Senate Bill S9055

                                
 
BILL NUMBER: S9055

SPONSOR: VALESKY
 
TITLE OF BILL:  An act to amend the elder law, in relation to author-
izing private pay protocols

 
PURPOSE OF THE BILL:

This bill would amend section 203 of the elder law authorizing the
Director to implement a private pay program for programs administered by
the Office that are funded by a state appropriation.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill would authorize the director to implement private
pay protocols for programs administered by the Office that are funded by
a state appropriation. The program would be at the option of the Area
Agency on Aging and would only be applicable to new participants. In
addition, no participant shall be required to pay for any service that
they are receiving at the time these protocols are implemented. Private
payments received by an area agency on aging directly or by contract
              

shall be used to supplement, not supplant, funds by state, federal or
county appropriations.  Private payments received must be used by the
local area agency on aging to support and/or enhance the services
provided by or through the area agency on aging. To the extent that a
match is required, the private payments received under this bill may not
be applied towards such match. Private payments under this bill shall
not be required of individuals with incomes below 400% of the federal
poverty level.  This subdivision shall not prevent cost sharing for the
programs established pursuant to section two hundred fourteen of this
title for individuals below four hundred percent of the federal poverty
level.

Section 2 of the bill would require the act to take effect immediately.

 
JUSTIFICATION:

The Older Americans Act that was passed in 1965 was designed to comple-
ment both the Medicare and the Medicaid program. The funding provided to
states was designed and intended to delay/prevent emergency room visits
and hospitalizations and for safe and appropriate discharges from acute
care or rehabilitation settings through a coordinated system of non-
clinical community based long term services and supports that promoted
independence and autonomy.  The Older Americans Act and New York State
requirements direct the state units on aging and the designated area
agencies on aging to target limited funds to those most in need, includ-
ing low-income, those at risk of Medicaid spend-down and nursing home
placement, culturally and ethnic minorities and those in rural areas to
name a few. Demographic shifts as well as significant reforms in health
care and long-term care have changed the landscape for how services for
older adults are provided and require new approaches in terms of how
they are financed.

Because of the history of the OAA, services are required to be targeted
to those who are low-income and most in need. It should be noted that
services offered by the state unit on aging and the Area Agencies on
Aging are not entitlement services. Due to limited funding, many Area
Agencies on Aging have waiting lists. The programs and services that are
offered by Area Agencies on Aging and their contractors are valuable,
are in demand, assist in reducing Medicaid spend-down and nursing home
placement, are key to addressing the social determinants of health and
are central to safe discharges from acute care and longterm care facili-
ties as well as reducing preventable hospital readmissions.

This legislation would enable Area Agencies on Aging to serve more indi-
viduals by allowing individuals whose income is at or above four hundred
(400) percent of the federal poverty level to pay for certain services
thereby generating revenue that must be reinvested back into service
provision. This would reduce waiting lists and help to meet new and
emerging needs.

In addition to the benefits of increased revenue, there are many other
benefits for entering a private pay marketplace including:

*Leveraging the over 50 years of experience of the network of aging
professionals who have strong cross systems community partnerships and
who are required by law to strengthen and maintain partnerships in vari-
ous systems - i.e. health, legal, law enforcement, adult protective,
service providers, community-based organizations, volunteer, etc.

*Having strong partnerships with local agencies, to streamline and coor-
dinate multi-system issues

*State certified and trained professional staff who are required to be
objective and be person-centered in their approach to care

*Cost effective, non-medical services

*Important part of the Governor's Prevention Agenda, health Across All
Policies Approach, Age Friendly New York and Olmstead Plan Implementa-
tion,

*The majority of older New Yorkers are not recipients of Medicaid and
the provision of these services provide needed non-medical services to
avert spenddown

The most recent economic statistics for New York, almost 1.5 million
people over the age of 60 have incomes at or above 400% of poverty
($48,240 per year). According to AARP, those ages 50+ hold 83 % of the
US household wealth. This legislation will be as important in the coming
years as it is now in order to help older adults and their caregivers
with their number one priority as they age - aging in their homes and
communities of choice.

According to the American Community Service Survey, older New Yorkers at
or above 400% of poverty self-report:

*Ambulatory difficulty - 223,276

*Independent living difficulty - 142,479

*Self-care difficulty - 78,350

*Cognitive difficulty - 78,125

*Hearing difficulty - 132,362

*Vision difficulty - 57,980

 
PRIOR LEGISLATIVE HISTORY:

This is a new bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.