any ownership, beneficial or trust interest in  the  assets  of
the operator, the assets of the facility, or both. Assets shall include,
but  are  not limited to, property, trusts, reserves, interest and other
assets.
  S 10. Subdivision 1 of section 4612 of the public health law, as added
by chapter 689 of the laws of 1989, is amended to read as follows:
  1. Residents [living] in a community authorized by this article  shall
have  the right of self-organization, the right to be represented by one
or more individuals of their own choosing, and the right  to  engage  in
concerted  activities  for the purpose of keeping informed of the opera-
tion of the community in which they live.
  S 11. Subdivisions 1 and 2 of section 4614 of the public  health  law,
as  amended  by  chapter  659  of  the laws of 1997 and subdivision 2 as
further amended by section 104 of part A of chapter 62 of  the  laws  of
2011, are amended to read as follows:
  1. The commissioner, or designee; AND the superintendent, or designee;
[and,  with  regard  to  communities  for which the department of social
services has  regulatory  responsibility,  the  commissioner  of  social
services,  or  designee,] may at any time, and shall at least once every
three years, visit each community and examine the business of any appli-
cant for a certificate of authority and  any  operator  engaged  in  the
execution  of continuing care retirement COMMUNITY contracts OR CONTINU-
ING CARE AT HOME CONTRACTS or engaged in the performance of  obligations
under  such contracts.   Routine examinations may be conducted by having
documents designated by and submitted to such  commissioners  or  super-
intendent,  which shall include financial documents and records conform-
ing to commonly accepted accounting principles and practices. The  final
written  report of each such examination conducted by such commissioners
or superintendent shall be filed with  the  commissioner  and,  when  so
filed, shall constitute a public record.  A copy of each report shall be
provided to members of the continuing care retirement community council.
Any  operator  being  examined  shall, upon request, give reasonable and
timely access to all of its  records.  The  representative  or  examiner
designated by the commissioners or superintendent, respectively, may, at
any  time,  examine  the records and affairs and inspect the community's
facilities, whether in connection with a formal examination or not.
  2. Any duly authorized officer,  employee,  or  agent  of  the  health
department,  [social  services  department,]  or department of financial
services may, upon presentation of proper  identification,  have  access
to,  and  inspect,  any  records  maintained  by the community OR BY THE
CONTINUING CARE AT HOME CORPORATION relevant to the respective  agency's
regulatory  authority, with or without advance notice, to secure compli-
ance with, or to prevent a violation of, any provision of this article.
  S 12. Paragraph k of subdivision 1  of  section  4615  of  the  public
health law, as amended by chapter 659 of the laws of 1997, is amended to
read as follows:

S. 2118--A                          8

  k. The commissioner [or the commissioner of social services] has found
violations  of  applicable statutes, rules or regulations which threaten
to affect directly the health, safety, or welfare of  a  resident  of  a
continuing  care retirement community OR A CONTRACT HOLDER OF A CONTINU-
ING CARE AT HOME CONTRACT.
  S 13. The section heading of section 4623 of the public health law, as
amended  by  chapter  659  of  the  laws  of 1997, is amended to read as
follows:
  Long  term  care  insurance  [for]  AND  continuing  care   retirement
contracts.
  S  14.  This  act  shall  take effect on the one hundred eightieth day
after it shall have become a  law;  provided,  however,  that  effective
immediately the department of health is authorized to take such steps in
advance of such effective date, including the addition, amendment and/or
repeal of any rule or regulation as may be necessary to ensure the time-
ly implementation of this act on such effective date.

Co-Sponsors

S2118B (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A4611A
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally
Versions Introduced in 2011-2012 Legislative Session:
S5224B

S2118B (ACTIVE) - Bill Texts

view summary

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

view sponsor memo
BILL NUMBER:S2118B

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

PURPOSE OR GENERAL IDEA OF BILL:

To allow continuing care communities to offer life care and life care
at home programs to seniors.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 - amends and adds a new subdivision to section 4601 of the
Public Health Law to allow for continuing care at home as a continuing
care retirement community contract option.

