The New York State Senate

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

                                  1803

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                            January 16, 2019
                               ___________

Introduced  by  Sen.  RIVERA -- 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  promoting  the
  development,  expansion  and  efficient  operation  of continuing care
  retirement communities;  and  providing  for  the  repeal  of  certain
  provisions upon expiration thereof

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

  Section 1. Paragraphs e and f of subdivision 2-b of  section  4601  of
the  public health law, as amended by chapter 7 of the laws of 2015, are
amended and a new paragraph g is added to read as follows:
  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; [and]
  f. communities established under this article offering continuing care
at  home  contracts must also offer continuing care retirement contracts
and must maintain a continuing care retirement community  that  operates
in support of the continuing care at home contracts[.]; AND
  G.  FOR  PURPOSES  OF  THIS ARTICLE, ANY REFERENCE TO "CONTINUING CARE
RETIREMENT COMMUNITY" OR "COMMUNITY" SHALL ALSO APPLY TO THE TERM  "LIFE
PLAN COMMUNITY".
  § 2. Paragraph a of subdivision 8 of section 4651 of the public health
law,  as  amended by chapter 545 of the laws of 2004, is amended to read
as follows:
  a. "Fee-for-service continuing care retirement community" OR "COMMUNI-
TY" shall mean a facility or facilities  established  pursuant  to  this
article  to provide a comprehensive, cohesive living arrangement for the
elderly, oriented to the enhancement of the quality of life, pursuant to
the terms of the fee-for-service continuing care contract on a  fee-for-
service  schedule.  Such facility, at a minimum, shall provide access to

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

                                                           LBD03963-01-9

S. 1803                             2

on-site geriatric services,  including,  but  not  limited  to,  nursing
facility  services,  services  provided  by an adult care facility, home
health services, a meal plan, social  services  and  independent  living
units.  FOR  PURPOSES OF THIS ARTICLE, ANY REFERENCE TO "FEE-FOR-SERVICE
CONTINUING CARE RETIREMENT COMMUNITY" OR "COMMUNITY" SHALL ALSO APPLY TO
THE TERM "LIFE PLAN COMMUNITY".
  § 3. Section 4602 of the public health law, as added by chapter 689 of
the laws of 1989, the section  heading  and  subdivisions  1  and  2  as
amended  by  chapter  659  of the laws of 1997, the opening paragraph of
subdivision 1 as amended by section 81 of part A of chapter  62  of  the
laws of 2011, the opening paragraph of subdivision 2 as amended by chap-
ter  549 of the laws of 2014, subdivision 3 as amended by chapter 155 of
the laws of 2012, is amended to read as follows:
  § 4602. Continuing  care  retirement  community  council;  powers  and
duties.    1. The continuing care retirement community council is hereby
established, to consist of the following, or their designees: the attor-
ney general; the commissioner; the director of the office for the aging;
and eight public members appointed by the governor with the  advice  and
consent  of  the  senate. Such public members shall be representative of
the public, and have a demonstrated expertise or interest in  continuing
care  retirement  communities;  provided  that no [more] LESS than [one]
THREE such [member] MEMBERS shall be a sponsor, owner, operator,  manag-
er,  member of a board of directors, or shareholder of a continuing care
retirement community. At least two public members shall be residents  of
a  continuing  care  retirement  community.  At  least one of the public
members shall be a representative of an organization  with  demonstrated
experience  in representing the interests of senior citizens. The public
members of the council shall have fixed terms of four years. The council
shall be chaired by the commissioner or his or her designee.
  Members of such council shall serve  without  compensation  for  their
services  as  members  of  the  council, except that each of them may be
allowed the necessary and actual expenses which [he] THEY shall incur in
the performance of [his] THEIR duties under this article.
  2. The council shall meet as often  as  may  be  deemed  necessary  to
fulfill  its  responsibilities.  The  council  shall  have the following
powers and duties:
  a. to [approve or reject  applications  to  obtain  a  certificate  of
authority  for  the  establishment  and  operation  of a continuing care
retirement community.  In  reviewing  applications,  the  council  shall
consider  the  extent to which the applications reflect various sponsor-
ships, organizational structures, geographic dispersion, and the  public
benefit.  In  determining  the  public  benefit of a community requiring
construction of a total nursing facility component greater than or equal
to ninety beds, the council shall obtain and consider the recommendation
of the state hospital review and planning council  with  regard  to  the
effect of the construction of the community's nursing facility beds upon
existing facilities in the same geographic area] ASSIST THE COMMISSIONER
ON POLICY MATTERS RELATED TO THE ESTABLISHMENT AND OPERATION OF CONTINU-
ING CARE RETIREMENT COMMUNITIES;
  b.  to  [require  the  reporting  of such facts and information as the
council may deem necessary to enforce the provisions of  this  article;]
ASSIST THE COMMISSIONER IN THE DEVELOPMENT OF THE STATE'S OVERALL POLICY
REGARDING  CONTINUING  CARE RETIREMENT COMMUNITIES AND CAUSE STUDIES AND
RESEARCH TO BE CONDUCTED AS IT MAY DEEM ADVISABLE AND NECESSARY; AND
  c. [to coordinate the oversight of operating communities and to assign
review and regulatory responsibility  for  particular  aspects  of  such

S. 1803                             3

communities  to  the  appropriate  agencies, consistent with their legal
authority, to assure consistent state supervision without duplication of
inspection or regulatory review;
  d.]  to  make such recommendations to the governor and the legislature
as may be necessary to encourage or further regulate the development  of
continuing care retirement communities[;
  e. to establish and charge equitable and reasonable annual charges for
operators,  not  to  exceed  fifty  dollars per approved living unit, to
subsidize, in part, expenditures incurred in reviewing applications  for
certificates of authority and in inspecting, regulating, supervising and
auditing continuing care retirement communities;
  f.  to  review  reports  from the participating agencies regarding the
operations and financial management of approved  communities,  including
any  reports regarding the financial condition of any community that may
be in need of close supervision and any reports of deficiencies  in  the
provision of health or social services to residents of any community;
  g. to adopt rules and regulations and amendments thereto to effectuate
the provisions of this article;
  h.  to  revoke,  suspend,  limit,  or annul a certificate of authority
under conditions set forth in section forty-six hundred fifteen of  this
article,  including when such action is taken at the specific request of
any participating council agency. When action  has  been  taken  by  the
commissioner  pursuant to subdivision seven of section forty-six hundred
three of this article, the council shall  meet  as  soon  as  reasonably
possible  to  approve  or  disapprove the action of the commissioner and
shall take such further action as may be appropriate;
  i. to develop guidelines for applications for certificates of authori-
ty;
  j. to make a final determination regarding an application for authori-
zation to enter into priority reservation agreements where  the  commis-
sioner has proposed to reject such application;
  k. to require the reporting of such facts and information as the coun-
cil  may deem necessary to determine whether characteristics of residen-
tial health care demonstration facilities such as comprehensive  systems
of  residential and support services for the elderly may be successfully
incorporated into existing or approved continuing care retirement commu-
nities;
  l. to review and approve or reject  applications  by  continuing  care
retirement community operators to use entrance fees to assist the opera-
tor  in  financing the construction or purchase of a proposed continuing
care retirement community in accordance with paragraph b of  subdivision
six of section forty-six hundred ten of this article; and
  m.  to  review  and approve or reject any proposed financing by indus-
trial development agencies of  continuing  care  retirement  communities
pursuant  to  article eighteen-A of the general municipal law as author-
ized by section forty-six hundred four-a of this article.
  3. The council shall establish guidelines under which the commissioner
is authorized to approve or reject  any  proposed  refinancing,  if  the
council  has  already approved an application pursuant to paragraph a of
subdivision two of this section].
  § 4. Section 4603 of the public health law, as amended by chapter  659
of  the  laws of 1997, subdivisions 10 and 11 as amended and subdivision
12 as added by chapter 401 of the laws of 2003, is amended  to  read  as
follows:
  §  4603. Commissioner; power and duties. The commissioner[, in consul-
tation with the council,] shall have the following powers and duties:

S. 1803                             4

  1. A. to receive applications from potential operators  of  continuing
care  retirement  communities  and  to  distribute such applications for
review to the participating agencies;
  [2.]  B. to collect and compile recommendations from the participating
agencies and to present consolidated materials[,  including  recommenda-
tions, to the council for its review and action];
  [3.]  C. to develop uniform forms for applications for certificates of
authority, to review the status of such applications, and to  coordinate
the  review  of  such  applications  in order to minimize duplication or
delay;
  [4.] D. to  provide  information  to  entities  wishing  to  establish
continuing  care  retirement  communities  and  to persons interested in
becoming residents of such communities and to assist operators and resi-
dents of such communities, to  the  extent  appropriate,  with  concerns
relating to the operation of such facilities;
  [5.]  E.  to  [issue  certificates  of  authority  to those applicants
approved by the council] APPROVE OR  REJECT  APPLICATIONS  TO  OBTAIN  A
CERTIFICATE  OF  AUTHORITY  FOR  THE  ESTABLISHMENT  AND  OPERATION OF A
CONTINUING CARE RETIREMENT COMMUNITY.  IN  REVIEWING  APPLICATIONS,  THE
COMMISSIONER SHALL CONSIDER THE EXTENT TO WHICH THE APPLICATIONS REFLECT
VARIOUS  SPONSORSHIPS,  ORGANIZATIONAL STRUCTURES, GEOGRAPHIC DISPERSION
AND THE PUBLIC BENEFIT. IN DETERMINING THE PUBLIC BENEFIT OF A COMMUNITY
REQUIRING CONSTRUCTION OF A TOTAL  NURSING  FACILITY  COMPONENT  GREATER
THAN OR EQUAL TO NINETY BEDS, THE COMMISSIONER SHALL OBTAIN AND CONSIDER
THE RECOMMENDATION OF THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL WITH
REGARD  TO  THE  EFFECT  OF  THE CONSTRUCTION OF THE COMMUNITY'S NURSING
FACILITY BEDS UPON EXISTING FACILITIES IN THE SAME GEOGRAPHIC AREA;
  [6.] F. to coordinate the [interagency regulatory review of the appli-
cations, development and operations of communities in order to  minimize
duplication  or delay] OVERSIGHT OF OPERATING COMMUNITIES AND TO CONSOL-
IDATE REVIEW AND REGULATORY  RESPONSIBILITY,  INCLUDING  INSPECTIONS  OF
CONTINUING  CARE  RETIREMENT  COMMUNITY FACILITIES, TO ASSURE CONSISTENT
STATE  SUPERVISION  WITHOUT  DUPLICATION  OF  INSPECTION  OR  REGULATORY
REVIEW;
  [7.]  G.  if  the  immediate  health,  safety, or financial needs of a
community's residents are in jeopardy, to suspend or limit a certificate
of authority pursuant to subdivision two of  section  forty-six  hundred
fifteen  of  this article. If the commissioner suspends a certificate of
authority, he OR SHE shall [immediately] notify the council;
  [8.] H. to [make recommendations concerning and  to  promulgate  rules
and  regulations  and  amendments  thereto that have been adopted by the
council to effectuate the provisions of this article]  ADOPT  RULES  AND
REGULATIONS  AND AMENDMENTS THERETO TO EFFECTUATE THE PROVISIONS OF THIS
ARTICLE;
  [9.] I. to carry out  any  other  responsibilities  entrusted  to  the
commissioner  pursuant to this chapter that may be necessary with regard
to the health care activities of continuing care retirement communities;
  [10.] J. to make available to all prospective operators all  pertinent
regulations regarding health and insurance necessary to comply with this
article;
  [11.]  K.  to  approve  or  reject  applications for authorization, by
prospective continuing care retirement  community  applicants,  entities
that have filed an application for a certificate of authority and opera-
tors,  to  enter  into cancelable priority reservation agreements and to
collect refundable priority  reservation  fees  from  prospective  resi-
dents[;  provided  that  in  any case where the commissioner proposes to

