Bill Text: NY S02185 | 2011-2012 | General Assembly | Introduced
Bill Title: Establishes the New York state compact for long term care; requires federal financial participation; requires that the state provide assurance of quality of services in designing the waiver; outlines participation in such compact and pledge amounts; authorizes the waiver of all or part of the participation fee and the requirement that a beneficiary pay the difference between the compact rate and the compact subsidy if the beneficiary's countable income, after deductions of these items is less than certain protected income amounts; describes fraudulent practices.
Spectrum: Moderate Partisan Bill (Republican 8-1)
Status: (Engrossed - Dead) 2012-05-30 - REPORTED AND COMMITTED TO FINANCE [S02185 Detail]
Download: New_York-2011-S02185-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2185
2011-2012 Regular Sessions
I N S E N A T E
January 18, 2011
___________
Introduced by Sens. GOLDEN, DeFRANCISCO, GRISANTI, LAVALLE, RANZENHOFER
-- read twice and ordered printed, and when printed to be committed to
the Committee on Aging
AN ACT to amend the elder law and the insurance law, in relation to
establishing the New York state compact for long term care
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Article 2 of the elder law is amended by adding a new title
2 4 to read as follows:
3 TITLE 4
4 COMPACT FOR LONG TERM CARE
5 SECTION 260. SHORT TITLE.
6 261. DEFINITIONS.
7 262. COMPACT FOR LONG TERM CARE CREATED; PURPOSES.
8 263. REQUIREMENT FOR CONSULTATION.
9 264. IMPLEMENTATION.
10 265. SELECTION OF PROGRAM MANAGEMENT ENTITY.
11 266. PARTICIPATION AND PLEDGE.
12 267. BENEFITS OF PARTICIPATION.
13 268. PROTECTED INCOME.
14 269. IMPOSITION OF LIEN IN CERTAIN CASES.
15 270. PROHIBITED ACTS.
16 271. FRAUDULENT PRACTICES.
17 271-A. PAYMENTS AND DEFAULTS.
18 272. APPEALS.
19 273. TREATMENT OF ASSETS.
20 274. SPECIAL PROVISIONS REGARDING COUPLES.
21 275. ADVISORY COMMITTEE.
22 276. REQUIREMENT FOR CONFIDENTIALITY.
23 277. EDUCATION AND INFORMATION.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04236-01-1
S. 2185 2
1 S 260. SHORT TITLE. THIS TITLE SHALL BE KNOWN AND MAY BE CITED AS THE
2 "NEW YORK STATE COMPACT FOR LONG TERM CARE".
