S T A T E O F N E W Y O R K
________________________________________________________________________
9023
I N A S S E M B L Y
January 21, 2022
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the social services law and the public health law, in
relation to independent assessment of person-centered service plans
for long term care assistance; and to repeal certain provisions of the
social services law relating thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (i) of paragraph (e) of subdivision 2 of
section 365-a of the social services law, as amended by section 2 of
part MM of chapter 56 of the laws of 2020, is amended to read as
follows:
(i) personal care services, including personal emergency response
services, shared aide and an individual aide, subject to the provisions
of subparagraphs (ii), (iii), (iv), (v) and (vi) of this paragraph,
furnished to an individual who is not an inpatient or resident of a
hospital, nursing facility, intermediate care facility for individuals
with intellectual disabilities, or institution for mental disease, as
determined to meet the recipient's needs for assistance when cost effec-
tive and appropriate, and when prescribed by a [qualified independent]
physician [selected or approved by the department of health], PHYSICIAN
ASSISTANT OR NURSE PRACTITIONER in accordance with the recipient's plan
of treatment and provided by individuals who are qualified to provide
such services, who are supervised by a registered nurse and who are not
members of the recipient's family, and furnished in the recipient's home
or other location;
§ 2. Subdivision 10 of section 365-a of the social services law is
REPEALED.
§ 3. Section 365-a of the social services law is amended by adding a
new subdivision 10 to read as follows:
10. (A) (I) LONG TERM CARE ASSISTANCE UNDER THIS ARTICLE SHALL REQUIRE
A PERSON-CENTERED SERVICE PLAN (WHICH MAY BE REFERRED TO IN THIS SUBDI-
VISION AS A "SERVICE PLAN") FOR THE RECIPIENT. A "PERSON-CENTERED
SERVICE PLAN" IS A WRITTEN DOCUMENT OF SPECIFIC HEALTH CARE GOALS TO BE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14340-02-2
A. 9023 2
ACHIEVED AND THE AMOUNT, DURATION AND SCOPE OF THE COVERED SERVICES TO
BE PROVIDED TO A MEDICAL ASSISTANCE RECIPIENT IN ORDER TO ACHIEVE THOSE
GOALS. THE SERVICE PLAN SHALL BE BASED ON ASSESSMENT OF THE RECIPIENT'S
HEALTH CARE NEEDS AND DEVELOPED IN CONSULTATION WITH THE RECIPIENT AND
THE RECIPIENT'S INFORMAL SUPPORTS. THE SERVICE PLAN SHALL INCLUDE
CONSIDERATION OF THE CURRENT AND SPECIFIC PSYCHO-SOCIAL, COGNITIVE, AND
MEDICAL NEEDS AND HISTORY OF THE RECIPIENT, AS WELL AS THE RECIPIENT'S
FUNCTIONAL LEVEL AND SUPPORT SYSTEMS. THE SERVICE PLAN SHALL INCLUDE
THE PLAN OF CARE DETERMINED BY AN INDEPENDENT ASSESSOR WHICH STATES THE
TYPE OF LONG TERM CARE SERVICES APPROPRIATE TO A RECIPIENT'S NEEDS AND
THE NUMBER OF HOURS OF CARE PER WEEK NECESSARY TO MEET THOSE NEEDS.
(II) THE EFFECTIVENESS AND APPROPRIATENESS OF THE RECIPIENT'S SERVICE
PLAN SHALL BE MONITORED THROUGH REASSESSMENT AND A DETERMINATION AS TO
WHETHER THE HEALTH CARE GOALS ARE BEING MET. THE SERVICE PLAN SHALL BE
REASSESSED AND REVIEWED, AND REVISED APPROPRIATELY, AT LEAST ANNUALLY.
(III) SERVICES NOT COVERED BY MEDICAL ASSISTANCE WHICH INTERRELATE
WITH THE COVERED SERVICES IDENTIFIED IN THE SERVICE PLAN AND SERVICES OF
INFORMAL SUPPORTS NECESSARY TO SUPPORT THE HEALTH CARE GOALS AND EFFEC-
TIVENESS AND APPROPRIATENESS OF THE COVERED SERVICES SHOULD BE CLEARLY
IDENTIFIED IN THE SERVICE PLAN OR ELSEWHERE IN THE CARE MANAGEMENT
RECORD.