S. 1803                             5

reject such application, the council  shall  meet  within  a  reasonable
period  of  time not to exceed ninety days to make a final determination
regarding such application]; [and
  12.] L. to approve or reject any proposed refinancing [consistent with
the  guidelines  established  pursuant  to  subdivision three of section
forty-six hundred two of this article.];
  M. TO REVOKE, SUSPEND, LIMIT OR ANNUL A CERTIFICATE OF AUTHORITY UNDER
CONDITIONS SET FORTH IN SECTION FORTY-SIX HUNDRED FIFTEEN OF THIS  ARTI-
CLE,  INCLUDING WHEN SUCH ACTION IS TAKEN AT THE SPECIFIC REQUEST OF ANY
PARTICIPATING COUNCIL AGENCY;
  N. TO REQUIRE THE REPORTING OF SUCH FACTS AND INFORMATION TO DETERMINE
WHETHER CHARACTERISTICS OF RESIDENTIAL HEALTH CARE DEMONSTRATION FACILI-
TIES SUCH AS COMPREHENSIVE SYSTEMS OF RESIDENTIAL AND  SUPPORT  SERVICES
FOR  THE  ELDERLY  MAY  BE  SUCCESSFULLY  INCORPORATED  INTO EXISTING OR
APPROVED CONTINUING CARE RETIREMENT COMMUNITIES;
  O. TO REVIEW AND APPROVE OR REJECT  APPLICATIONS  BY  CONTINUING  CARE
RETIREMENT COMMUNITY OPERATORS TO USE ENTRANCE FEES TO ASSIST THE OPERA-
TOR  IN  FINANCING THE CONSTRUCTION OR PURCHASE OF A PROPOSED CONTINUING
CARE RETIREMENT COMMUNITY IN ACCORDANCE WITH PARAGRAPH B OF  SUBDIVISION
SIX OF SECTION FORTY-SIX HUNDRED TEN OF THIS ARTICLE; AND
  P.  TO  REVIEW  AND APPROVE OR REJECT ANY PROPOSED FINANCING BY INDUS-
TRIAL DEVELOPMENT AGENCIES OF  CONTINUING  CARE  RETIREMENT  COMMUNITIES
PURSUANT  TO  ARTICLE EIGHTEEN-A OF THE GENERAL MUNICIPAL LAW AS AUTHOR-
IZED BY SECTION FORTY-SIX HUNDRED FOUR-A OF THIS ARTICLE.
  2. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, THIS SUBDIVI-
SION SHALL APPLY TO ANY APPLICATION TO OBTAIN A CERTIFICATE OF AUTHORITY
FOR THE ESTABLISHMENT AND OPERATION  OF  A  CONTINUING  CARE  RETIREMENT
COMMUNITY  OR  FEE-FOR-SERVICE  CONTINUING CARE RETIREMENT COMMUNITY AND
ANY APPLICATION FOR THE CERTIFICATION OR LICENSURE OF ANY COMPONENT OF A
CONTINUING CARE RETIREMENT COMMUNITY OR FEE-FOR-SERVICE CONTINUING  CARE
RETIREMENT COMMUNITY.
  A.  FOR  AN  APPLICATION  TO OBTAIN A CERTIFICATE OF AUTHORITY FOR THE
ESTABLISHMENT AND OPERATION OF A CONTINUING  CARE  RETIREMENT  COMMUNITY
SUBMITTED  TO  THE  COMMISSIONER  PURSUANT  TO  THIS ARTICLE AND ARTICLE
FORTY-SIX-A OF THIS CHAPTER, WITHIN ONE HUNDRED EIGHTY CALENDAR DAYS  OF
THE  DEPARTMENT DEEMING THE APPLICATION COMPLETE, THE COMMISSIONER SHALL
MAKE A DECISION TO APPROVE OR DISAPPROVE THE APPLICATION. IF THE COMMIS-
SIONER DETERMINES TO DISAPPROVE  THE  APPLICATION,  THE  BASIS  OF  SUCH
DISAPPROVAL SHALL BE PROVIDED IN WRITING; HOWEVER, DISAPPROVAL SHALL NOT
BE  BASED  ON THE INCOMPLETENESS OF THE APPLICATION. IF THE COMMISSIONER
FAILS TO TAKE ACTION TO APPROVE OR DISAPPROVE THE APPLICATION WITHIN ONE
HUNDRED EIGHTY DAYS OF THE APPLICATION BEING DEEMED COMPLETE, THE APPLI-
CATION SHALL BE DEEMED APPROVED.
  B. THE COMMISSIONER, IN CONSULTATION WITH THE PUBLIC HEALTH AND HEALTH
PLANNING COUNCIL, SHALL DEVELOP A  STREAMLINED  APPLICATION  REVIEW  AND
APPROVAL PROCESS TO BE AVAILABLE FOR USE ON OR BEFORE JANUARY FIRST, TWO
THOUSAND  TWENTY IN RELATION TO THE APPROVAL OF COMPONENTS OF A CONTINU-
ING CARE RETIREMENT COMMUNITY, INCLUDING, BUT NOT LIMITED TO, A RESIDEN-
TIAL HEALTH CARE FACILITY,  ADULT  CARE  FACILITY  AND  ASSISTED  LIVING
FACILITY; PROVIDED, HOWEVER, THAT NO SUCH STREAMLINED APPLICATION REVIEW
AND APPROVAL PROCESS SHALL LIMIT OR RESTRICT THE AUTHORITY OF THE PUBLIC
HEALTH  AND  PLANNING COUNCIL TO ISSUE FINAL APPROVAL OR DISAPPROVAL FOR
THE ESTABLISHMENT, CONSTRUCTION OR ADDITION OF RESIDENTIAL  HEALTH  CARE
FACILITY BEDS.
  C.  FOR AN APPLICATION THAT REQUIRES APPROVAL BY THE PUBLIC HEALTH AND
HEALTH PLANNING COUNCIL, THE APPLICATION SHALL BE  PLACED  ON  THE  NEXT

S. 1803                             6

COUNCIL  AGENDA  FOLLOWING  THE  COMMISSIONER  DEEMING  THE  APPLICATION
COMPLETE.
  D. WHERE THE COMMISSIONER REQUIRES THE APPLICANT TO SUBMIT INFORMATION
TO  SATISFY A CONTINGENCY IMPOSED ON THE APPROVAL OF AN APPLICATION, THE
COMMISSIONER SHALL HAVE THIRTY CALENDAR DAYS TO REVIEW  AND  APPROVE  OR
DISAPPROVE  THE  SUBMITTED  INFORMATION.  IF THE COMMISSIONER DETERMINES
THAT THE INFORMATION IS INCOMPLETE,  THE  DEPARTMENT  SHALL  NOTIFY  THE
APPLICANT IN WRITING AND PROVIDE THE APPLICANT WITH TEN CALENDAR DAYS TO
CORRECT THE DEFICIENCY OR PROVIDE ADDITIONAL INFORMATION. IF THE COMMIS-
SIONER  DETERMINES  THAT  THE SUBMITTED INFORMATION DOES NOT SATISFY THE
CONTINGENCY, THE BASIS FOR SUCH DISAPPROVAL SHALL BE PROVIDED  IN  WRIT-
ING;  HOWEVER,  DISAPPROVAL  SHALL NOT BE BASED ON THE INCOMPLETENESS OF
THE APPLICATION. WITHIN FIFTEEN CALENDAR DAYS OF  COMPLETE  SATISFACTION
OF  A  CONTINGENCY,  THE  COMMISSIONER SHALL TRANSMIT THE FINAL APPROVAL
LETTER TO THE APPLICANT.
  § 5. Subdivision 1 of section  4604  of  the  public  health  law,  as
amended  by  chapter  659  of  the  laws  of 1997, is amended to read as
follows:
  1. No person shall construct, expand, acquire, maintain, or operate  a
continuing  care  retirement  community,  or enter into a contract as an
operator, or solicit the execution of any contract for  continuing  care
retirement  community services to be provided within the state or adver-
tise itself or otherwise hold itself as a  "continuing  care  retirement
community"  OR  A "LIFE PLAN COMMUNITY", without obtaining a certificate
of authority pursuant to this article;  provided,  however,  nothing  in
this subdivision shall prohibit a person, authorized pursuant to section
forty-six  hundred  twenty-one  or  forty-six hundred twenty-two of this
article, from entering into priority reservation agreements, soliciting,
collecting or receiving priority reservation fees, or  constructing  and
maintaining  sales  offices  and  model units with respect to a proposed
continuing care retirement community.
  § 6. Subdivision 1 of section  4655  of  the  public  health  law,  as
amended  by  chapter  545  of  the  laws  of 2004, is amended to read as
follows:
  1. No person shall construct, expand, acquire, maintain, or operate  a
fee-for-service  continuing  care  retirement community, or enter into a
contract as an operator, or solicit the execution of  any  contract  for
fee-for-service  continuing  care  retirement  community  services to be
provided within the state or advertise itself or otherwise  hold  itself
as  a  "fee-for-service continuing care retirement community" OR A "LIFE
PLAN COMMUNITY", without obtaining a certificate of  authority  pursuant
to  this  article;  provided, however, nothing in this subdivision shall
prohibit a person, authorized  pursuant  to  section  forty-six  hundred
seventy-four  or  forty-six  hundred  seventy-five of this article, from
entering into priority reservation agreements, soliciting, collecting or
receiving priority reservation fees,  or  constructing  and  maintaining
sales offices and model units with respect to a proposed fee-for-service
continuing   care  retirement  community.  Such  facility  shall  obtain
approval to utilize residential health  care  facility  beds  authorized
under subdivision five of section forty-six hundred four of this chapter
and/or  shall meet such other conditions for acquisition of the residen-
tial health care facility beds as the commissioner may determine.
  § 7. Subdivision 3 of section  4604  of  the  public  health  law,  as
amended by chapter 7 of the laws of 2015, is amended to read as follows:
  3.  Nothing in this article shall be construed to enlarge, diminish or
modify: a social services  district's  otherwise  valid  recovery  under