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

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

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

Section 5 - amends paragraph b of subdivision 4 of section 4604 of the
Public Health Law to provide oversight by the Commissioner of Health
rather than the Commissioner of Social Services.

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

Section 7 - amends subdivision 13 of section 4605 of the Public Health
Law to change language to reflect the option of continuing care at
home contracts.

Section 8 - Paragraphs e, f and g of subdivision 14 of section 4606 of
the Public Health Law are relettered paragraphs f, g and h and a new
paragraph e is added to list the types of meal plans available.

Section 9 - amends section 4608 of the Public Health Law to include
continuing care retirement community or continuing care at home
contracts and limit certain provisions to life care and modified
contracts only, and set forth certain requirements for life care at
home contracts.

Section 10 - amends subdivision 1 of section 4612 of the Public Health
Law to recognize that some residents under this section may be living
at home.


Section 11 - amends subdivisions 1 and 2 of section 4614 of the Public
Health Law to reflect that the Commissioner of Health shall have
responsibility for oversight.

Section 12 - amends paragraph k of subdivision 1 of section 4615 of
the Public Health Law to reflect responsibility of the Commissioner of
Health.

Section 13 - section heading 4623 is amended to read as follows: Long
term care insurance and continuing care retirement contracts.

Section 14 - provides that this act shall take effect immediately.

JUSTIFICATION:

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

PRIOR LEGISLATIVE HISTORY:

2011-12 - S.5224-B/A .8405-A - PASSED SENATE/Health
2013 - S.2118-A/A.4611-A - HEALTH/Health

FISCAL IMPLICATIONS:

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

EFFECTIVE DATE:

This act shall take effect immediately.

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

                                 2118--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 11, 2013
                               ___________

Introduced  by  Sens. RANZENHOFER, DeFRANCISCO, LIBOUS -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health -- reported favorably from said committee, ordered to first and
  second report, ordered to a third reading, passed by Senate and deliv-
  ered  to  the Assembly, recalled, vote reconsidered, restored to third
  reading, amended and ordered reprinted, retaining  its  place  in  the
  order  of  third  reading -- recommitted to the Committee on Health in
  accordance with Senate Rule 6, sec. 8 --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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

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

  Section 1. Subdivisions 2-a, 2-b, 3, 8, 10 and 10-a of section 4601 of
the public health law, subdivision 2-a as added and subdivisions 3 and 8
as amended by chapter 659 of  the  laws  of  1997,  subdivision  2-b  as
amended  by  chapter 523 of the laws of 2011, subdivision 10 as added by
chapter 689 of the laws of 1989, and subdivision 10-a as added by  chap-
ter 401 of the laws of 2003, are amended and three new subdivisions 7-a,
7-b and 7-c are added to read as follows:
  2-a.  "Continuing  care  retirement  COMMUNITY  contract" shall mean a
single contract to provide a person the services provided by a  continu-
ing care retirement community.
  2-b.  "Continuing care retirement community" or "community" shall mean
a facility or facilities established to provide a  comprehensive,  cohe-
sive  living arrangement for the elderly, oriented to the enhancement of
the quality of life and which, pursuant to the terms of  the  continuing
care RETIREMENT COMMUNITY contract, at a minimum:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05244-08-4