3 S 261. DEFINITIONS. AS USED IN THIS TITLE:
4 1. "ASSESSMENT" MEANS AN ASSESSMENT TO DETERMINE WHETHER AN INDIVIDUAL
5 IS A CHRONICALLY ILL INDIVIDUAL WHO QUALIFIES AS A PARTICIPANT OR AS A
6 BENEFICIARY IN THE COMPACT, AND TO PROVIDE INFORMATION FOR THE PLAN OF
7 CARE REQUIRED HEREUNDER FOR SUCH ENROLLEES. AN ASSESSMENT MAY BE
8 PERFORMED ONLY BY A LICENSED HEALTH CARE PRACTITIONER CONTRACTED TO
9 PERFORM SUCH ASSESSMENTS WITH AN INSURER, THE COMMISSIONER, OR THE
10 PROGRAM MANAGEMENT ENTITY. THE ASSESSMENT SHALL BE PERFORMED ANNUALLY
11 OR WHENEVER A CHANGE IN THE CONDITION OF THE BENEFICIARY OR PARTICIPANT
12 WARRANTS AN UPDATE TO THE PLAN OF CARE. THE COST OF AN ASSESSMENT SHALL
13 BE PAID BY AN INDIVIDUAL SEEKING TO ENROLL IN THE COMPACT.
14 2. "ADVISORY COMMITTEE" MEANS THE ADVISORY COMMITTEE ESTABLISHED
15 PURSUANT TO THIS TITLE.
16 3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
17 4. "COMPACT" MEANS THE COMPACT FOR LONG TERM CARE PROGRAM AUTHORIZED
18 BY THIS TITLE.
19 5. "COMPACT BENEFICIARY" OR "BENEFICIARY" MEANS A PARTICIPANT WHO BY
20 PAYING HIS OR HER PLEDGE AMOUNT AND MEETING OTHER REQUIREMENTS ESTAB-
21 LISHED BY THIS TITLE HAS BECOME ELIGIBLE FOR THE COMPACT SUBSIDY.
22 6. "COMPACT PARTICIPANT" OR "PARTICIPANT" MEANS AN INDIVIDUAL WHO: (A)
23 HAS APPLIED FOR MEMBERSHIP IN THE COMPACT; (B) IS A STATE RESIDENT
24 RESIDING IN THIS STATE AT THE TIME OF SUCH APPLICATION AND HAS BEEN A
25 STATE RESIDENT FOR AT LEAST TWO YEARS PRIOR TO THE DATE OF APPLICATION;
26 (C) HAS BEEN DETERMINED BY AN ASSESSMENT TO BE A CHRONICALLY ILL PERSON,
27 AND A PLAN OF CARE HAS BEEN DEVELOPED FOR SUCH PERSON; AND (D) HAS
28 AGREED TO PAY A PLEDGE AMOUNT AS PROVIDED IN THIS TITLE. A PARTICIPANT
29 SHALL BE DEEMED ENROLLED IN THE COMPACT.
30 7. "COMPACT RATE" MEANS THE RATE THAT A PROVIDER MAY CHARGE A COMPACT
31 BENEFICIARY FOR A SERVICE PROVIDED PURSUANT TO THE COMPACT. THE COMPACT
32 RATE SHALL BE COMPUTED BY THE COMMISSIONER AT ONE HUNDRED TEN PERCENT OF
33 THE COMPACT SUBSIDY FOR THE SERVICE.
34 8. "COMPACT SUBSIDY" OR "SUBSIDY" MEANS THE SUBSIDY PROVIDED PURSUANT
35 TO THE COMPACT FOR THE COSTS OF ANY QUALIFIED LONG TERM CARE SERVICE
36 RECEIVED BY A COMPACT BENEFICIARY PURSUANT TO THE PLAN OF CARE. THE
37 AMOUNT OF THE SUBSIDY SHALL EQUAL THE MEDICAID RATE ESTABLISHED FOR THE
38 SAME OR A SIMILAR SERVICE IN THE REGION IN WHICH THE BENEFICIARY
39 RESIDES. IF THERE IS NO MEDICAID RATE FOR A SERVICE IN A REGION, THE
40 COMMISSIONER SHALL ESTABLISH A RATE ON RECOMMENDATION OF THE ADVISORY
41 COMMITTEE WHICH SHALL BE APPLICABLE IN THE REGION FOR THE SERVICE. THE
42 COMMISSIONER SHALL ADJUST THE METHODOLOGY FOR ESTABLISHING THE AMOUNT OF
43 THE COMPACT SUBSIDY ONLY ON RECOMMENDATION OF THE ADVISORY COMMITTEE.
44 9. "COUNTABLE ASSET" SHALL HAVE THE SAME MEANING AS THE TERM "ASSETS"