S. 1803                             7

section three hundred sixty-nine of the social services law, nor medical
assistance  eligibility under title eleven of article five of the social
services law nor applicable provisions of the estates, powers and trusts
law.  Except  as  otherwise  provided in this article, the activities of
continuing care retirement communities shall be subject to any other law
governing such activities including but not limited to  article  twenty-
eight  of  this chapter and article seven of the social services law and
regulations  promulgated  thereunder;  provided,   however,   that   the
provisions  of  paragraphs  (d)  and  (e) of subdivision four of section
twenty-eight hundred one-a and section twenty-eight hundred two of  this
chapter  shall  not apply, and provided that the provisions of paragraph
(a) of subdivision one and the provisions of subdivision two of  section
four  hundred  sixty-one-b  of  the  social services law with respect to
public need and the  provisions  of  subdivision  one  of  section  four
hundred  sixty-one-c of the social services law shall not apply to resi-
dents who have been admitted in  accordance  with  a  contract  provided
that, upon admission to the adult care facility, such residents shall be
given  a notice which shall include, at a minimum, information regarding
facility services,  resident  responsibilities,  supplemental  services,
resident rights and protections and circumstances that warrant transfer,
SUBJECT TO THE PROVISIONS OF SUBDIVISION TWENTY-ONE OF SECTION FORTY-SIX
HUNDRED  EIGHT  OF  THIS  ARTICLE. The number of residential health care
facility beds available pursuant to subdivision five  of  this  section,
without proof of public need therefor, shall be reduced by the number of
residential  health  care  demonstration facility beds that are approved
pursuant to this article.
  § 8. Subdivision 3 of section 4655 of the public health law, as  added
by chapter 519 of the laws of 2004, is amended to read as follows:
  3.  Nothing in this article shall be construed to enlarge, diminish or
modify: a social services  district's  otherwise  valid  recovery  under
section three hundred sixty-nine of the social services law, nor medical
assistance  eligibility under title eleven of article five of the social
services law, nor applicable  provisions  of  the  estates,  powers  and
trusts law. Except as otherwise provided in this article, the activities
of  fee-for-service  continuing  care  retirement  communities  shall be
subject to any other law governing such  activities  including  but  not
limited to article twenty-eight of this chapter and article seven of the
social  services  law  and regulations promulgated thereunder; provided,
however, that the provisions of paragraphs (d) and  (e)  of  subdivision
four  of  section  twenty-eight  hundred  one-a and section twenty-eight
hundred two of this chapter shall  not  apply,  and  provided  that  the
provisions  of  paragraph  (a)  of subdivision one and the provisions of
subdivision two of  section  four  hundred  sixty-one-b  of  the  social
services  law with respect to public need and the provisions of subdivi-
sion one of section four hundred sixty-one-c of the social services  law
shall not apply to residents who have been admitted in accordance with a
fee-for-service  continuing  care contract provided that, upon admission
to the adult care facility, such residents shall be given a notice which
shall include, at a minimum, information  regarding  facility  services,
resident  responsibilities,  supplemental  services, resident rights and
protections and circumstances that  warrant  transfer,  SUBJECT  TO  THE
PROVISIONS  OF SUBDIVISION SEVENTEEN OF SECTION FORTY-SIX HUNDRED FIFTY-
NINE OF THIS ARTICLE.  The number of residential  health  care  facility
beds  available  pursuant  to  subdivision four of this section, without
proof of public need therefor, shall be reduced by the number  of  resi-

S. 1803                             8

dential health care demonstration facility beds that are approved pursu-
ant to this article.
  §  9.  Subdivision  4  of  section  4604  of the public health law, as
amended by chapter 659 of the laws of 1997, subparagraphs (i), (ii)  and
(iii)  of  paragraph  a  as  further amended by section 104 of part A of
chapter 62 of the laws of 2011, paragraphs b and d as amended by chapter
549 of the laws of 2014, paragraph c as amended by chapter 7 of the laws
of 2015, is amended to read as follows:
  4. No certificate of authority shall be issued unless  an  application
meeting  the  requirements  of  this  section and all other requirements
established by law has been approved by THE COMMISSIONER:
  a. [(i)] the [superintendent of financial services as to the actuarial
principles involved, the financial feasibility of the facility, the form
and content of the proposed contracts to be entered into with  residents
and insurance contracts between an operator and an insurer requiring the
insurer  to  assume,  wholly  or  in part, the cost of medical or health
related services to be provided  to  a  resident]  ACTUARIAL  PRINCIPLES
INVOLVED,  THE  FINANCIAL  FEASIBILITY  OF THE FACILITY AND THE FORM AND
CONTENT OF THE PROPOSED CONTRACTS TO BE  ENTERED  INTO  WITH  RESIDENTS,
PROVIDED  THAT THE REVIEW MAY BE CONDUCTED BY THE COMMISSIONER OR HIS OR
HER DESIGNEE, INCLUDING ANY NECESSARY INDEPENDENT ACTUARIAL REVIEW;
  [(ii) the superintendent of financial services as to] B. the rates and
rating methodology, if any, to be used by the operator to determine  any
entrance fee, monthly care fee and/or any separate charges for the hous-
ing  component of the continuing care contract including but not limited
to a cooperative or condominium fee charged to the resident as  proposed
in said operator's application for certificate of authority.  Subsequent
increases  in  any entrance or monthly care fee in excess of fees calcu-
lated pursuant to the approved rating methodology shall require approval
of the [superintendent] COMMISSIONER.  The term "rating methodology"  as
used  herein  shall incorporate a combination of variables including but
not limited to a pricing structure for  comparable  services,  projected
operating  and  health care costs and the applicable inflationary impact
thereon, projected income and  occupancy  rates  and  the  refundability
component of the continuing care retirement contract[.
  (iii) the superintendent of financial services as to];
  C.  any  monthly care fee charged to a resident which may be increased
or decreased subject to approval by  the  [superintendent  of  financial
services]   COMMISSIONER,  provided,  that  monthly  care  fees  may  be
increased or  decreased  without  specific  approval  as  long  as  such
increase  or  decrease  does not exceed a relevant cost index or indices
which reflect all components of  continuing  care  including  the  costs
associated  with  provision of health care as determined and promulgated
at least annually by the [superintendent] COMMISSIONER  OR  HIS  OR  HER
DESIGNEE,  INCLUDING  ANY  NECESSARY  INDEPENDENT  ACTUARIAL REVIEW, and
provided further that the [superintendent] COMMISSIONER is  notified  of
any such increase or decrease prior to its taking effect[.
  (iv) An] D. THE REQUIREMENT THAT AN individual resident's monthly care
fee  shall not be modified because of the increased need for services of
that resident;
  [b. the commissioner as to those] E. aspects of the application relat-
ing to adult care facility beds, if any;
  [c.] F. FOLLOWING REVIEW BY the  public  health  and  health  planning
council  as  to  the  establishment of a skilled nursing facility by the
applicant and as to such other facilities and services  as  may  require
the public health and health planning council's approval of the applica-

S. 1803                             9

tion;  provided, however, that the recommendations of 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 facili-
ty beds provided for in subdivision five of this section in  communities
statewide;
  [d.  the  commissioner  under section twenty-eight hundred two of this
chapter;] G. provided, however, that, the recommendations of the  public
health  and health planning council and the health systems agency having
geographical jurisdiction of the area where the continuing care  retire-
ment  community  is  located  shall  not be required with respect to the
construction of an on-site or affiliated residential health care facili-
ty to serve residents as part of the continuing care retirement communi-
ty, for up to the total number of residential health care facility  beds
provided  for  in subdivision five of this section in communities state-
wide; and
  [e. the] H. UPON CONSULTATION WITH THE attorney general, as  to  those
aspects  of  the  application  relating to a cooperative, condominium or
other equity arrangement for the independent living unit, if any.
  § 10. The opening paragraph of subdivision 6 of section  4604  of  the
public  health  law,  as  amended by chapter 659 of the laws of 1997, is
amended to read as follows:
  If the [approvals] APPLICANT HAS SATISFIED THE  CRITERIA  required  by
subdivision  four  of  this  section [have been obtained], the [council]
COMMISSIONER shall[, by majority vote,] either  approve  or  reject  the
application  [within  sixty  days  of  the  date  on which the last such
approval has been obtained]. In order to approve  the  application,  the
[council] COMMISSIONER shall have determined that:
  §  11.  Subdivisions 7 and 9 of section 4604 of the public health law,
subdivision 7 as amended by chapter 659 of the laws of 1997 and subdivi-
sion 9 as added by chapter 689 of the laws of 1989, are amended to  read
as follows:
  7.  Any  change  in  the  legal  entity  operating the continuing care
retirement community, or in a controlling person of the community  shall
require  approval  in  the  same  manner  as  an  original  application;
provided,  however,  that  the  [council]  COMMISSIONER  may  waive  any
requirement  to  provide information that is not relevant to such change
and provided, further, that the continued public need for the  community
shall be presumed.
  9.  [If  the  council  approves the application, the] THE commissioner
shall issue the certificate of authority to the applicant UPON  APPROVAL
OF THE APPLICATION.
  §  12.  Section 4604-a of the public health law, as amended by chapter
659 of the laws of 1997, paragraph g of  subdivision  2  as  amended  by
chapter 549 of the laws of 2014, is amended to read as follows:
  §  4604-a.  [Council]  COMMISSIONER  approval  required for industrial
development agency financing in connection with continuing care  retire-
ment  communities.  1.  No person seeking financing in connection with a
continuing care retirement community through an  industrial  development
agency  shall undertake such financing without the prior approval of the
[council] COMMISSIONER. Upon approving a proposed financing pursuant  to
this  section,  the  [council] COMMISSIONER shall issue a certificate of
authorization to the applicant.

