S T A T E O F N E W Y O R K
________________________________________________________________________
2120
2019-2020 Regular Sessions
I N A S S E M B L Y
January 22, 2019
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Introduced by M. of A. ENGLEBRIGHT -- read once and referred to the
Committee on Aging
AN ACT to amend the elder law, in relation to establishing a senior care
choices program in the office for the aging
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 214 of the elder law is amended by adding a new
subdivision 8 to read as follows:
8. SENIOR CARE CHOICES PROGRAM. (A) NOTWITHSTANDING ANY OTHER LAW TO
THE CONTRARY, THE DIRECTOR SHALL FILE, OR CAUSE TO BE FILED, WITHIN ONE
HUNDRED TWENTY DAYS OF THE EFFECTIVE DATE OF THIS SUBDIVISION AN APPLI-
CATION FOR A FEDERAL WAIVER PURSUANT TO SECTION 1115 OF THE FEDERAL
SOCIAL SECURITY ACT, OR ANY SUCCESSOR THERETO, FOR A SENIOR CARE CHOICES
PROGRAM, UNDER WHICH THE OFFICE SHALL AND IS HEREBY AUTHORIZED TO
PROVIDE DIRECTLY OR BY CONTRACT A COORDINATED PLAN OF CARE AND SERVICES
AT HOME TO SENIORS IN A SEAMLESS NETWORK THAT SHALL INCLUDE SERVICES
PROVIDED BY AND THROUGH THE OFFICE AND ANY ADDITIONAL SERVICES AS MAY BE
NECESSARY TO MAINTAIN SUCH PERSONS AT HOME AS AUTHORIZED IN THIS SUBDI-
VISION. EVERY STATE AGENCY IS HEREBY EMPOWERED AND DIRECTED TO COOPERATE
WITH THE OFFICE AND TO COMPLY WITH ANY REQUEST FOR THE FILING OF SUCH
WAIVER IF THE DIRECTOR SHALL LACK POWER AND AUTHORITY TO FILE SUCH A
WAIVER. AS USED IN THIS SUBDIVISION, THE TERM "SENIOR" MEANS PERSONS WHO
ARE AGED SIXTY AND OLDER WHO ARE MEDICALLY ELIGIBLE FOR PLACEMENT IN A
LONG-TERM CARE FACILITY, AS SUCH TERM IS DEFINED IN SECTION TWENTY-ONE
HUNDRED NINETY-ONE OF THE PUBLIC HEALTH LAW.
(1) THE SENIOR CARE CHOICES PROGRAM SHALL BE PROVIDED IN THE SENIOR'S
HOME OR IN THE HOME OF A RESPONSIBLE RELATIVE OR OTHER RESPONSIBLE
ADULT, AND, OTHER PROVISIONS OF THIS SECTION TO THE CONTRARY NOTWITH-
STANDING, IF THE WAIVER GRANTED PURSUANT TO SECTION 1115 OF THE FEDERAL
SOCIAL SECURITY ACT OR ANY SUCCESSOR THERETO SHALL SO PROVIDE, MAY ALSO
BE PROVIDED IN ADULT CARE FACILITIES, OTHER THAN SHELTERS FOR ADULTS,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05061-01-9
A. 2120 2
CERTIFIED PURSUANT TO SECTION FOUR HUNDRED SIXTY-B OF THE SOCIAL
SERVICES LAW, PROVIDED THAT THE SENIOR MEETS THE ADMISSION AND CONTINUED
STAY CRITERIA FOR SUCH FACILITY, EXCEPT THAT SERVICES PROVIDED BY THE
PROGRAM SHALL NOT DUPLICATE OR REPLACE THOSE WHICH THE FACILITY IS
REQUIRED BY LAW OR REGULATION TO PROVIDE.