45 IN CLAUSE (I) OF SUBPARAGRAPH ONE OF PARAGRAPH (D) OF SUBDIVISION FIVE
46 OF SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW APPLICABLE
47 TO TRANSFERS MADE AFTER AUGUST TENTH, NINETEEN HUNDRED NINETY-THREE,
48 EXCEPT AS OTHERWISE PROVIDED HEREIN OR BY RULES ESTABLISHED PURSUANT TO
49 THIS TITLE. COUNTABLE ASSET DOES NOT INCLUDE INCOME.
50 10. "COUNTABLE INCOME" MEANS INCOME REQUIRED TO BE CONSIDERED IN THE
51 CASE OF A PERSON APPLYING FOR MEDICAID PURSUANT TO SECTION THREE HUNDRED
52 SIXTY-SIX OF THE SOCIAL SERVICES LAW, EXCEPT AS OTHERWISE PROVIDED HERE-
53 IN OR BY RULES ESTABLISHED PURSUANT TO THIS TITLE. THE FOLLOWING HEALTH
54 CARE EXPENDITURES SHALL BE EXCLUDED FROM COUNTABLE INCOME: EXPENDITURES
55 FOR MEDICARE SUPPLEMENTAL INSURANCE POLICIES MEETING THE STANDARDS
56 ESTABLISHED PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED EIGHTEEN OF
S. 2185 3
1 THE INSURANCE LAW, EXPENDITURES FOR A MEDICARE PRESCRIPTION DRUG PLAN
2 APPROVED PURSUANT TO PROCEDURES ESTABLISHED BY THE U.S. DEPARTMENT OF
3 HEALTH AND HUMAN SERVICES, AND PREMIUMS FOR THE PURCHASE OF LONG TERM
4 CARE INSURANCE.
5 11. "DIRECTOR" MEANS THE DIRECTOR OF THE STATE OFFICE FOR THE AGING.