S. 2118--B                          2

  a.  provides, OR SUPPORTS THROUGH CONTINUING CARE AT HOME, independent
living units, and [provides a]  meal  plan  OPTIONS.    The  independent
living  unit  can be made available either through a non-equity arrange-
ment or through an equity arrangement including, but not  limited  to  a
cooperative  or  condominium. For purposes of this article, the purchase
price of an independent living unit in an equity arrangement, regardless
of the form of the purchase agreement, shall not be considered an  entry
fee  for  purposes  of  calculating  reserve  liabilities,  but shall be
considered an entry fee for escrow purposes;
  b. provides a range of health care and  social  services,  subject  to
such  terms  as may be included within the contract, which shall include
adult care facility services of an  on-site  or  affiliated  adult  care
facility, and at a minimum, sixty days of prepaid services of an on-site
or  affiliated  nursing  facility  for  residents not receiving services
under a fee-for-service contract;
  c. provides access to health services  as  defined  in  the  contract,
prescription drugs, and rehabilitation services;
  d. nothing in this article shall eliminate the obligation of a contin-
uing care retirement community to provide at least sixty days of prepaid
nursing  facility services to all residents, with the exception of resi-
dents receiving services under the terms of a fee-for-service continuing
care contract as defined in this section. The prepaid days must  include
the  first  sixty  days  of  nursing  facility  services, whether or not
consecutive, not covered by Title XVIII of the federal  social  security
act; and
  e.  communities  established  under this article and offering fee-for-
service continuing care contracts must offer, along with  such  fee-for-
service  continuing  care  contracts,  life  care and/or continuing care
contracts as defined in subdivision eight-a of this section.
  3. "Contracts" or "agreements" shall mean CONTINUING CARE AT  HOME  OR
continuing  care retirement COMMUNITY contracts as defined in this arti-
cle.
  7-A. "CONTINUING CARE AT HOME CORPORATION" SHALL MEAN A NOT-FOR-PROFIT
CORPORATION AFFILIATED  WITH  A  CONTINUING  CARE  RETIREMENT  COMMUNITY
CAMPUS PROVIDER THROUGH WHICH CONTRACT HOLDERS PAY AN ENTRANCE FEE AND A
MONTHLY  FEE,  BOTH  OF  WHICH  WOULD CORRESPOND TO THE LEVEL OF SERVICE
CHOSEN BY THE CONTRACT HOLDER.
  7-B. "CONTINUING CARE AT HOME CONTRACT" SHALL MEAN A  SINGLE  CONTRACT
TO PROVIDE A PERSON WITH LONG TERM CARE SERVICES AND SUPPORTS BASED UPON
AN  INDIVIDUAL'S  NEEDS  AND  COORDINATED BY A CASE MANAGER, WHICH SHALL
INCLUDE SERVICES PROVIDED TO THE INDIVIDUAL IN HIS OR HER RESIDENCE  AND
SERVICES  OF  THE AFFILIATED COMMUNITY'S NURSING FACILITY AND ADULT CARE
FACILITY, OR AFFILIATED FACILITIES.
  7-C. A. "CONTINUING CARE AT HOME" CORPORATIONS PROVIDING SERVICES IN A
NURSING HOME AS DEFINED IN SECTION  TWENTY-EIGHT  HUNDRED  ONE  OF  THIS
CHAPTER MUST BE LICENSED UNDER ARTICLE TWENTY-EIGHT AND SHALL BE SUBJECT
TO THE PROVISIONS AND STANDARDS OF SUCH ARTICLE.
  B. "CONTINUING CARE AT HOME" CORPORATIONS PROVIDING HOME CARE SERVICES
AS  DEFINED  IN  SECTION  THIRTY-SIX HUNDRED TWO OF THIS CHAPTER MUST BE
LICENSED UNDER ARTICLE THIRTY-SIX AND SHALL BE SUBJECT TO THE PROVISIONS
AND STANDARDS OF SUCH ARTICLE.
  8. "Life care contract" shall mean a single continuing care retirement
COMMUNITY contract OR A CONTINUING CARE AT HOME CONTRACT  to  provide  a
person, for the duration of such person's life, the services provided by
the  continuing care retirement community OR THE CONTINUING CARE AT HOME
CORPORATION, which services shall  include  unlimited  services  of  [an

