S T A T E O F N E W Y O R K
________________________________________________________________________
6315
2015-2016 Regular Sessions
I N A S S E M B L Y
March 20, 2015
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Introduced by M. of A. ENGLEBRIGHT, GOTTFRIED, ABBATE, CAHILL, CLARK,
DINOWITZ, GALEF, LUPARDO -- Multi-Sponsored by -- M. of A. LIFTON,
PERRY, RIVERA -- read once and referred to the Committee on Health
AN ACT to amend the public health law, in relation to creating adult day
services respite demonstration programs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section
2801-i to read as follows:
S 2801-I. RESPITE DAY DEMONSTRATION PROGRAM. 1. DEFINITIONS. AS USED
IN THIS SECTION:
(A) "RESPITE DAY DEMONSTRATION PROGRAM" MEANS A STRUCTURED, COMPREHEN-
SIVE PROGRAM ESTABLISHED BY THE COMMISSIONER UNDER THIS SECTION, IN
CONJUNCTION WITH THE DIRECTOR OF THE OFFICE FOR THE AGING, PROVIDING
LEVEL I, LEVEL II OR LEVEL III SERVICES TO REGISTRANTS.
(B) "REGISTRANT" MEANS A PERSON:
(I) WHO IS NOT A RESIDENT OF A RESIDENTIAL HEALTH CARE FACILITY, IS
FUNCTIONALLY IMPAIRED AND NOT HOMEBOUND, AND REQUIRES SUPERVISION AND
MONITORING BUT DOES NOT REQUIRE CONTINUOUS TWENTY-FOUR HOUR A DAY INPA-
TIENT CARE AND SERVICES;
(II) WHOSE ASSESSED SOCIAL AND HEALTH CARE NEEDS CAN SATISFACTORILY BE
MET IN WHOLE OR IN PART BY THE DELIVERY OF APPROPRIATE SERVICES IN THE
COMMUNITY SETTING; AND
(III) WHO HAS BEEN ADMITTED TO THE PROGRAM BASED ON AN INTERDISCIPLI-
NARY COMPREHENSIVE ASSESSMENT.
(C) "FUNCTIONALLY IMPAIRED" MEANS A PERSON WHO NEEDS THE ASSISTANCE OF
ANOTHER PERSON IN AT LEAST ONE OF THE FOLLOWING ACTIVITIES OF DAILY
LIVING: TOILETING, MOBILITY, TRANSFERRING OR EATING; OR WHO NEEDS SUPER-
VISION DUE TO COGNITIVE OR PSYCHO-SOCIAL IMPAIRMENT.
(D) "ADULT DAY HEALTH" MEANS THE HEALTH CARE SERVICES AND ACTIVITIES
DEFINED BY THE COMMISSIONER UNDER REGULATIONS UNDER SUBPARAGRAPH (VII)
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09559-01-5
A. 6315 2
OF PARAGRAPH F OF SUBDIVISION SIX-A OF SECTION THREE HUNDRED SIXTY-SIX
OF THE SOCIAL SERVICES LAW.
(E) "LEVEL I SERVICES" MEANS THE FOLLOWING SERVICES:
(I) SOCIALIZATION AND PLANNED ACTIVITIES;
(II) SUPERVISION AND MONITORING;
(III) ROUTINE PERSONAL CARE, WHICH INCLUDES:
(A) ASSISTANCE FOR THE REGISTRANT WITH ANY OF THE FOLLOWING: TOILET-
ING, MOBILITY, TRANSFER AND EATING;
(B) ROUTINE SKIN CARE;
(C) CHANGING SIMPLE DRESSINGS; AND
(D) USING SUPPLIES AND ADAPTIVE AND ASSISTIVE EQUIPMENT;
(IV) MEDICATION DISTRIBUTION;
(V) CASE MANAGEMENT; AND
(VI) MEALS CONSISTENT WITH STANDARDS SET FOR THE NUTRITION PROGRAM FOR
THE ELDERLY ESTABLISHED BY THE STATE OFFICE FOR THE AGING.
(F) "LEVEL II SERVICES" MEANS ALL LEVEL I SERVICES, PLUS THE FOLLOWING
SERVICES:
(I) MAJOR PERSONAL CARE SERVICES, WHICH INCLUDES:
(A) ASSISTANCE FOR THE REGISTRANT WITH SHOWERING AND BATHING; AND
(B) SOME OR TOTAL ASSISTANCE WITH DRESSING AND GROOMING;
(II) HEALTH EDUCATION;
(III) NURSING MONITORING AND SUPERVISION OF BASIC TREATMENTS;
(IV) COUNSELING; AND
(V) RESTORATIVE THERAPIES NOT LASTING LONGER THAN SIX MONTHS.
