S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3940
                              2011-2012 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 31, 2011
                                      ___________
       Introduced  by  M.  of  A.  ENGLEBRIGHT -- read once and referred to the
         Committee on Aging
       AN ACT to amend the elder law, in relation to establishing a senior care
         choices program in the office for the aging
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Section  214  of the elder law is amended by adding a new
    2  subdivision 8 to read as follows:
    3    8. SENIOR CARE CHOICES PROGRAM. (A) NOTWITHSTANDING ANY OTHER  LAW  TO
    4  THE  CONTRARY, THE DIRECTOR SHALL FILE, OR CAUSE TO BE FILED, WITHIN ONE
    5  HUNDRED TWENTY DAYS OF THE EFFECTIVE DATE OF THIS SUBDIVISION AN  APPLI-
    6  CATION  FOR  A  FEDERAL  WAIVER  PURSUANT TO SECTION 1115 OF THE FEDERAL
    7  SOCIAL SECURITY ACT, OR ANY SUCCESSOR THERETO, FOR A SENIOR CARE CHOICES
    8  PROGRAM, UNDER WHICH THE  OFFICE  SHALL  AND  IS  HEREBY  AUTHORIZED  TO
    9  PROVIDE  DIRECTLY OR BY CONTRACT A COORDINATED PLAN OF CARE AND SERVICES
   10  AT HOME TO SENIORS IN A SEAMLESS NETWORK  THAT  SHALL  INCLUDE  SERVICES
   11  PROVIDED BY AND THROUGH THE OFFICE AND ANY ADDITIONAL SERVICES AS MAY BE
   12  NECESSARY  TO MAINTAIN SUCH PERSONS AT HOME AS AUTHORIZED IN THIS SUBDI-
   13  VISION. EVERY STATE AGENCY IS HEREBY EMPOWERED AND DIRECTED TO COOPERATE
   14  WITH THE OFFICE AND TO COMPLY WITH ANY REQUEST FOR THE  FILING  OF  SUCH
   15  WAIVER  IF  THE  DIRECTOR  SHALL LACK POWER AND AUTHORITY TO FILE SUCH A
   16  WAIVER. AS USED IN THIS SUBDIVISION, THE TERM "SENIOR" MEANS PERSONS WHO
   17  ARE AGED SIXTY AND OLDER WHO ARE MEDICALLY ELIGIBLE FOR PLACEMENT  IN  A
   18  LONG-TERM  CARE  FACILITY, AS SUCH TERM IS DEFINED IN SECTION TWENTY-ONE
   19  HUNDRED NINETY-ONE OF THE PUBLIC HEALTH LAW.
   20    (1) THE SENIOR CARE CHOICES PROGRAM SHALL BE PROVIDED IN THE  SENIOR'S
   21  HOME  OR  IN  THE  HOME  OF  A RESPONSIBLE RELATIVE OR OTHER RESPONSIBLE
   22  ADULT, AND, OTHER PROVISIONS OF THIS SECTION TO  THE  CONTRARY  NOTWITH-
   23  STANDING,  IF THE WAIVER GRANTED PURSUANT TO SECTION 1115 OF THE FEDERAL
   24  SOCIAL SECURITY ACT OR ANY SUCCESSOR THERETO SHALL SO PROVIDE, MAY  ALSO
   25  BE  PROVIDED  IN  ADULT CARE FACILITIES, OTHER THAN SHELTERS FOR ADULTS,
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD07375-01-1
       A. 3940                             2
    1  CERTIFIED PURSUANT  TO  SECTION  FOUR  HUNDRED  SIXTY-B  OF  THE  SOCIAL
    2  SERVICES LAW, PROVIDED THAT THE SENIOR MEETS THE ADMISSION AND CONTINUED
    3  STAY  CRITERIA  FOR  SUCH FACILITY, EXCEPT THAT SERVICES PROVIDED BY THE
    4  PROGRAM  SHALL  NOT  DUPLICATE  OR  REPLACE  THOSE WHICH THE FACILITY IS
    5  REQUIRED BY LAW OR REGULATION TO PROVIDE.