S. 1803                            10

  2. Prior to approving such financing, the [council] COMMISSIONER shall
find that:
  a.  The  operator  has  (i)  executed  contracts  for at least seventy
percent of all living units and has on deposit at least ten  percent  of
the  entrance  fees  or  purchase price for such units; or (ii) executed
contracts for at least sixty percent of all  living  units  and  has  on
deposit  at  least  twenty-five percent of the entrance fees or purchase
price for such units.
  b. The operator has demonstrated capability to comply fully  with  the
requirements  for  a certificate of authority and has obtained a contin-
gent certificate of authority pursuant to section forty-six hundred four
of this article and the operator has agreed to meet the requirements  of
article eighteen-A of the general municipal law.
  c. The applicant is a not-for-profit corporation as defined in section
one hundred two of the not-for-profit corporation law that is (i) eligi-
ble  for tax-exempt financing under this section and (ii) is exempt from
taxation pursuant to section 501(c)(3) of the federal  internal  revenue
code,  and either has (i) an equity position in the community equivalent
to no less than fifteen percent of the amount  to  be  financed  in  the
aggregate; or (ii) covenants (A) to meet a ratio of cash and investments
to  outstanding debt (reserve ratio) of no less than twenty-five percent
commencing at the end of the first quarter after twenty-four months from
the receipt of a certificate of occupancy for the facility, and  (B)  to
maintain  that reserve ratio, as tested quarterly based upon the facili-
ty's interim financial statements and annually based upon audited finan-
cial statements, until debt reduction equal to  twenty-five  percent  of
total  indebtedness  is  accomplished;  and  (c) to reduce total debt by
twenty-five percent of the total indebtedness at the  time  the  certif-
icate  of  occupancy  is  received by no later than five years after the
receipt of the certificate of occupancy.
  d. The operator has submitted in connection with the proposed  financ-
ing  a  financial  feasibility study, including a financial forecast and
market study prepared by an independent firm nationally  recognized  for
continuing  care retirement community feasibility studies, demonstrating
to the satisfaction of the [council] COMMISSIONER the  financial  sound-
ness of the financing. In addition, the operator has submitted an analy-
sis   of  economic  costs  and  benefits,  including  job  creation  and
retention, the estimated value of tax exemptions provided, the project's
impact on local businesses and the availability and comparative cost  of
alternative  financing  sources.  Such  analysis shall be prepared by an
independent entity.
  e. The operator will  establish  and  maintain  a  fully  funded  debt
service  reserve equal to the sum of maximum annual debt service (inter-
est plus annual scheduled  principal  payments,  not  including  balloon
maturities, if any) on bonds authorized thereby having a maturity of ten
years  or less, plus the maximum annual debt service on bonds authorized
thereby having a maturity of greater than ten years, provided,  however,
that  in  the  case of tax-exempt bond issues, such debt service reserve
shall not exceed the maximum amount permitted by federal tax law.
  f. The operator will provide for such remedies or limitations of reme-
dies of bondholders as  may  be  required  by  or  consistent  with  the
provisions  of this article and any regulations in existence at the time
of the issuance promulgated thereunder.
  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-

S. 1803                            11

four  of  this article and has agreed to fund the liability in the event
that such resident's or contract holder's assets are insufficient to pay
for nursing facility services for a one year period.
  3. In addition, an operator which is subject to the provisions of this
section shall:
  a.  provide  the [council or its designee] COMMISSIONER with notice of
any monetary default or covenant default in connection with such financ-
ing and shall further notify the [council or its designee]  COMMISSIONER
of  any  withdrawal  from  the  debt service reserve fund established in
connection with such financing;
  b. respond in writing to the operational recommendations of the [coun-
cil or its designee] COMMISSIONER with respect to protecting the  inter-
ests  of  continuing care retirement community residents in the event of
any monetary default or covenant default provided for in connection with
such financing;
  c. provide adequate security for the repayment of  the  bonds  issued,
including  the  granting  of liens on real and personal property and the
pledge of project revenues; the  maintenance  of  minimum  debt  service
coverage  and other financial ratios as shall be required in regulations
in existence at the time of issuance by the [council] COMMISSIONER;  and
restrictions on other debt and expenditures; and
  d.  undertake  to  maintain the financial feasibility of the facility,
including the retention of an independent consultant  to  recommend  and
help implement remedial action.
  4.  The  [council]  COMMISSIONER  may  request, and shall receive, the
technical assistance of any state agency or state  public  authority  in
performing its functions under this article.
  §  13.  Paragraphs  a  and  b  of subdivision 2 of section 4605 of the
public health law, paragraph a as amended by chapter 659 of the laws  of
1997  and paragraph b as amended by chapter 401 of the laws of 2003, are
amended to read as follows:
  a. The commissioner[, in consultation with the council,] may authorize
an operator of a community with an  on-site  or  affiliated  residential
health  care  facility  to  provide[, for a limited period,] residential
health care facility services to persons, who are not residents  of  the
community,  provided,  however, that the operator shall not discriminate
in the admission, retention or care of  any  such  person  because  such
person  is or will be eligible for, or receives or will receive, medical
assistance benefits pursuant to title eleven  of  article  five  of  the
social  services  law.    FOR  COMMUNITIES IN EXISTENCE PRIOR TO JANUARY
FIRST, TWO THOUSAND NINETEEN WITH AN ON-SITE OR  AFFILIATED  RESIDENTIAL
HEALTH  CARE  FACILITY,  EACH  COMMUNITY  IS  AUTHORIZED  TO CONTINUE TO
PROVIDE RESIDENTIAL HEALTH CARE FACILITY SERVICES TO PERSONS WHO ARE NOT
RESIDENTS OF THE COMMUNITY AT A PERCENTAGE  DEEMED  PERMISSIBLE  BY  THE
COMMISSIONER.  FOR  COMMUNITIES  APPROVED  FOLLOWING  JANUARY FIRST, TWO
THOUSAND NINETEEN WITH AN ON-SITE OR AFFILIATED RESIDENTIAL HEALTH  CARE
FACILITY,  EACH  COMMUNITY  SHALL  BE  PERMITTED  TO PROVIDE RESIDENTIAL
HEALTH CARE FACILITY SERVICES TO PERSONS WHO ARE NOT  RESIDENTS  OF  THE
COMMUNITY FOR A PERIOD OF SEVEN YEARS, PROVIDED, HOWEVER, THAT THE OPER-
ATOR  MAY  SEEK  AN  EXTENSION  OF  THIS AUTHORIZATION AT THE END OF THE
SEVEN-YEAR PERIOD UPON WRITTEN APPLICATION TO THE COMMISSIONER.
  b. [The] UPON WRITTEN NOTICE TO  THE  commissioner,  [in  consultation
with  the  council,  may  authorize]  an operator of a community with an
on-site or affiliated adult care  facility  [to]  MAY  provide[,  for  a
limited  period,]  adult  care facility services to persons, who are not
residents of the community, provided, however, that the  operator  shall