(2) IN FILING SUCH WAIVER FOR THE OPERATION OF THE PROGRAM, THE OFFICE
SHALL SEEK TO PROVIDE SERVICES PURSUANT TO THE PRINCIPLE THAT SENIORS
HAVE THE PRIMARY AUTHORITY TO MAKE CHOICES THAT WORK BEST FOR THEM,
REGARDLESS OF THE NATURE OR EXTENT OF THEIR DISABILITY OR THE SOURCE OF
PAYMENT FOR SERVICES. IN DESIGNING THE PROGRAM AND PROVIDING SERVICES,
THE OFFICE IS AUTHORIZED TO WAIVE ANY PROVISION OF THE SOCIAL SERVICES
LAW OR THE PUBLIC HEALTH LAW, OR ANY RULE OR REGULATION PROMULGATED
THEREUNDER, WHICH IN THE JUDGMENT OF THE OFFICE RESTRICTS ITS ABILITY TO
PROVIDE SERVICES AS REQUIRED BY THIS SUBDIVISION, SO LONG AS SUCH WAIVER
IS CONSISTENT WITH ANY FEDERAL WAIVER GRANTED PURSUANT TO SECTION 1115
OF THE FEDERAL SOCIAL SECURITY ACT OR ANY SUCCESSOR THERETO.
(3) THE OFFICE SHALL SEEK TO EXPAND SOURCE OF PAYMENT FOR THE PROGRAM,
INCLUDING SEEKING PAYMENTS FROM VOLUNTARY AND WILLING PRIVATE SOURCES,
INSURANCE PLANS, CHARITIES AND FOUNDATIONS, AND INDIVIDUALS.
(4) THE OFFICE IS HEREBY EMPOWERED TO PROVIDE OR CONTRACT FOR THE
PROVISION OF SUCH SENIOR CARE CHOICES PROGRAM IN ANY COUNTY WITHIN THE
STATE. THE OFFICE SHALL SEEK TO COORDINATE SERVICES WITH ANY CURRENT
PROVIDER OF SERVICES. NO STATE AGENCY SHALL IMPOSE A LIMITATION ON THE
NUMBER OF ELIGIBLE INDIVIDUALS SERVED IN THIS PROGRAM. THE OFFICE SHALL
NOT BE SUBJECT TO AUDIT, ASSESSMENT, SUSPENSION, SANCTION, OR REPORT BY
A STATE AGENCY FOR A PROGRAM CONDUCTED PURSUANT TO THE AUTHORITY OF THIS
SUBDIVISION, EXCEPT THAT IT SHALL BE SUBJECT TO AUDIT BY THE OFFICE OF
THE STATE COMPTROLLER TO THE EXTENT THAT SUCH PROGRAMS WOULD HAVE BEEN
SUBJECT TO AUDIT BUT FOR THIS PARAGRAPH.
(B) IF A SENIOR DEEMED BY HIS OR HER PHYSICIAN ABLE TO REMAIN IN HIS
OR HER OWN HOME OR THE HOME OF A RESPONSIBLE RELATIVE OR OTHER RESPONSI-
BLE ADULT IF THE NECESSARY SERVICES ARE PROVIDED APPLIES FOR ADMISSION
TO THE PROGRAM, THE OFFICE IN CONSULTATION WITH THE LOCAL SOCIAL
SERVICES COMMISSIONER SHALL ORDER AN ASSESSMENT TO BE PERFORMED USING
THE ASSESSMENT INSTRUMENT DEVELOPED PURSUANT TO THE PROVISION OF SECTION
THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW, AND IN ADDITION AN
ASSESSMENT OF THE INFORMAL CAREGIVING NETWORK AND SUPPORTS CAPABLE OF
PROVIDING SOCIAL AND NON-MEDICAL SERVICES TO THE SENIOR. IF THE RESULTS
OF THE ASSESSMENT INDICATE THAT THE SENIOR CAN RECEIVE THE APPROPRIATE
LEVEL OF CARE AT HOME OR IN THE HOME OF SUCH RESPONSIBLE RELATIVE OR
OTHER RESPONSIBLE ADULT, AND THAT THE SENIOR CAN BE APPROPRIATELY