S. 2118--B                          3

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

S. 2118--B                          4

license to operate a hospital as defined by section twenty-eight hundred
one  of this chapter, or a facility required to be licensed or certified
by the department [of social services]. The statement  shall  set  forth
the court or agency, date of conviction or judgment, the penalty imposed
or damages assessed, or the date, nature and issuer of the order;
  S  5.  Paragraphs  b,  c and d of subdivision 4 of section 4604 of the
public health law, as amended and paragraph d as added by chapter 659 of
the laws of 1997, are amended to read as follows:
  b. the commissioner [of social services] as to those  aspects  of  the
application relating to adult care facility beds, if any;
  c.  the  public health AND HEALTH PLANNING council under section twen-
ty-eight hundred one-a of this chapter as  to  the  establishment  of  a
skilled  nursing  facility by the applicant and as to such other facili-
ties and services as may require the public health AND  HEALTH  PLANNING
council's  approval  of  the  application;  provided,  however, that the
recommendations of the [state hospital review and planning  council  and
the]  health systems agency having geographical jurisdiction of the area
where the continuing care retirement community is located shall  not  be
required  with  respect to the establishment of an on-site or affiliated
residential health care facility to  serve  residents  as  part  of  the
continuing  care  retirement  community,  for  up to the total number of
residential health care facility beds provided for in  subdivision  five
of this section in communities statewide;
  d.  the  commissioner  under  section twenty-eight hundred two of this
chapter; provided, however, that,  the  recommendations  of  the  [state
hospital  review  and] PUBLIC HEALTH AND HEALTH planning council and the
health systems agency having geographical jurisdiction of the area where
the continuing  care  retirement  community  is  located  shall  not  be
required  with  respect  to the construction of an on-site or affiliated
residential health care facility to  serve  residents  as  part  of  the
continuing  care  retirement  community,  for  up to the total number of
residential health care facility beds provided for in  subdivision  five
of this section in communities statewide; and
  S  6.  Paragraph  g  of  subdivision 2 of section 4604-a of the public
health law, as added by chapter 659 of the laws of 1997, is  amended  to
read as follows:
  g.  Unless  all  residents OR CONTINUING CARE AT HOME CONTRACT HOLDERS
have life care contracts, the operator has adequately  made  the  assur-
ances  required  by subdivision two of section forty-six hundred twenty-
four of this article and has agreed to fund the liability in  the  event
that [resident] SUCH RESIDENT'S OR CONTRACT HOLDER'S assets are insuffi-
cient to pay for nursing facility services for a one year period.
  S 7. Subdivision 13 of section 4606 of the public health law, as added
by chapter 659 of the laws of 1997, is amended to read as follows:
  13.  The  initial  disclosure  statement  and marketing materials of a
continuing care retirement community AND CONTINUING CARE AT HOME  CORPO-
RATION  must  clearly  include  a description of the services offered as
part of its contract, including, but not limited to, any limitations  on
nursing  facility services. The initial disclosure statement and market-
ing materials of a continuing care retirement  community  OR  CONTINUING
CARE  AT HOME CORPORATION which offers various types of contracts, which
may include life care contracts, must clearly  differentiate  among  the
various types of contracts which it may offer.
  S  8.  Paragraphs  e, f and g of subdivision 14 of section 4606 of the
public health law are relettered paragraphs f, g and h and a  new  para-
graph e is added to read as follows:

S. 2118--B                          5

  E. THE TYPES OF MEAL PLANS AVAILABLE;
  S 9. Section 4608 of the public health law, as added by chapter 689 of
the  laws of 1989, the section heading, the opening paragraph and subdi-
vision 6 as amended and subdivision 17 as added by chapter  659  of  the
laws  of  1997,  subdivision  2 as amended by chapter 120 of the laws of
1993, subdivision 8 as amended by chapter 66 of the  laws  of  1994  and
subdivision 15 as further amended by section 104 of part A of chapter 62
of the laws of 2011, is amended to read as follows:
  S  4608.  Continuing care retirement COMMUNITY contract.  A continuing
care retirement COMMUNITY OR CONTINUING  CARE  AT  HOME  contract  shall
contain  all  of  the following information in no less than twelve point
type and in plain language, in addition to any other terms or matter  as
may  be required by regulations adopted by the council and issued by the
superintendent, EXCEPT WHEN SPECIFICALLY NOTED:
  1. The amount of all money transferred, including, but not limited to,
donations, subscriptions, deposits, fees, and any other amounts paid  or
payable  by,  or  on  behalf of, the resident or residents OR CONTINUING
CARE AT HOME CONTRACT HOLDER OR HOLDERS;
  2. A description of all services which are  to  be  furnished  by  the
operator,  a description of any fees in addition to the entrance fee and
periodic charges provided for in the contract, and the conditions  under
which  the  fees  may  be  adjusted, provided that an operator shall not
charge any non-refundable application fee to a prospective resident  who
has  paid  a  non-refundable  priority reservation agreement application
fee;
  3. The procedures of the community OR CONTINUING CARE AT  HOME  CORPO-
RATION  relating to a resident's OR CONTRACT HOLDER'S failure to pay the
required monthly fees;
  4. A statement of the figures and terms  concerning  the  entry  of  a
spouse to the community and the consequences if the spouse does not meet
the requirements for entry;
  5.  A statement of the terms and conditions under which a contract may
be cancelled by the operator or by a resident OR CONTRACT HOLDER and the
conditions under which all or any portion of the entrance  fee  will  be
refunded  by the operator, including the mandatory refund provisions set
forth in sections forty-six hundred nine and forty-six  hundred  ten  of
this article;
  6.  a.  The  procedures  and  conditions under which a resident may be
transferred from his or her living unit OR HOME  including  a  statement
that,  at  the  time of transfer, the resident will be given the reasons
for the transfer; the process by which a transfer decision is made;  the
persons  with  the  authority  to  make  the  decision  to  transfer;  a
description of any change in charges to be  paid  by  the  resident  for
services  not  covered by the contract fees as a result of the transfer;
and a statement regarding the disposition of and the right to return  to
the living unit in cases of temporary and permanent transfers.
  b.  [The]  FOR  CONTINUING  CARE  RETIREMENT  COMMUNITY CONTRACTS, THE
circumstances under which a living unit may  be  considered  vacant  and
eligible  for  transfer  or  resale to a new resident, either due to the
permanent transfer of a resident to the  community's  nursing  or  other
specialized facility or due to the permanent transfer of a resident to a
hospital  or other facility outside of the community; provided, however,
that nothing therein shall relieve a community from its  obligations  to
provide or to insure provision of all contractually required care pursu-
ant  to  the  terms  of a continuing care retirement contract.  Should a
resident's chronic condition require placement  in  a  more  specialized