S. 1803                            12

not  discriminate in the admission, retention or care of any such person
because such person is or will be eligible  for,  or  receives  or  will
receive, medical assistance benefits pursuant to title eleven of article
five of the social services law or supplemental security income benefits
pursuant  to  title  sixteen  of the federal social security act and any
additional state payments made under title six of article  five  of  the
social  services law. FOR PERSONS WHO ARE NOT RESIDENTS OF THE COMMUNITY
AT THE TIME OF ADMISSION TO AN ADULT CARE FACILITY, THE TRANSFER OF SUCH
RESIDENT TO AN ON-SITE OR AFFILIATED RESIDENTIAL  HEALTH  CARE  FACILITY
DUE  TO  MEDICAL  NECESSITY SHALL NOT CONSTITUTE RESIDENTIAL HEALTH CARE
FACILITY SERVICES TO PERSONS WHO ARE NOT RESIDENTS OF THE COMMUNITY.
  § 14. Paragraphs a and b of subdivision  2  of  section  4656  of  the
public  health  law,  as  added  by chapter 519 of the laws of 2004, are
amended to read as follows:
  a. The commissioner[, in consultation with the council,] may authorize
an operator of a community with an  on-site  or  affiliated  residential
health  care  facility  to  provide[, for a limited period,] residential
health care facility services to persons, who are not residents  of  the
community,  provided,  however, that the operator shall not discriminate
in the admission, retention or care of  any  such  person  because  such
person  is or will be eligible for, or receives or will receive, medical
assistance benefits pursuant to title eleven  of  article  five  of  the
social  services  law.  FOR  COMMUNITIES  IN  EXISTENCE PRIOR TO JANUARY
FIRST, TWO THOUSAND NINETEEN WITH AN ON-SITE OR  AFFILIATED  RESIDENTIAL
HEALTH  CARE  FACILITY,  EACH  COMMUNITY  IS  AUTHORIZED  TO CONTINUE TO
PROVIDE RESIDENTIAL HEALTH CARE FACILITY SERVICES TO PERSONS WHO ARE NOT
RESIDENTS OF THE COMMUNITY AT A PERCENTAGE  DEEMED  PERMISSIBLE  BY  THE
COMMISSIONER.  FOR  COMMUNITIES  APPROVED  FOLLOWING  JANUARY FIRST, TWO
THOUSAND NINETEEN WITH AN ON-SITE OR AFFILIATED RESIDENTIAL HEALTH  CARE
FACILITY,  EACH  COMMUNITY  SHALL  BE  PERMITTED  TO PROVIDE RESIDENTIAL
HEALTH CARE FACILITY SERVICES TO PERSONS WHO ARE NOT  RESIDENTS  OF  THE
COMMUNITY FOR A PERIOD OF SEVEN YEARS, PROVIDED, HOWEVER, THAT THE OPER-
ATOR  MAY  SEEK  AN  EXTENSION  OF  THIS AUTHORIZATION AT THE END OF THE
SEVEN-YEAR PERIOD UPON WRITTEN APPLICATION TO  THE  COMMISSIONER.    FOR
PERSONS  WHO ARE NOT RESIDENTS OF THE COMMUNITY AT THE TIME OF ADMISSION
TO AN ADULT CARE FACILITY, THE TRANSFER OF SUCH RESIDENT TO  AN  ON-SITE
OR  AFFILIATED RESIDENTIAL HEALTH CARE FACILITY DUE TO MEDICAL NECESSITY
SHALL NOT  CONSTITUTE  RESIDENTIAL  HEALTH  CARE  FACILITY  SERVICES  TO
PERSONS WHO ARE NOT RESIDENTS OF THE COMMUNITY.
  b.  [The]  UPON  WRITTEN  NOTICE TO THE commissioner, [in consultation
with the council, may authorize] an operator  of  a  community  with  an
on-site  or  affiliated  adult  care  facility  [to] MAY provide[, for a
limited period,] adult care facility services to persons,  who  are  not
residents  of  the community, provided, however, that the operator shall
not discriminate in the admission, retention or care of any such  person
because  such  person  is  or  will be eligible for, or receives or will
receive, medical assistance benefits pursuant to title eleven of article
five of the social services law or supplemental security income benefits
pursuant to title sixteen of the federal social  security  act  and  any
additional  state  payments  made under title six of article five of the
social services law. FOR PERSONS WHO ARE NOT RESIDENTS OF THE  COMMUNITY
AT THE TIME OF ADMISSION TO AN ADULT CARE FACILITY, THE TRANSFER OF SUCH
RESIDENT  TO  AN  ON-SITE OR AFFILIATED RESIDENTIAL HEALTH CARE FACILITY
DUE TO MEDICAL NECESSITY SHALL NOT CONSTITUTE  RESIDENTIAL  HEALTH  CARE
FACILITY SERVICES TO PERSONS WHO ARE NOT RESIDENTS OF THE COMMUNITY.

S. 1803                            13

  §  15.  Section 4605-a of the public health law, as added by chapter 7
of the laws of 2015, is amended to read as follows:
  § 4605-a. Certificate of authority; authority to offer continuing care
at  home  contracts.    A continuing care retirement community may offer
continuing care at home contracts upon approval by the [council] COMMIS-
SIONER to amend the continuing care retirement  community's  certificate
of authority. In order to qualify for an amendment to its certificate of
authority,  the continuing care retirement community shall submit to the
commissioner the following:
  1. a business plan  to  the  commissioner  [and  superintendent]  that
includes the following:
  (a) a description of the continuing care at home services that will be
provided,  the market that will be served by the continuing care at home
contracts, and the fees to be charged to prospective continuing care  at
home contract holders;
  (b) a copy of the proposed continuing care at home contract; and
  (c)  an  actuarial study prepared by an independent actuary in accord-
ance with standards adopted by the American Academy of Actuaries  demon-
strating the impact that the continuing care at home contracts will have
on  the  overall  operations of the continuing care retirement community
and further demonstrating that the addition of continuing care  at  home
contracts  will  not jeopardize the financial solvency of the continuing
care retirement community.
  2. a market feasibility study demonstrating to the  commissioner  [and
superintendent]  sufficient consumer interest in continuing care at home
contracts and further demonstrating that the addition of continuing care
at home contracts will not have an adverse impact on  the  provision  of
services to continuing care retirement contract holders.
  3.  materials  that meet all requirements established by the [New York
state] department [of financial services].
  4. [A] A copy of the notification sent to continuing  care  retirement
contract  holders  describing  the anticipated impact of the addition of
continuing care at home contracts on continuing care retirement communi-
ty resources and proof that such notification has  been  distributed  to
all continuing care retirement contract holders.
  §  16.  Section 4605-b of the public health law, as added by chapter 7
of the laws of 2015, is amended to read as follows:
  § 4605-b. Certificate of authority; limitation on continuing  care  at
home  contracts.    The  number  of  continuing  care  at home contracts
approved on a certificate of authority shall be limited to:
  1. The number of approved living units on the continuing care  retire-
ment  community's  premises  that are intended for ILU residents, except
that the [council] COMMISSIONER may approve additional contracts upon  a
submission  [to  the  commissioner]  by  an operator consistent with the
provisions set forth in section forty-six hundred five-a of  this  arti-
cle;
  2. The demonstrated number of continuing care at home contract holders
that can be supported in the existing or approved future capacity of the
adult  care  facility  and  skilled nursing facility consistent with the
provisions set forth in section forty-six hundred five-a of  this  arti-
cle; and
  3.  Conditions set forth by the [New York state] department [of finan-
cial services], based upon the [superintendent]  COMMISSIONER'S  assess-
ment of the following:
  (a) the overall financial impact on the community; and

S. 1803                            14

  (b)  the  submitted  materials  set forth in section forty-six hundred
five-a of this article.
  §  17.  Section 4607 of the public health law, as added by chapter 689
of the laws of 1989, paragraph d of subdivision 2 as amended by  chapter
659 of the laws of 1997, is amended to read as follows:
  § 4607. Annual statement.  1. Within four months of close of the oper-
ator's  fiscal year, unless an extension of time to file has been grant-
ed, the operator shall file an annual statement  with  the  commissioner
[and  superintendent]  showing  the  condition as of the last day of the
preceding calendar or fiscal year. If the commissioner [and  superinten-
dent do] DOES not receive the annual statement within four months of the
end  of  the  operator's fiscal year or have not granted an extension of
time to file, the [council] COMMISSIONER may charge a late fee.
  2. The annual statement shall be in such form as the [council] COMMIS-
SIONER prescribes and shall contain at least the following:
  a. Any change in status with respect to the information required to be
submitted pursuant to section forty-six hundred four of this article;
  b. Financial statements audited by  an  independent  certified  public
accountant, which shall contain, for two or more periods if the communi-
ty has been in existence that long, the following:
  (i) an accountant's opinion and, in accordance with generally accepted
accounting principles:
  (A) a balance sheet,
  (B) a statement of income and expenses,
  (C) a statement of equity or fund balances,
  (D) a statement of changes in financial position,
  (ii)  notes to the financial statements considered customary or neces-
sary to ensure full disclosure of the  financial  statements,  financial
condition, and operation;
  c. A detailed listing of the assets maintained for the reserves;
  d.  A  copy  of  the  most  recent  actuarial review of the community,
including such information as may be required  by  the  [superintendent]
COMMISSIONER  including an opinion of a qualified consulting actuary, as
to the current and projected soundness of the community, provided howev-
er that a new actuarial review must be submitted triennially; and
  e. Such other reasonable financial and other information as the [coun-
cil] COMMISSIONER may require with respect to the operator or the commu-
nity, or its directors, controlling persons, trustees, members,  branch-
es,  subsidiaries or affiliates to determine the financial status of the
community and the management capabilities of the operator.
  3. Sixty days before commencement of each calendar or fiscal  year  or
official opening date, whichever is applicable, each operator shall file
with  the  commissioner [and superintendent] a computation of the annual
long-term debt service and a projected annual revenue and expense summa-
ry for the next ten years.
  § 18. Section 4658 of the public health law, as added by  chapter  519
of the laws of 2004, is amended to read as follows:
  §  4658. Annual statement. 1. Within four months of close of an opera-
tor's fiscal year, unless an extension of time to file has been granted,
the operator shall file an annual statement with the commissioner  show-
ing the condition as of the last day of the preceding calendar or fiscal
year.  If  the commissioner does not receive the annual statement within
four months of the end of the operator's fiscal year or has not  granted
an extension of time to file, the council may charge a late fee.
  2. The annual statement shall be in such form as the [council] COMMIS-
SIONER prescribes and shall contain at least the following:

S. 1803                            15

  a. Any change in status with respect to the information required to be
submitted  pursuant  to  section  forty-six  hundred fifty-seven of this
article;
  b.  Financial  statements  audited  by an independent certified public
accountant, which shall contain, for two or more periods if the communi-
ty has been in existence that long, the following:
  (i) notes to the financial statements considered customary  or  neces-
sary  to  ensure  full disclosure of the financial statements, financial
condition, and operation; and
  (ii)  an  accountant's  opinion  and,  in  accordance  with  generally
accepted  accounting principles: (A) a balance sheet, (B) a statement of
income and expenses, (C) a statement of equity or fund balances, and (D)
a statement of changes in financial position;
  c. A detailed listing of the assets maintained for the reserves; and
  d. Such other reasonable financial and other information as the [coun-
cil] COMMISSIONER may require with respect to the operator or the commu-
nity, or its directors, controlling persons, trustees, members,  branch-
es,  subsidiaries or affiliates to determine the financial status of the
community and the management capabilities of the operator.
  3. Sixty days before commencement of each calendar or fiscal  year  or
official opening date, whichever is applicable, each operator shall file
with the commissioner a computation of the annual long-term debt service
and  a  projected  annual  revenue  and expense summary for the next ten
years.
  § 19. Paragraphs a and c of subdivision 15  of  section  4608  of  the
public  health  law,  as  amended  by chapter 7 of the laws of 2015, are
amended to read as follows:
  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; PROVIDED, HOWEVER,
THAT  SUCH  MEDICARE  SUPPLEMENT  COVERAGE  SHALL  COVER ANY COINSURANCE
AMOUNTS DUE AND PAYABLE FOR THE TWENTY-FIRST DAY THROUGH  THE  HUNDREDTH
DAY  OF  ANY  MEDICARE  PART  A BENEFIT PERIOD FOR POST-HOSPITAL SKILLED
NURSING FACILITY CARE;
  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] COMMISSIONER, to fund the additional
risk to the facility; and
  § 20. Subdivision 16 of section 4608 of  the  public  health  law,  as
amended by chapter 7 of the laws of 2015, is amended to read as follows:
  16.  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 financial
services] COMMISSIONER;
  § 21. Section 4608 of the public health law is amended by adding a new
subdivision 21 to read as follows:
  21. A STATEMENT THAT, EXCEPT AS OTHERWISE REQUIRED  BY  LAW,  RULE  OR
REGULATION,  A CONTINUING CARE RETIREMENT CONTRACT OR CONTINUING CARE AT
HOME CONTRACT SHALL TAKE PRECEDENCE OVER  ANY  CONFLICTING  REQUIREMENTS
FOR SEPARATE ADMISSIONS AGREEMENTS FOR COVERED LEVELS OF CARE INCLUDING,
BUT  NOT  LIMITED TO, A NURSING HOME ADMISSIONS AGREEMENT, AN ADULT CARE
FACILITY ADMISSION AGREEMENT OR AN ASSISTED LIVING RESIDENCY AGREEMENT.