(G) "LEVEL III SERVICES" MEANS AND INCLUDES ALL LEVEL I AND LEVEL II
SERVICES, PLUS THE FOLLOWING SERVICES:
(I) PSYCHIATRIC EVALUATIONS AND DIAGNOSIS;
(II) SKILLED NURSING SERVICES;
(III) MEDICATION MANAGEMENT;
(IV) MAINTENANCE AND RESTORATIVE THERAPIES GREATER THAN SIX MONTHS IN
DURATION; AND
(V) ADDITIONAL MEDICAL SERVICES AS REQUIRED BY REGULATION.
(H) "BASE RATE" MEANS THE RATE PAID FOR APPROVED ADULT DAY HEALTH
SERVICES UNDER SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES
LAW.
(I) "OPERATOR" MEANS (A) AN ADULT DAY HEALTH CARE PROGRAM OR (B) A
SOCIAL ADULT DAY SERVICES PROGRAM, AS DEFINED IN SECTION TWO HUNDRED
FIFTEEN OF THE ELDER LAW.
2. RESPITE DAY DEMONSTRATION PROGRAM. THE COMMISSIONER, IN CONJUNCTION
WITH THE DIRECTOR OF THE OFFICE FOR THE AGING, MAY ESTABLISH RESPITE DAY
DEMONSTRATION PROGRAMS BASED UPON ADULT DAY HEALTH CARE AND SOCIAL ADULT
DAY SERVICES, AS DEFINED IN SECTION TWO HUNDRED FIFTEEN OF THE ELDER
LAW, TO EXTEND THE PERIOD A CAREGIVER CAN REMAIN ACTIVE IN THE CARE OF
ELDERLY OR DISABLED INDIVIDUALS, AVOIDING THE NEED FOR MORE COSTLY
INSTITUTIONAL PLACEMENT.
3. ESTABLISHMENT. THERE SHALL BE A MINIMUM OF TEN PROGRAMS ESTAB-
LISHED IN SIX LOCATIONS, WITH AT LEAST ONE SITE TO BE LOCATED WITHIN
EACH OF THE FOLLOWING SIX REGIONS: NEW YORK CITY, LONG ISLAND, HUDSON
VALLEY, NORTH COUNTRY, CENTRAL AND WESTERN. EACH LOCATION'S PROGRAM
SHALL CONSIST OF UP TO FIFTEEN REGISTRANTS. OPERATORS SHALL BE SELECTED
BASED ON A REQUEST FOR PROPOSAL PROCESS WITH PREFERENCE GIVEN TO THOSE
APPLICANTS WHO ARE ABLE TO DEMONSTRATE THEIR CAPACITY TO BUILD PARTNER-
SHIPS AND ENTER INTO COOPERATIVE ARRANGEMENTS. THIS SECTION SHALL NOT BE
CONSTRUED TO PERMIT AN OPERATOR TO PROVIDE SERVICES FOR WHICH THE OPERA-
TOR IS NOT OTHERWISE LICENSED OR CERTIFIED TO PROVIDE.
4. REGISTRANT CARE PLAN. THE OPERATOR SHALL ENSURE:
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(A) THAT A CARE PLAN BASED ON A COMPREHENSIVE INTERDISCIPLINARY
ASSESSMENT AND, WHEN APPLICABLE, A TRANSFER OR DISCHARGE PLAN IS DEVEL-
OPED FOR EACH REGISTRANT WITHIN FIVE VISITS, NOT TO EXCEED THIRTY DAYS,
FROM REGISTRATION;
(B) EACH REGISTRANT'S CARE PLAN SHALL INCLUDE:
(I) DESIGNATION OF A PROFESSIONAL PERSON TO BE RESPONSIBLE FOR COORDI-
NATING THE CARE PLAN;
(II) THE REGISTRANT'S PERTINENT DIAGNOSES, INCLUDING MENTAL STATUS,
TYPES OF EQUIPMENT AND SERVICES REQUIRED, CASE MANAGEMENT, FREQUENCY OF
PLANNED VISITS, PROGNOSIS, REHABILITATION POTENTIAL, FUNCTIONAL LIMITA-
TIONS, PLANNED ACTIVITIES, NUTRITIONAL REQUIREMENTS, MEDICATIONS AND
TREATMENTS, NECESSARY MEASURES TO PROTECT AGAINST INJURY, INSTRUCTIONS
FOR DISCHARGE OR REFERRAL IF APPLICABLE, ORDERS FOR THERAPY SERVICES
INCLUDING THE SPECIFIC PROCEDURES AND MODALITIES TO BE USED AND THE
AMOUNT, FREQUENCY AND DURATION OF SUCH SERVICES, AND ANY OTHER APPROPRI-
ATE ITEM;
(III) THE MEDICAL AND NURSING GOALS AND LIMITATIONS ANTICIPATED FOR
THE REGISTRANT AND, AS APPROPRIATE, THE NUTRITIONAL, SOCIAL, REHABILITA-
TIVE AND LEISURE TIME GOALS AND LIMITATIONS;
(IV) THE REGISTRANT'S POTENTIAL FOR REMAINING IN THE COMMUNITY; AND
(V) A DESCRIPTION OF ALL SERVICES TO BE PROVIDED TO THE REGISTRANT BY
THE PROGRAM, INFORMAL SUPPORTS AND OTHER COMMUNITY RESOURCES PURSUANT TO