(B) THE ASSESSMENT OF THE RECIPIENT AND THE DEVELOPMENT OF THE SERVICE
PLAN SHALL BE CONDUCTED BY AN INDEPENDENT ASSESSOR THAT IS AN ENTITY
THAT IS UNAFFILIATED WITH ANY MANAGED LONG TERM CARE PLAN AND HAS BEEN
CONTRACTED BY THE COMMISSIONER FOR THIS PURPOSE. INDEPENDENT ASSESSORS
SHALL BE NOT-FOR-PROFIT ORGANIZATIONS THAT HAVE DEMONSTRATED CULTURAL
AND LINGUISTIC COMPETENCE AND EXPERTISE IN EVALUATING SERVICE NEEDS OF
INDIVIDUALS NEEDING LONG TERM CARE, INCLUDING INDIVIDUALS WITH DISABILI-
TIES, SEEKING TO LIVE IN THE COMMUNITY.
§ 4. Paragraph (g) of subdivision 7 of section 4403-f of the public
health law, as amended by section 41-b of part H of chapter 59 of the
laws of 2011, subparagraph (i) as amended by section 1 of part GGG of
chapter 59 of the laws of 2017, subparagraph (iii) as amended by section
54 of part A of chapter 56 of the laws of 2013, subparagraph (iv) as
amended by section 22 of part MM of chapter 56 of the laws of 2020, is
amended to read as follows:
(g) (i) Managed long term care plans and demonstrations may enroll
eligible persons in the plan or demonstration upon the completion of a
[comprehensive assessment that shall include, but not be limited to, an
evaluation of the medical, social, cognitive, and environmental needs of
each prospective enrollee in such program] PERSON-CENTERED SERVICE PLAN
UNDER SUBDIVISION TEN OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THE
SOCIAL SERVICES LAW. This [assessment] SERVICE PLAN shall also serve as
the basis for the development and provision of an appropriate plan of
care for the enrollee. Upon approval of federal waivers pursuant to
paragraph (b) of this subdivision which require medical assistance
recipients who require community-based long term care services to enroll
in a plan, and upon approval of the commissioner, a plan may enroll an
applicant who is currently receiving home and community-based services
and complete the [comprehensive assessment] PERSON-CENTERED SERVICE PLAN
within thirty days of enrollment provided that the plan continues to
cover transitional care until such time as the [assessment] SERVICE PLAN
is completed.
(ii) [The assessment shall be completed by a representative of the
managed long term care plan or demonstration, in consultation with the
prospective enrollee's health care practitioner as necessary. The
A. 9023 3
commissioner shall prescribe the forms on which the assessment shall be
made.
(iii)] The enrollment application shall be submitted by the managed
long term care plan or demonstration to the entity designated by the
department prior to the commencement of services under the managed long
term care plan or demonstration. Enrollments conducted by a plan or
demonstration shall be subject to review and audit by the department or
a contractor selected pursuant to paragraph (d) of this subdivision.
[(iv)] (III) Continued enrollment in a managed long term care plan or
demonstration paid for by government funds shall be based upon a
[comprehensive assessment of the medical, social and environmental needs
of the recipient of the services] PERSON-CENTERED SERVICE PLAN UNDER
SUBDIVISION TEN OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL
SERVICES LAW, INCLUDING PERIODIC REVISIONS OF THE SERVICE PLAN. [Such
assessment shall be performed a least annually by the managed long term
care plan serving the enrollee. The commissioner shall prescribe the
forms on which the assessment will be made.]
§ 5. Subparagraph (i) of paragraph (g) of subdivision 7 of section
4403-f of the public health law, as added by section 65-c of part A of
chapter 57 of the laws of 2006 and as relettered by section 20 of part C
of chapter 58 of the laws of 2007, is amended to read as follows:
(i) Managed long term care plans and demonstrations may enroll eligi-
ble persons in the plan or demonstration upon the completion of a
[comprehensive assessment that shall include, but not be limited to, an
evaluation of the medical, social and environmental needs of each
prospective enrollee in such program] PERSON-CENTERED SERVICE PLAN UNDER
SUBDIVISION TEN OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL
SERVICES LAW. This [assessment] SERVICE PLAN shall also serve as the
basis for the development and provision of an appropriate plan of care
for the prospective enrollee.
§ 6. This act shall take effect immediately; provided, however, that
sections three and four of this act shall take effect on the one hundred
eightieth day after it shall have become a law; provided, further, that
the amendments to paragraph (g) of subdivision 7 of section 4403-f of
the public health law as amended by sections four and five of this act
shall not affect the repeal of such section and shall be deemed repealed
therewith; and provided, further, that the amendments to subparagraph
(i) of paragraph (g) of subdivision 7 of section 4403-f of the public
health law made by section four of this act shall be subject to the
expiration and reversion of such subparagraph when upon such date the
provisions of section five of this act shall take effect. Effective
immediately, the commissioner of health shall make regulations and take
other actions reasonably necessary to implement those sections on that
date.