S. 1803                            16

  §  22. Section 4659 of the public health law, as added by chapter  519
of  the  laws of 2004, is amended by adding a new subdivision 17 to read
as follows:
  17.  A STATEMENT THAT A FEE-FOR-SERVICE CONTINUING CARE CONTRACT SHALL
TAKE PRECEDENCE OVER ANY CONFLICTING REQUIREMENTS  FOR  SEPARATE  ADMIS-
SIONS  AGREEMENTS FOR COVERED LEVELS OF CARE, INCLUDING, BUT NOT LIMITED
TO, A NURSING HOME ADMISSIONS AGREEMENT, AN ADULT CARE  FACILITY  ADMIS-
SION AGREEMENT, OR AN ASSISTED LIVING RESIDENCY AGREEMENT.
  § 23. Subdivision 4 of section 4609 of the public health law, as added
by  chapter  689 of the laws of 1989, is amended and a new subdivision 5
is added to read as follows:
  4. Any refund made pursuant to this section must be paid no later than
thirty days after the formerly occupied unit has been resold, but in  no
event  later  than [one year] TWO YEARS after the formerly occupied unit
has been vacated.
  5. NOTHING IN THIS SECTION SHALL PRECLUDE A RESIDENT  FROM  MAKING  AN
IMMEDIATE  IRREVOCABLE GIFT OR A BEQUEST TO THE COMMUNITY OF ALL OR PART
OF THE ENTRANCE  FEE  WHICH  WOULD  OTHERWISE  BE  REFUNDED  UNDER  THIS
SECTION.
  § 24. Subdivision 4 of section 4660 of the public health law, as added
by  chapter  519 of the laws of 2004, is amended and a new subdivision 5
is added to read as follows:
  4. Any refund made pursuant to this section shall  be  paid  no  later
than  thirty  days after the formerly occupied unit has been resold, but
in no event later than [one year] TWO YEARS after the formerly  occupied
unit  has  been  vacated; PROVIDED, FURTHER, THAT A RESIDENT TRANSFER TO
ANOTHER LEVEL OF CARE IN THE COMMUNITY SHALL NOT BE CONSIDERED  A  WITH-
DRAWAL  OF  SUCH  RESIDENT FOR PURPOSES OF REQUIRING A REFUND UNDER THIS
SECTION.
  5. NOTHING IN THIS SECTION SHALL PRECLUDE A RESIDENT  FROM  MAKING  AN
IMMEDIATE  IRREVOCABLE GIFT OR A BEQUEST TO THE COMMUNITY OF ALL OR PART
OF THE ENTRANCE  FEE  WHICH  WOULD  OTHERWISE  BE  REFUNDED  UNDER  THIS
SECTION.
  § 25. Subparagraph (v) of paragraph b of subdivision 6 of section 4610
of the public health law, as amended by chapter 659 of the laws of 1997,
is amended to read as follows:
  (v) the total amount of escrowed entrance fees or deposits that may be
approved  for  release  under  this paragraph shall not exceed [fifteen]
EIGHTY-FIVE percent of [the total costs of acquiring,  constructing  and
equipping the proposed community] ENTRANCE FEES OR DEPOSITS COLLECTED;
  §  26.  Paragraph  e  of subdivision 1-a of section 4663 of the public
health law, as added by chapter 545 of the laws of 2004, is  amended  to
read as follows:
  e.  the total amount of escrowed entrance fees or deposits that may be
approved for release under this subdivision shall not  exceed  [fifteen]
EIGHTY-FIVE  percent  of [the total costs of acquiring, constructing and
equipping the proposed community] ENTRANCE FEES OR DEPOSITS COLLECTED;
  § 27. Subdivisions 1 and 2 of section 4614 of the public  health  law,
as  amended  by  chapter  7  of the laws of 2015, are amended to read as
follows:
  1. The commissioner, or designee[; and the superintendent,  or  desig-
nee;]  may at any time, and shall at least once every three years, visit
each community and examine the business of any applicant for  a  certif-
icate of authority and any operator engaged in the execution of continu-
ing  care  retirement  contracts or continuing care at home contracts or
engaged in the performance of obligations under such contracts.  Routine

S. 1803                            17

examinations  may  be  conducted  by  having documents designated by and
submitted to such [commissioners or superintendent] COMMISSIONER,  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 superinten-
dent] COMMISSIONER 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,]
COMMISSIONER  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[, or department of financial services] may, upon presentation
of proper identification, have access to, and inspect, any records main-
tained 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.
  § 28. Section 4615 of the public health law, as added by  chapter  689
of  the laws of 1989, paragraph j of subdivision 1 as further amended by
section 104 of part A of chapter 62 of the laws of 2011, paragraph k  of
subdivision  1  as amended by chapter 7 of the laws of 2015 and subdivi-
sion 3 as amended by chapter 659 of the laws of 1997, is amended to read
as follows:
  § 4615. Revocation, suspension or annulment of certificate of authori-
ty.  1. The [council] COMMISSIONER may revoke, suspend, limit  or  annul
the certificate of authority of an operator upon proof that:
  a.  The  operator  failed to continue to meet the requirements for the
authority originally granted;
  b. The operator lacked one or  more  of  the  qualifications  for  the
certificate of authority as specified by this article;
  c.  The  operator  made a material misstatement, misrepresentation, or
committed fraud  in  obtaining  the  certificate  of  authority,  or  in
attempting to obtain the same;
  d. The operator lacked fitness or was untrustworthy;
  e.  The  operator  engaged  in  fraudulent  or  dishonest practices of
management in the conduct of business under the certificate of  authori-
ty;
  f. The operator converted or withheld funds;
  g.  The operator failed to comply with, or violated, any proper order,
rule or regulation of the council or  violated  any  provision  of  this
article;
  h.  The unsound business practices of the operator renders its further
transactions in this state hazardous or injurious to the public;
  i. The operator has refused to be examined or to produce its accounts,
records, and files for  examination,  or  its  officers,  employees,  or
controlling persons have refused to give information with respect to the
affairs  of the community or to perform any other legal obligation as to
such examination;
  j. The [superintendent of financial services] COMMISSIONER has made  a
determination  that  the  operator  is  insolvent  within the meaning of
section one thousand three hundred nine of the insurance law; or

S. 1803                            18

  k. The commissioner has found violations of applicable statutes, rules
or regulations which threaten to affect directly the health, safety,  or
welfare of a resident.
  1-A.  THE  COMMISSIONER  SHALL NOT REVOKE, SUSPEND, LIMIT OR ANNUL THE
CERTIFICATE OF AUTHORITY OF AN OPERATOR PURSUANT TO SUBDIVISION  ONE  OF
THIS  SECTION WITHOUT FIRST CONSULTING WITH, AND RECEIVING A RECOMMENDA-
TION FROM, THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL.
  2. No certificate of authority shall be revoked, suspended, limited or
annulled without a hearing, except that a certificate of  authority  may
be  temporarily suspended or limited prior to a hearing for a period not
in excess of sixty days upon written notice to the operator following  a
finding by the commissioner that the public health or safety is in immi-
nent  danger  or  there exists any condition or practice or a continuing
pattern of conditions or practices that pose an imminent danger  to  the
health or safety of any resident. Any delay in the hearing process occa-
sioned  by  the  operator  shall  toll the running of said suspension or
limitation and shall not abridge the full time provided in this subdivi-
sion.
  3. Any state agency which seeks to revoke, suspend, limit or annul the
certificate of authority or any other license or certificate required to
be obtained by an operator of a  continuing  care  retirement  community
pursuant  to law, shall request the [council] COMMISSIONER to commence a
hearing pursuant to this section.
  4. The [council] COMMISSIONER shall fix a time and place for the hear-
ing. The commissioner shall cause to be served in person  or  mailed  by
registered  or  certified  mail to the operator at least ten days before
the date fixed for the hearing a copy of the charges, together with  the
notice  of  the  time  and place of the hearing. The operator shall file
with the commissioner not less than three days prior to  the  hearing  a
written answer to the charges. The agency which initiated the proceeding
shall be responsible for providing evidence in support of the charges to
the  commissioner  in  order to prepare a statement of charges and shall
provide evidence in support of the charges at the hearing.
  5. All orders hereunder shall be subject  to  review  as  provided  in
article  seventy-eight  of the civil practice law and rules. Application
for such review must be made within sixty days after service  in  person
or by registered or certified mail of a copy of the order upon the oper-
ator.
  §  29.  Section 4616 of the public health law, as added by chapter 689
of the laws of 1989, the opening paragraph as amended by chapter 659  of
the laws of 1997, is amended to read as follows:
  § 4616. Appointment of a caretaker. Upon a determination by the [coun-
cil]  COMMISSIONER  that  there  exists  operational  deficiencies  in a
continuing care retirement community that show:
  1. a condition or conditions in substantial violation of the standards
for health, safety or patient care established under  federal  or  state
law or regulations; OR
  2.  [or]  that  there  exists in the facility a pattern or practice of
habitual violation of the standards of health, safety  or  patient  care
established  under  federal  or  state law or regulations, the [council]
COMMISSIONER shall take the  actions  prescribed  by  section  forty-six
hundred  fifteen  of this article, and, where the [council] COMMISSIONER
deems it to be in the public interest, the [council may request that the
commissioner, and upon request of the council the] commissioner shall[,]
petition a court of competent jurisdiction to  appoint  a  caretaker  as
defined  in  section twenty-eight hundred one of this chapter. The peti-