THE CARE PLAN, AND HOW SUCH SERVICES WILL BE COORDINATED;
(C) DEVELOPMENT AND MODIFICATION OF THE CARE PLAN IS COORDINATED WITH
OTHER HEALTH CARE PROVIDERS OUTSIDE THE PROGRAM WHO ARE INVOLVED IN THE
REGISTRANT'S CARE; AND
(D) THE RESPONSIBLE PERSONS, WITH THE APPROPRIATE PARTICIPATION OF
CONSULTANTS IN THE MEDICAL, SOCIAL, PARAMEDICAL AND RELATED FIELDS
INVOLVED IN THE REGISTRANT'S CARE:
(I) RECORD IN THE CLINICAL RECORD CHANGES IN THE REGISTRANT'S STATUS
WHICH REQUIRE ALTERATIONS IN THE REGISTRANT CARE PLAN;
(II) MODIFY THE CARE PLAN ACCORDINGLY;
(III) REVIEW THE CARE PLAN AT LEAST ONCE EVERY SIX MONTHS AND WHENEVER
THE REGISTRANT'S CONDITION WARRANTS AND DOCUMENT EACH SUCH REVIEW IN THE
CLINICAL RECORD; AND
(IV) PROMPTLY ALERT THE REGISTRANT'S AUTHORIZED HEALTH CARE PRACTI-
TIONER OF ANY SIGNIFICANT CHANGES IN THE REGISTRANT'S CONDITION WHICH
INDICATE A NEED TO REVISE THE CARE PLAN.
5. REIMBURSEMENT. FOR THE PURPOSES OF THIS SECTION, REIMBURSEMENT
RATES UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW FOR
PROGRAMS SHALL BE AS FOLLOWS:
(A) LEVEL I SERVICES WILL BE REIMBURSED AT FORTY PERCENT OF THE BASE
RATE;
(B) LEVEL II SERVICES WILL BE REIMBURSED AT SEVENTY-FIVE PERCENT OF
THE BASE RATE; AND
(C) LEVEL III SERVICES WILL BE REIMBURSED AT ONE HUNDRED PERCENT OF
THE BASE RATE.
6. EVALUATION AND REPORT. NO LATER THAN JANUARY FIRST, TWO THOUSAND
EIGHTEEN, THE COMMISSIONER SHALL PROVIDE THE GOVERNOR, THE TEMPORARY
PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY WITH A WRITTEN
EVALUATION OF THE PROGRAM, BASED ON AN ASSESSMENT TOOL DEVELOPED BY THE
DEPARTMENT. SUCH EVALUATION SHALL ADDRESS THE OVERALL EFFECTIVENESS OF
THE PROGRAM IN IMPROVING OUTCOMES FOR INDIVIDUAL PATIENTS AND GROUPS OF
PATIENTS, REDUCING COSTS, ENCOURAGING PLACEMENTS IN APPROPRIATE ADULT
DAY HEALTH SERVICES SETTINGS, AND ENHANCING THE AVAILABILITY OF LESS
RESTRICTIVE AND LESS INSTITUTIONAL SERVICES; SHALL EVALUATE THE NEED FOR
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LEVEL I, II AND III SERVICES AND THE IMPACT ON THE AVAILABILITY OF EACH
OF THE SERVICES ON COST AND INSTITUTIONAL PLACEMENT; AND SHALL CONTAIN
RECOMMENDATIONS RELATIVE TO EXTENDING AND EXPANDING THE PROGRAM. IN
EVALUATING INDIVIDUAL OUTCOMES, THE COMMISSIONER SHALL CONSULT WITH THE
CENTER FOR FUNCTIONAL ASSESSMENT RESEARCH AT THE STATE UNIVERSITY OF NEW
YORK AT BUFFALO.
7. WAIVERS AND FEDERAL APPROVALS. (A) THE PROVISIONS OF THIS SECTION
SHALL NOT APPLY UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND
REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
IN THE COSTS OF SERVICES PROVIDED UNDER THIS SECTION.
(B) THE COMMISSIONER IS AUTHORIZED TO SUBMIT AMENDMENTS TO THE STATE
PLAN FOR MEDICAL ASSISTANCE AND SUBMIT ONE OR MORE APPLICATIONS FOR
WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT, TO OBTAIN THE FEDERAL
APPROVALS NECESSARY TO IMPLEMENT THIS SECTION. THE COMMISSIONER SHALL
SUBMIT SUCH AMENDMENTS OR APPLICATIONS FOR WAIVERS BY SEPTEMBER THIRTI-
ETH, TWO THOUSAND FIFTEEN, AND SHALL USE BEST EFFORTS TO OBTAIN THE
APPROVALS REQUIRED BY THIS SUBDIVISION IN A TIMELY MANNER SO AS TO ALLOW
EARLY IMPLEMENTATION OF THIS SECTION.
S 2. This act shall take effect immediately.