Legislation

§ 4623. Long term care insurance and continuing care retirement
contracts or continuing care at home contracts. 1. The commissioner may
approve an application for a certificate of authority and 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 facility 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 superintendent, 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.

2. With regard to nursing facility or home health care services which
are part of the continuing care retirement contract or continuing care
at home contract, any elimination or waiting periods and any
deductibles, copayments, or other amounts not paid for by such long term
care insurance or medical assistance payments shall be the
responsibility of the continuing care retirement community. The resident
shall not be liable to pay any such amounts.

3. The continuing care retirement community operator shall not require
that long term care insurance be purchased from a specified insurer or
group of insurers and the operator shall not, without the approval of
the council and the approval of the superintendent, specify a minimum
acceptable benefit level different from that established under the
partnership for long term care program.

4. Entrance fees and monthly care fees shall reflect that the cost of
a resident's nursing facility and home health care services are or will
be paid for in whole or in part in accordance with (a) the partnership
for long term care program or (b) other group or individual long term
care insurance approved by the superintendent and the council in
connection with the application.

5. a. If a resident fails to maintain minimum long term care insurance
coverage in accordance with this section, the continuing care retirement
community operator shall purchase, if possible, such coverage on behalf
of and at the expense of the resident and may require an appropriate
adjustment in payments by the resident to the operator.

b. If the continuing care retirement community operator cannot
purchase long term care insurance coverage under paragraph a of this
subdivision, the operator may require an adjustment in the resident's
monthly fees, subject to the approval of the superintendent, to fund the
additional risk to the facility.

c. If the resident fails to maintain long term care insurance coverage
in accordance with this section and the community operator has not
purchased such coverage, the operator shall be responsible for any
expenses which would have been covered under the long term care
insurance policy which the resident failed to maintain. The operator may
add the amount of such expenses to the resident's monthly fees.