S. 1803                            19

tion, the proceedings, and the procedures for appointment of a caretaker
shall be governed by the provisions of section forty-six hundred  seven-
teen  of  this article, and the powers, duties and rights of a caretaker
appointed pursuant to such section shall be the same as those authorized
by subdivision four of such section.
  §  30.  Subdivisions  1,  2 and 8 of section 4617 of the public health
law, subdivision 1 as amended by chapter 659 of the laws  of  1997,  and
subdivisions  2  and  8 as added by chapter 689 of the laws of 1989, are
amended to read as follows:
  1. The [council] COMMISSIONER may, [if it determines] UPON A  DETERMI-
NATION  that serious operational deficiencies exist or serious financial
problems exist and such action is desirable,  enter  into  an  agreement
with  the  operator  or owners of a continuing care retirement community
with respect to the appointment of a receiver  to  take  charge  of  the
community  under conditions as found acceptable by both parties. Receiv-
ership commenced in accordance with the provisions of  this  subdivision
shall  terminate  at  such  time  as may be provided in the receivership
agreement, or at such time as either party notifies the other in writing
that it wishes to terminate such receivership.
  2. [Upon request of the council, the] THE commissioner shall,  at  the
time  of revocation, suspension or temporary suspension of a certificate
of authority, apply to the supreme court where the community is situated
for an order directing the owner of the land and/or structure on  or  in
which  the community is located, to show cause why a receiver should not
be appointed to take charge of the community.  In those cases where  the
certificate  of  authority  has  been  revoked, suspended or temporarily
suspended, the supreme  court  shall  appoint  a  receiver  that,  where
reasonably possible, is a legal entity that holds a valid certificate of
authority.  Such  application  shall contain proof by affidavit that the
facility has had its certificate of  authority  revoked,  suspended,  or
temporarily  suspended. Such order to show cause shall be returnable not
less than five days after service is completed  and  shall  provide  for
personal  service of a copy thereof and the papers on which it is based,
on the owner or owners of the land and/or structures on or in which  the
community  is  located.  If  any  such owner and manager cannot with due
diligence be served personally within the county where the  property  is
located  and  within  the  time fixed in such order, then service may be
made on such person by posting a copy thereof  in  a  conspicuous  place
within  the  community  in  question,  and  by sending a copy thereof by
registered mail, return receipt requested, to such  owner  at  the  last
address  registered by him with the department or in the absence of such
registration to the address set forth in the  last  recorded  deed  with
respect  to  the  facility.  Service  shall be deemed complete on filing
proof of service thereof in the office of the county clerk, or the clerk
of the city of New York, as the case may be.
  8. Any other provision of this article notwithstanding, the  [council]
COMMISSIONER  may,  if  [it]  HE  OR SHE deems appropriate, grant to any
community operating or scheduled to operate under a receivership author-
ized by this section a certificate of authority, the duration  of  which
shall be limited to the duration of the receivership.
  §  31.  Section 4668 of the public health law, as added by chapter 519
of the laws of 2004, is amended to read as follows:
  § 4668. Revocation, suspension or annulment of certificate of authori-
ty. 1. The [council] COMMISSIONER may revoke, suspend,  limit  or  annul
the certificate of authority of an operator upon proof that:

S. 1803                            20

  a.  The  operator  failed to continue to meet the requirements for the
authority originally granted;
  b.  The  operator  lacked  one  or  more of the qualifications for the
certificate of authority as specified by this article;
  c. The operator made a material  misstatement,  misrepresentation,  or
committed  fraud  in  obtaining  the  certificate  of  authority,  or in
attempting to obtain the same;
  d. The operator lacked fitness or was untrustworthy;
  e. The operator  engaged  in  fraudulent  or  dishonest  practices  of
management  in the conduct of business under the certificate of authori-
ty;
  f. The operator converted or withheld funds;
  g. The operator failed to comply with, or violated, any proper  order,
rule  or  regulation  of  the  council or violated any provision of this
article;
  h. The unsound business practices of the operator renders its  further
transactions in this state hazardous or injurious to the public;
  i. The operator has refused to be examined or to produce its accounts,
records  and  files  for  examination,  or  its  officers,  employees or
controlling persons have refused to give information with respect to the
affairs of the community or to perform any other legal obligation as  to
such examination; or
  j. The commissioner has found violations of applicable statutes, rules
or  regulations which threaten to affect directly the health, safety, or
welfare of a resident of a fee-for-service  continuing  care  retirement
community.
  1-A.  THE  COMMISSIONER  SHALL NOT REVOKE, SUSPEND, LIMIT OR ANNUL THE
CERTIFICATE OF AUTHORITY OF AN OPERATOR PURSUANT TO SUBDIVISION  ONE  OF
THIS  SECTION WITHOUT FIRST CONSULTING WITH, AND RECEIVING A RECOMMENDA-
TION FROM, THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL.
  2. No certificate of authority shall be revoked, suspended, limited or
annulled without a hearing, except that a certificate of  authority  may
be  temporarily suspended or limited prior to a hearing for a period not
in excess of sixty days upon written notice to the operator following  a
finding  by the commissioner that public health or safety is in imminent
danger or there exists any condition or practice or a continuing pattern
of conditions or practices that pose an imminent danger to the health or
safety of any resident. Any delay in the hearing process  occasioned  by
the operator shall toll the running of said suspension or limitation and
shall not abridge the full time provided in this subdivision.
  3. Any state agency which seeks to revoke, suspend, limit or annul the
certificate of authority or any other license or certificate required to
be obtained by an operator of a community pursuant to law, shall request
the  [council]  COMMISSIONER  to  commence  a  hearing  pursuant to this
section.
  4. The [council] COMMISSIONER shall fix a time and place for the hear-
ing. The commissioner shall cause to be served in person  or  mailed  by
registered  or  certified  mail to the operator at least ten days before
the date fixed for the hearing a copy of the charges, together with  the
notice  of  the  time  and place of the hearing. The operator shall file
with the commissioner not less than three days prior to  the  hearing  a
written answer to the charges. The agency which initiated the proceeding
shall be responsible for providing evidence in support of the charges to
the  commissioner  in  order to prepare a statement of charges and shall
provide evidence in support of the charges at the hearing.

S. 1803                            21

  5. All orders pursuant to this section shall be subject to  review  as
provided  in  article seventy-eight of the civil practice law and rules.
Application for such review  shall  be  made  within  sixty  days  after
service  in  person  or by registered or certified mail of a copy of the
order upon the operator.
  §  32.  Section 4669 of the public health law, as added by chapter 519
of the laws of 2004, is amended to read as follows:
  § 4669. Appointment of a caretaker.    Upon  a  determination  by  the
[council]  COMMISSIONER  that there exists operational deficiencies in a
fee-for-service continuing care retirement community that show:
  1. there exists in the facility a  pattern  or  practice  of  habitual
violation of the standards of health, safety or patient care established
under  federal  or  state law or regulations, the [council] COMMISSIONER
shall take the actions prescribed by section  forty-six  hundred  sixty-
eight of this article, and, where the [council] COMMISSIONER deems it to
be  in  the  public interest, the [council may request the commissioner,
and upon request of the council the] commissioner  shall[,]  petition  a
court  of  competent  jurisdiction  to appoint a caretaker as defined in
section twenty-eight hundred one of  this  chapter.  The  petition,  the
proceedings,  and the procedures for appointment of a caretaker shall be
governed by the provisions of section forty-six hundred seventy of  this
article,  and  the  power,  duties  and  rights of a caretaker appointed
pursuant to such section shall be the same as those authorized by subdi-
vision four of such section; or
  2. a condition or conditions in substantial violation of the standards
for health, safety or patient care established under  federal  or  state
law or regulations.
  §  33.  Subdivisions  1,  2 and 8 of section 4670 of the public health
law, as added by chapter 519 of the laws of 2004, are amended to read as
follows:
  1. The [council] COMMISSIONER may, [if it determines] UPON A  DETERMI-
NATION  that serious operational deficiencies exist or serious financial
problems exist and such action is desirable,  enter  into  an  agreement
with the operator or owners of a fee-for-service continuing care retire-
ment  community  with  respect  to the appointment of a receiver to take
charge of the community under conditions as  found  acceptable  by  both
parties.    Receivership  commenced in accordance with the provisions of
this subdivision shall terminate at such time as may be provided in  the
receivership  agreement,  or  at  such time as either party notifies the
other in writing that it wishes to terminate such receivership.
  2. [Upon request of the council, the] THE commissioner shall,  at  the
time  of revocation, suspension or temporary suspension of a certificate
of authority, apply to the supreme court where the community is situated
for an order directing the owner of the land and/or structure on  or  in
which  the community is located, to show cause why a receiver should not
be appointed to take charge of the community. In those cases  where  the
certificate  of  authority  has  been  revoked, suspended or temporarily
suspended, the supreme  court  shall  appoint  a  receiver  that,  where
reasonably possible, is a legal entity that holds a valid certificate of
authority.  Such  application  shall contain proof by affidavit that the
facility has had its certificate  of  authority  revoked,  suspended  or
temporarily  suspended. Such order to show cause shall be returnable not
less than five days after service is completed  and  shall  provide  for
personal  service of a copy thereof and the papers on which it is based,
on the owner or owners of the land and/or structures on or in which  the
community  is  located.  If  any  such owner and manager cannot with due