SUPPORTED BY FAMILY, INTIMATES, FRIENDS AND COMMUNITY, THE OFFICE SHALL,
AFTER CONSULTING WITH THOSE WHO PERFORMED THE ASSESSMENT, PREPARE FOR
THAT SENIOR A PLAN FOR THE PROVISION OF SERVICES THAT MAY INCLUDE ANY
SERVICE THAT WOULD BE RENDERED IN A NURSING HOME PLUS SUCH ADDITIONAL
SERVICES AS THE OFFICE IS AUTHORIZED TO PROVIDE DIRECTLY OR THROUGH
CONTRACT PURSUANT TO THE PROVISIONS OF THE WAIVER AUTHORIZED BY THIS
SUBDIVISION. CONTINUED PROVISION OF SERVICES PURSUANT TO THIS SUBDIVI-
SION SHALL BE CONTINGENT ON ADDITIONAL ASSESSMENTS PERFORMED EVERY ONE
HUNDRED TWENTY DAYS. AT THE TIME OF THE INITIAL ASSESSMENT, AND AT THE
TIME OF EACH SUBSEQUENT ASSESSMENT (OR MORE OFTEN IF THE SENIOR'S NEEDS
REQUIRE), THE OFFICE SHALL ESTABLISH A MONTHLY BUDGET FOR PAYMENT FOR
THE SERVICES PROVIDED UNDER SUCH PLAN. TOTAL ANNUAL EXPENDITURES FOR
MEDICAL ASSISTANCE SERVICES MADE PURSUANT TO TITLE ELEVEN OF ARTICLE
FIVE OF THE SOCIAL SERVICES LAW FOR ALL SUCH SENIORS WITHIN THE SOCIAL
SERVICES DISTRICT WITHIN WHICH SUCH SENIORS RESIDE SHALL NOT EXCEED
A. 2120 3
SIXTY-FIVE PERCENT OF THE AVERAGE OF THE ANNUAL RATES PAYABLE UNDER SUCH
TITLE FOR NURSING HOME SERVICES WITHIN THE SOCIAL SERVICES DISTRICT IN
WHICH SUCH SENIORS RESIDE, SUCH AMOUNT TO BE DETERMINED BY MULTIPLYING
THE TOTAL NUMBER OF SENIORS WITHIN THE PROGRAM IN ANY YEAR BY THE AVER-
AGE OF THE ANNUAL RATES PAYABLE FOR SUCH NURSING HOME SERVICES.
(C) SERVICES PROVIDED UNDER THE SENIOR CARE CHOICES PROGRAM INCLUDE
SERVICES PROVIDED BY THE OFFICE, AND PROVIDED PURSUANT TO THE WAIVER,
INCLUDING BUT NOT LIMITED TO SUCH LONG TERM CARE SERVICES AS CARE,
TREATMENT, MAINTENANCE AND SERVICES PROVIDED IN A NURSING FACILITY
LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, OR
PROVIDED BY A HOME CARE SERVICES AGENCY, CERTIFIED HOME HEALTH AGENCY OR
LONG TERM HOME HEALTH CARE PROGRAM, AS DEFINED IN SECTION THIRTY-SIX
HUNDRED TWO OF THE PUBLIC HEALTH LAW, OR PROVIDED BY AN ADULT DAY HEALTH
CARE PROGRAM IN ACCORDANCE WITH REGULATIONS OF THE DEPARTMENT OF HEALTH,
OR PROVIDED BY A PERSONAL CARE PROVIDER LICENSED OR REGULATED BY ANY
OTHER STATE OR LOCAL AGENCY, AND SUCH OTHER SERVICES FOR WHICH MEDICAL
ASSISTANCE IS OR OTHERWISE WOULD BE AVAILABLE PURSUANT TO THE SOCIAL
SERVICES LAW INCLUDING THOSE WHICH ARE DESIGNATED AS LONG TERM CARE
SERVICES IN LAW OR REGULATIONS OF THE DEPARTMENT OF HEALTH, CONSUMER
DIRECTED PERSONAL ASSISTANCE SERVICES AND SUCH OTHER SERVICES AS HOME
MODIFICATION, TELEHEALTH, PHARMACY REVIEW AND PALLIATIVE CARE.
§ 2. This act shall take effect immediately.