    6    (2) IN FILING SUCH WAIVER FOR THE OPERATION OF THE PROGRAM, THE OFFICE
    7  SHALL SEEK TO PROVIDE SERVICES PURSUANT TO THE  PRINCIPLE  THAT  SENIORS
    8  HAVE  THE  PRIMARY  AUTHORITY  TO  MAKE CHOICES THAT WORK BEST FOR THEM,
    9  REGARDLESS OF THE NATURE OR EXTENT OF THEIR DISABILITY OR THE SOURCE  OF
   10  PAYMENT  FOR  SERVICES. IN DESIGNING THE PROGRAM AND PROVIDING SERVICES,
   11  THE OFFICE IS AUTHORIZED TO WAIVE ANY PROVISION OF THE  SOCIAL  SERVICES
   12  LAW  OR  THE  PUBLIC  HEALTH  LAW, OR ANY RULE OR REGULATION PROMULGATED
   13  THEREUNDER, WHICH IN THE JUDGMENT OF THE OFFICE RESTRICTS ITS ABILITY TO
   14  PROVIDE SERVICES AS REQUIRED BY THIS SUBDIVISION, SO LONG AS SUCH WAIVER
   15  IS CONSISTENT WITH ANY FEDERAL WAIVER GRANTED PURSUANT TO  SECTION  1115
   16  OF THE FEDERAL SOCIAL SECURITY ACT OR ANY SUCCESSOR THERETO.
   17    (3) THE OFFICE SHALL SEEK TO EXPAND SOURCE OF PAYMENT FOR THE PROGRAM,
   18  INCLUDING  SEEKING  PAYMENTS FROM VOLUNTARY AND WILLING PRIVATE SOURCES,
   19  INSURANCE PLANS, CHARITIES AND FOUNDATIONS, AND INDIVIDUALS.
   20    (4) THE OFFICE IS HEREBY EMPOWERED TO  PROVIDE  OR  CONTRACT  FOR  THE
   21  PROVISION  OF  SUCH SENIOR CARE CHOICES PROGRAM IN ANY COUNTY WITHIN THE
   22  STATE. THE OFFICE SHALL SEEK TO COORDINATE  SERVICES  WITH  ANY  CURRENT
   23  PROVIDER  OF  SERVICES. NO STATE AGENCY SHALL IMPOSE A LIMITATION ON THE
   24  NUMBER OF ELIGIBLE INDIVIDUALS SERVED IN THIS PROGRAM. THE OFFICE  SHALL
   25  NOT  BE SUBJECT TO AUDIT, ASSESSMENT, SUSPENSION, SANCTION, OR REPORT BY
   26  A STATE AGENCY FOR A PROGRAM CONDUCTED PURSUANT TO THE AUTHORITY OF THIS
   27  SUBDIVISION, EXCEPT THAT IT SHALL BE SUBJECT TO AUDIT BY THE  OFFICE  OF
   28  THE  STATE  COMPTROLLER TO THE EXTENT THAT SUCH PROGRAMS WOULD HAVE BEEN
   29  SUBJECT TO AUDIT BUT FOR THIS PARAGRAPH.
   30    (B) IF A SENIOR DEEMED BY HIS OR HER PHYSICIAN ABLE TO REMAIN  IN  HIS
   31  OR HER OWN HOME OR THE HOME OF A RESPONSIBLE RELATIVE OR OTHER RESPONSI-
   32  BLE  ADULT  IF THE NECESSARY SERVICES ARE PROVIDED APPLIES FOR ADMISSION
   33  TO THE PROGRAM,  THE  OFFICE  IN  CONSULTATION  WITH  THE  LOCAL  SOCIAL
   34  SERVICES  COMMISSIONER  SHALL  ORDER AN ASSESSMENT TO BE PERFORMED USING
   35  THE ASSESSMENT INSTRUMENT DEVELOPED PURSUANT TO THE PROVISION OF SECTION
   36  THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW, AND IN ADDITION  AN
   37  ASSESSMENT  OF  THE  INFORMAL CAREGIVING NETWORK AND SUPPORTS CAPABLE OF
   38  PROVIDING SOCIAL AND NON-MEDICAL SERVICES TO THE SENIOR. IF THE  RESULTS
   39  OF  THE  ASSESSMENT INDICATE THAT THE SENIOR CAN RECEIVE THE APPROPRIATE
   40  LEVEL OF CARE AT HOME OR IN THE HOME OF  SUCH  RESPONSIBLE  RELATIVE  OR
   41  OTHER  RESPONSIBLE  ADULT,  AND  THAT  THE  SENIOR  CAN BE APPROPRIATELY
   42  SUPPORTED BY FAMILY, INTIMATES, FRIENDS AND COMMUNITY, THE OFFICE SHALL,