S. 2118--B                          6

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

S. 2118--B                          7

medicare supplement coverage at least equivalent in  benefits  to  those
established  by  the  superintendent  as  minimum  benefits for medicare
supplement policies;
  b.  if  the  resident  OR  CONTRACT  HOLDER fails to maintain medicare
coverage and a medicare supplement coverage, or is ineligible  for  such
coverage  and  fails  to  purchase  the equivalent of such coverage, the
community OR CONTINUING CARE AT  HOME  CORPORATION  shall  purchase  the
coverage  or  equivalent  coverage  on  behalf and at the expense of the
resident OR CONTRACT HOLDER and shall have the authority to  require  an
appropriate adjustment in payments by the resident OR CONTRACT HOLDER to
the community OR CONTINUING CARE AT HOME CORPORATION;
  c.  if  the  community  OR  CONTINUING CARE AT HOME CORPORATION cannot
purchase medicare coverage  and  medicare  supplement  coverage  or  the
equivalent, the community shall have the authority to require an adjust-
ment  in monthly fees, subject to the approval of the superintendent, to
fund the additional risk to the facility OR CORPORATION; and
  d. if the resident OR CONTRACT HOLDER fails to  purchase  or  maintain
medicare  coverage  and  medicare supplement coverage or the equivalent,
and the community  OR  CONTINUING  CARE  AT  HOME  CORPORATION  has  not
purchased  such coverage, the community OR CORPORATION will be responsi-
ble for any expenses which would have been covered by medicare and medi-
care supplement coverage.   The community OR  CORPORATION  may  add  the
amount  of  such expenses to the resident's OR CONTRACT HOLDER'S monthly
fees.
  [15.] 17. A statement that any  amendment  to  the  contract  and  any
change  in fees or charges, other than those within the guidelines of an
approved rating system, must be approved by the superintendent of finan-
cial services; and
  [16.] 18. A statement  that  property  shall  not  be  substituted  as
payment for either the entrance fee or monthly fee.
  [17.]  19.  [A]  FOR CONTINUING CARE RETIREMENT COMMUNITY CONTRACTS, A
statement whether the  continuing  care  retirement  COMMUNITY  contract
includes  any  ownership,  beneficial or trust interest in the assets of
the operator, the assets of the facility, or both. Assets shall include,
but are not limited to, property, trusts, reserves, interest  and  other
assets.
  S 10. Subdivision 1 of section 4612 of the public health law, as added
by chapter 689 of the laws of 1989, is amended to read as follows:
  1.  Residents [living] in a community authorized by this article shall
have the right of self-organization, the right to be represented by  one
or  more  individuals  of their own choosing, and the right to engage in
concerted activities for the purpose of keeping informed of  the  opera-
tion of the community in which they live.
  S  11.  Subdivisions 1 and 2 of section 4614 of the public health law,
as amended by chapter 659 of the laws  of  1997  and  subdivision  2  as
further  amended  by  section 104 of part A of chapter 62 of the laws of
2011, are amended to read as follows:
  1. The commissioner, or designee; AND the superintendent, or designee;
[and, with regard to communities for  which  the  department  of  social
services  has  regulatory  responsibility,  the  commissioner  of social
services, or designee,] may at any time, and shall at least  once  every
three years, visit each community and examine the business of any appli-
cant  for  a  certificate  of  authority and any operator engaged in the
execution of continuing care retirement COMMUNITY contracts OR  CONTINU-
ING  CARE AT HOME CONTRACTS or engaged in the performance of obligations
under such contracts.  Routine examinations may be conducted  by  having

S. 2118--B                          8

documents  designated  by  and submitted to such commissioners or super-
intendent, which shall include financial documents and records  conform-
ing  to commonly accepted accounting principles and practices. The final
written  report of each such examination conducted by such commissioners
or superintendent shall be filed with  the  commissioner  and,  when  so
filed, shall constitute a public record.  A copy of each report shall be
provided to members of the continuing care retirement community council.
Any  operator  being  examined  shall, upon request, give reasonable and
timely access to all of its  records.  The  representative  or  examiner
designated by the commissioners or superintendent, respectively, may, at
any  time,  examine  the records and affairs and inspect the community's
facilities, whether in connection with a formal examination or not.
  2. Any duly authorized officer,  employee,  or  agent  of  the  health
department,  [social  services  department,]  or department of financial
services may, upon presentation of proper  identification,  have  access
to,  and  inspect,  any  records  maintained  by the community OR BY THE
CONTINUING CARE AT HOME CORPORATION relevant to the respective  agency's
regulatory  authority, with or without advance notice, to secure compli-
ance with, or to prevent a violation of, any provision of this article.
  S 12. Paragraph k of subdivision 1  of  section  4615  of  the  public
health law, as amended by chapter 659 of the laws of 1997, is amended to
read as follows:
  k. The commissioner [or the commissioner of social services] has found
violations  of  applicable statutes, rules or regulations which threaten
to affect directly the health, safety, or welfare of  a  resident  of  a
continuing  care retirement community OR A CONTRACT HOLDER OF A CONTINU-
ING CARE AT HOME CONTRACT.
  S 13. The section heading of section 4623 of the public health law, as
amended by chapter 659 of the laws  of  1997,  is  amended  to  read  as
follows:
  Long   term  care  insurance  [for]  AND  continuing  care  retirement
contracts.
  S 14. This act shall take effect immediately.

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