S. 1803                            22

diligence be served personally within the county where the  property  is
located  and  within  the  time fixed in such order, then service may be
made on such person by posting a copy thereof  in  a  conspicuous  place
within  the  community  in  question,  and  by sending a copy thereof by
registered mail, return receipt requested, to such  owner  at  the  last
address  registered  by him or her with the department or in the absence
of such registration to the address set forth in the last recorded  deed
with respect to the facility. Service shall be deemed complete on filing
proof of service thereof in the office of the county clerk, or the clerk
of the city of New York, as the case may be.
  8.  Any other provision of this article notwithstanding, the [council]
COMMISSIONER may, if [it] HE OR SHE  deems  appropriate,  grant  to  any
community operating or scheduled to operate under a receivership author-
ized  by  this section a certificate of authority, the duration of which
shall be limited to the duration of the receivership.
  § 34. Paragraph g of subdivision 4  of  section  4621  of  the  public
health  law,  as added by chapter 406 of the laws of 1991, is amended to
read as follows:
  g. If the funds in an escrow  account  under  this  section,  and  any
interest  thereon, are not released to the applicant within such time as
provided by rules and regulations adopted by the [council] COMMISSIONER,
then such funds shall be returned by the escrow agent to the person  who
had made the payments or the person's legal representative.
  §  35.  Subdivision  1  of  section  4623 of the public health law, as
amended by chapter 659 of the laws  of  1997,  is  amended  to  read  as
follows:
  1. The [council] COMMISSIONER may approve an application for a certif-
icate  of  authority  and  [the commissioner] may issue a certificate of
authority for the establishment  and  operation  of  a  continuing  care
retirement  community under an arrangement which otherwise complies with
the requirements of this article except that the costs of nursing facil-
ity or home health care services are paid for in whole or in part by (a)
long term care insurance obtained and paid for by  the  resident  or  by
medical  assistance payments in accordance with the partnership for long
term care program pursuant to section three hundred sixty-seven-f of the
social services law and section three thousand two  hundred  twenty-nine
of  the  insurance  law  or (b) other group or individual long term care
insurance approved by the superintendent and the council  in  connection
with  the application. The council, in consultation with the superinten-
dent, shall provide  for  adequate  disclosure  to  residents  of  their
options,  rights  and  obligations  under such an arrangement, and shall
establish standards for the remittance and collection  of  premiums  and
monthly care fees.
  §  36.  The  opening paragraph of subdivision 14 and subdivision 15 of
section 4657 of the public health law, as added by chapter  519  of  the
laws of 2004, are amended to read as follows:
  In  accordance  with  regulations promulgated by the [council] COMMIS-
SIONER, the operator shall prepare a standard information sheet for each
approved fee-for-service continuing  care  retirement  community,  which
must  be  approved  by  the department, distributed with the community's
marketing materials and attached to  the  initial  disclosure  statement
prepared in accordance with this section. The standard information sheet
shall  be  prepared in plain language and in twelve point type and shall
include, but shall not be limited to the following information:
  15. Any other information as may be required by regulations promulgat-
ed by the [council] COMMISSIONER.

S. 1803                            23

  § 37. The opening paragraph  and  paragraph  d  of  subdivision  2  of
section  4658  of  the public health law, as added by chapter 519 of the
laws of 2004, are amended to read as follows:
  The  annual  statement  shall be in such form as the [council] COMMIS-
SIONER prescribes and shall contain at least the following:
  d. Such other reasonable financial and other information as the [coun-
cil] COMMISSIONER may require with respect to the operator or the commu-
nity, or its directors, controlling persons, trustees, members,  branch-
es,  subsidiaries or affiliates to determine the financial status of the
community and the management capabilities of the operator.
  § 38. Subdivision 2 of section 4651 of the public health law, as added
by chapter 519 of the laws of 2004, is amended to read as follows:
  2. "Certificates" or "certificate of authority" shall mean an authori-
zation in writing, approved [by the council] and issued by  the  commis-
sioner,  for  an  operator  to operate a fee-for-service continuing care
retirement community and to enter into fee-for-service  continuing  care
contracts pertaining to such community.
  § 39. Section 4654 of the public health law, as amended by chapter 545
of the laws of 2004, is amended to read as follows:
  §  4654.  Authorization  of fee-for-service continuing care retirement
communities.  The commissioner[, upon approval of  the  continuing  care
retirement community council,] shall approve up to eight fee-for-service
continuing  care  retirement  communities  to  encourage affordable care
options for middle income seniors, up to two of which may be operated by
a for-profit entity.
  § 40. The opening paragraph of section 4659 of the public health  law,
as  added  by  chapter  519  of  the laws of 2004, is amended to read as
follows:
  A fee-for-service continuing care 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 commissioner:
  § 41. The opening paragraph of subdivision 5 of section  4655  of  the
public  health  law,  as  amended by chapter 545 of the laws of 2004, is
amended to read as follows:
  If the [approvals] APPLICANT HAS SATISFIED THE  CRITERIA  required  by
subdivision  four-a  of  this  section have been obtained, the [council]
COMMISSIONER shall[, by majority vote,] either  approve  or  reject  the
application  [within  sixty  days  of  the  date  on which the last such
approval has been obtained]. In order to approve  the  application,  the
[council] COMMISSIONER shall have determined that:
  §  42.  Subdivisions 6 and 8 of section 4655 of the public health law,
as added by chapter 519 of the laws of 2004,  are  amended  to  read  as
follows:
  6.  Any  change  in  the  legal  entity  operating the fee-for-service
continuing care retirement community, or in a controlling person of  the
community  shall  require  approval  in  the  same manner as an original
application; provided, however,  that  the  [council]  COMMISSIONER  may
waive  any  requirement  to  provide information that is not relevant to
such change and provided, further, that the continued  public  need  for
the community shall be presumed.
  8.  [If  the  council  approves the application, the] THE commissioner
shall issue a certificate of authority to the applicant UPON APPROVAL OF
THE APPLICATION.
  § 43. Section 4611 of the public health law, as added by  chapter  689
of  the  laws of 1989, the opening paragraph of subdivision 1 as further

S. 1803                            24

amended by section 104 of part A of chapter 62 of the laws of  2011,  is
amended to read as follows:
  § 4611. Reserves and supporting assets.  1. An operator shall maintain
reserve  liabilities  and  supporting  assets  in  an amount and for the
purposes set forth in a regulation  issued  by  the  [superintendent  of
financial  services] COMMISSIONER.  Liquid assets must be maintained for
the following reserve liabilities:
  a. Principal and interest payments and payments for taxes  and  insur-
ance for up to twelve months;
  b.  Total estimated operating costs for up to six months as set by the
[superintendent] COMMISSIONER;
  c. Repairs and replacements for up to twelve months; and
  d. In addition, the amount of liquid assets must meet  any  cash  flow
requirements and conditions as set forth in a regulation.
  2.  The assets in support of reserve liabilities of subdivision one of
this section shall meet quantitative and qualitative standards set forth
in regulations issued by the [superintendent] COMMISSIONER.
  § 44. The public health law is amended by adding a new section 4625 to
read as follows:
  § 4625. CONTINUING CARE RETIREMENT COMMUNITY WORKGROUP. 1. WITHIN  SIX
MONTHS  OF  THE  EFFECTIVE  DATE OF THIS SECTION, THE COMMISSIONER SHALL
CONVENE A CONTINUING CARE RETIREMENT  COMMUNITY  WORKGROUP  (HEREINAFTER
REFERRED  TO  IN  THIS  SECTION AS THE "WORKGROUP"). THE WORKGROUP SHALL
CONSIST OF, AT A MINIMUM, THE  COMMISSIONER  OR  HIS  OR  HER  DESIGNEE;
REPRESENTATIVES  OF  HEALTH CARE PROVIDER ORGANIZATIONS; REPRESENTATIVES
OF CONTINUING CARE RETIREMENT COMMUNITIES, AND REPRESENTATIVES WHO  HAVE
EXPERTISE IN THE CONTINUING CARE RETIREMENT COMMUNITY INDUSTRY.
  2.  WORKGROUP MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES
AS MEMBERS OF THE WORKGROUP, BUT SHALL  BE  REIMBURSED  FOR  ACTUAL  AND
NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
  3. THE WORKGROUP SHALL:
  A.  REVIEW  EXISTING CONTINUING CARE RETIREMENT COMMUNITY AND FEE-FOR-
SERVICE CONTINUING CARE RETIREMENT COMMUNITY MODELS  IN  THE  STATE  AND
NATIONALLY;
  B.  DEVELOP  RECOMMENDATIONS  ON  CREATING  COST-EFFECTIVE OPTIONS FOR
FINANCING THE  DEVELOPMENT  OF  ADDITIONAL  CONTINUING  CARE  RETIREMENT
COMMUNITIES  AND FEE-FOR-SERVICE CONTINUING CARE RETIREMENT COMMUNITIES;
AND
  C. SUBMIT A REPORT BY JANUARY FIRST, TWO THOUSAND  TWENTY-ONE  TO  THE
COMMISSIONER,  THE  COUNCIL,  THE TEMPORARY PRESIDENT OF THE SENATE, THE
SPEAKER OF THE ASSEMBLY, THE CHAIR OF THE SENATE HEALTH  COMMITTEE,  AND
THE  CHAIR  OF  THE ASSEMBLY HEALTH COMMITTEE CONTAINING RECOMMENDATIONS
FOR COST-EFFECTIVE OPTIONS TO ENCOURAGE THE GROWTH  OF  CONTINUING  CARE
RETIREMENT COMMUNITIES IN THE STATE OF NEW YORK.
  4. ALL STATE DEPARTMENTS, COMMISSIONS, AGENCIES AND PUBLIC AUTHORITIES
SHALL  PROVIDE THE WORKGROUP WITH ANY REASONABLY REQUESTED ASSISTANCE OR
ADVICE IN A TIMELY MANNER.
  § 45. This act shall take effect on  the  one  hundred  eightieth  day
after  it  shall have become a law, provided, however, that section 4625
of the public health law, as added by section forty-four  of  this  act,
shall  expire  and  be  deemed  repealed  December  31,  2022; provided,
further, that effective  immediately,  the  addition,  amendment  and/or
repeal  of  any  rule  or regulation necessary for the implementation of
this act on its effective date are authorized and directed  to  be  made
and completed on or before such effective date.