   43  AFTER CONSULTING WITH THOSE WHO PERFORMED THE  ASSESSMENT,  PREPARE  FOR
   44  THAT  SENIOR  A  PLAN FOR THE PROVISION OF SERVICES THAT MAY INCLUDE ANY
   45  SERVICE THAT WOULD BE RENDERED IN A NURSING HOME  PLUS  SUCH  ADDITIONAL
   46  SERVICES  AS  THE  OFFICE  IS  AUTHORIZED TO PROVIDE DIRECTLY OR THROUGH
   47  CONTRACT PURSUANT TO THE PROVISIONS OF THE  WAIVER  AUTHORIZED  BY  THIS
   48  SUBDIVISION.  CONTINUED  PROVISION OF SERVICES PURSUANT TO THIS SUBDIVI-
   49  SION SHALL BE CONTINGENT ON ADDITIONAL ASSESSMENTS PERFORMED  EVERY  ONE
   50  HUNDRED  TWENTY  DAYS. AT THE TIME OF THE INITIAL ASSESSMENT, AND AT THE
   51  TIME OF EACH SUBSEQUENT ASSESSMENT (OR MORE OFTEN IF THE SENIOR'S  NEEDS
   52  REQUIRE),  THE  OFFICE  SHALL ESTABLISH A MONTHLY BUDGET FOR PAYMENT FOR
   53  THE SERVICES PROVIDED UNDER SUCH PLAN.   TOTAL ANNUAL  EXPENDITURES  FOR
   54  MEDICAL  ASSISTANCE  SERVICES  MADE  PURSUANT TO TITLE ELEVEN OF ARTICLE
   55  FIVE OF THE SOCIAL SERVICES LAW FOR ALL SUCH SENIORS WITHIN  THE  SOCIAL
   56  SERVICES  DISTRICT  WITHIN  WHICH  SUCH  SENIORS RESIDE SHALL NOT EXCEED
       A. 3940                             3
    1  SIXTY-FIVE PERCENT OF THE AVERAGE OF THE ANNUAL RATES PAYABLE UNDER SUCH
    2  TITLE FOR NURSING HOME SERVICES WITHIN THE SOCIAL SERVICES  DISTRICT  IN
    3  WHICH  SUCH  SENIORS RESIDE, SUCH AMOUNT TO BE DETERMINED BY MULTIPLYING
    4  THE  TOTAL NUMBER OF SENIORS WITHIN THE PROGRAM IN ANY YEAR BY THE AVER-
    5  AGE OF THE ANNUAL RATES PAYABLE FOR SUCH NURSING HOME SERVICES.
    6    (C) SERVICES PROVIDED UNDER THE SENIOR CARE  CHOICES  PROGRAM  INCLUDE
    7  SERVICES  PROVIDED  BY  THE OFFICE, AND PROVIDED PURSUANT TO THE WAIVER,
    8  INCLUDING BUT NOT LIMITED TO SUCH  LONG  TERM  CARE  SERVICES  AS  CARE,
    9  TREATMENT,  MAINTENANCE  AND  SERVICES  PROVIDED  IN  A NURSING FACILITY
   10  LICENSED UNDER  ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW,  OR
   11  PROVIDED BY A HOME CARE SERVICES AGENCY, CERTIFIED HOME HEALTH AGENCY OR
   12  LONG  TERM  HOME  HEALTH  CARE PROGRAM, AS DEFINED IN SECTION THIRTY-SIX
   13  HUNDRED TWO OF THE PUBLIC HEALTH LAW, OR PROVIDED BY AN ADULT DAY HEALTH
   14  CARE PROGRAM IN ACCORDANCE WITH REGULATIONS OF THE DEPARTMENT OF HEALTH,
   15  OR PROVIDED BY A PERSONAL CARE PROVIDER LICENSED  OR  REGULATED  BY  ANY
   16  OTHER  STATE  OR LOCAL AGENCY, AND SUCH OTHER SERVICES FOR WHICH MEDICAL
   17  ASSISTANCE IS OR OTHERWISE WOULD BE AVAILABLE  PURSUANT  TO  THE  SOCIAL
   18  SERVICES  LAW  INCLUDING  THOSE  WHICH  ARE DESIGNATED AS LONG TERM CARE
   19  SERVICES IN LAW OR REGULATIONS OF THE  DEPARTMENT  OF  HEALTH,  CONSUMER
   20  DIRECTED  PERSONAL  ASSISTANCE  SERVICES AND SUCH OTHER SERVICES AS HOME
   21  MODIFICATION, TELEHEALTH, PHARMACY REVIEW AND PALLIATIVE CARE.
   22    S 2. This act shall take effect immediately.