6 12. "FEDERAL ACT" MEANS THE HEALTH INSURANCE PORTABILITY AND ACCOUNT-
7 ABILITY ACT OF 1996 OR ANY SUCCESSOR THERETO, AND RULES PROMULGATED
8 THEREUNDER. THE FOLLOWING TERMS SHALL HAVE THE SAME MEANINGS AS UNDER
9 THE FEDERAL ACT: "QUALIFIED LONG TERM CARE SERVICES"; "LICENSED HEALTH
10 CARE PRACTITIONER"; "ACTIVITIES OF DAILY LIVING"; "CHRONICALLY ILL
11 PERSON." ANY PROVISION OF ANY OTHER LAW TO THE CONTRARY NOTWITHSTAND-
12 ING, THE DEPARTMENT OF HEALTH SHALL NOT BE AUTHORIZED TO ISSUE, ENACT,
13 PROMULGATE, OR ENFORCE ANY REQUIREMENT, RULE, REGULATION OR DEFINITION
14 THAT IS MORE RESTRICTIVE THAN THE MEANINGS ASCRIBED TO SUCH TERMS PURSU-
15 ANT TO THE FEDERAL ACT. IN ADDITION:
16 (A) THE FOREGOING TO THE CONTRARY NOTWITHSTANDING AND SOLELY FOR
17 PURPOSES OF DETERMINING WHETHER A PARTICIPANT OR A BENEFICIARY IS
18 SUFFERING FROM "SEVERE COGNITIVE IMPAIRMENT," THE COMMISSIONER SHALL
19 REQUIRE THAT SUCH CONDITION BE CHARACTERIZED BY A DETERIORATION OR IRRE-
20 VERSIBLE LOSS IN INTELLECTUAL CAPACITY THAT REQUIRES SUBSTANTIAL SUPER-
21 VISION TO ASSURE THE SAFETY OF THE PARTICIPANT OR OF OTHERS, AND THAT IT
22 SHALL BE ESTABLISHED BY CLINICAL EVIDENCE AND STANDARDIZED TESTS THAT
23 RELIABLY MEASURE: SHORT-TERM OR LONG-TERM MEMORY; ORIENTATION AS TO
24 PEOPLE, PLACE OR TIME; DEDUCTIVE OR ABSTRACT REASONING; AND JUDGMENT AS
25 IT RELATES TO SAFETY AWARENESS. THE MEANS OF DETERMINATION AS TO WHETH-
26 ER A PERSON HAS SUFFERED SEVERE COGNITIVE IMPAIRMENT SHALL INSOFAR AS
27 PRACTICAL BE THE SAME AS THOSE USED PURSUANT TO THE FEDERAL ACT TO
28 DETERMINE SEVERE COGNITIVE IMPAIRMENT. "SUBSTANTIAL SUPERVISION" AS
29 USED IN THIS TITLE MEANS CONTINUAL OVERSIGHT THAT MAY INCLUDE CUEING BY
30 VERBAL PROMPTING, GESTURES OR OTHER DEMONSTRATIONS BY ANOTHER PERSON,
31 AND THAT IS NECESSARY TO PROTECT THE PATIENT FROM THREATS TO HIS OR HER
32 HEALTH OR SAFETY.
33 (B) "LICENSED HEALTH CARE PRACTITIONER" SHALL BE LIMITED TO A PHYSI-
34 CIAN, AS DEFINED IN SECTION 1861(R)(1) OF THE SOCIAL SECURITY ACT OR A
35 REGISTERED PROFESSIONAL NURSE, PROVIDED THAT SUCH PERSON IS NOT A FAMILY
36 MEMBER AND FURTHER PROVIDED THAT SUCH INDIVIDUAL SHALL BE LICENSED,
37 REGISTERED, OR CERTIFIED TO WORK IN NEW YORK.
38 (C) ANY LIMITATIONS IMPOSED BY THE FOREGOING TO THE CONTRARY NOTWITH-
39 STANDING, "QUALIFIED LONG TERM CARE SERVICES" SHALL INCLUDE ANY EXPENSES
40 FOR LONG TERM MEDICAL CARE AND SERVICES WHICH ARE OR, IN THE CASE OF AN
41 INDIVIDUAL WHO IS NOT A TAXPAYER, WHICH WOULD BE DEDUCTIBLE FROM FEDERAL
42 GROSS INCOME FOR SUCH TAXPAYER OR INDIVIDUAL AS LONG TERM CARE SERVICES
43 PURSUANT TO THE INTERNAL REVENUE CODE, AND BOTH MEDICAL AND NON-MEDICAL
44 SERVICES, INCLUDING HOME MODIFICATION AND THE PROVISION OF SERVICES
45 COORDINATION REQUIRED PURSUANT TO THE PLAN OF CARE PREPARED BY A
46 LICENSED HEALTH CARE PRACTITIONER IN ORDER TO MAINTAIN A PARTICIPANT OR
47 BENEFICIARY IN HIS OR HER OWN HOME, AND SUCH ADDITIONAL SERVICES AS MAY
48 BE APPROVED BY THE COMMISSIONER UPON RECOMMENDATION OF THE ADVISORY
49 COMMITTEE, SO LONG AS THE COMMISSIONER SHALL BE SATISFIED THAT INCLUSION
50 OF SUCH ADDITIONAL SERVICES DOES NOT PREVENT RECEIPT OF FEDERAL FINAN-
51 CIAL PARTICIPATION UNDER THE MEDICAL ASSISTANCE PROGRAM OR UNDER THE
52 COMPACT.
53 13. "FULFILLED PLEDGE" MEANS A PLEDGE AMOUNT THAT HAS BEEN FULLY PAID.
54 ONLY PAYMENTS MADE BY A PARTICIPANT, OR BY ANY PERSON OR ENTITY ON
55 BEHALF OF SUCH PARTICIPANT SHALL BE COUNTED AS ELIGIBLE PAYMENTS FOR
56 FULFILLING A PLEDGE. ELIGIBLE PAYMENTS SHALL INCLUDE REASONABLE AND
S. 2185 4
1 NECESSARY PAYMENTS FOR QUALIFIED LONG TERM CARE SERVICES, AND ANY ADDI-
2 TIONAL EXPENSES FOR SERVICES AS MAY BE APPROVED BY THE COMMISSIONER UPON
3 RECOMMENDATION OF THE ADVISORY COMMITTEE. SUCH PAYMENTS SHALL ALSO
4 INCLUDE PAYMENTS FOR QUALIFIED LONG TERM CARE SERVICES FOR THE
5 THREE-MONTH PERIOD PRIOR TO AN INDIVIDUAL BECOMING A PARTICIPANT. COUNT-
6 ABLE PAYMENTS MADE FOR A QUALIFIED LONG TERM CARE SERVICE IN FULFILLING
7 A PLEDGE SHALL NOT BE GREATER THAN THE AMOUNT USUALLY AND CUSTOMARILY
8 CHARGED FOR SUCH SERVICE BY A PROVIDER TO A NON-MEDICAID RECIPIENT.
9 14. "PLAN OF CARE" MEANS A WRITTEN, INDIVIDUALIZED PLAN FOR CARE AND
10 SUPPORT SERVICES DEVELOPED BY A LICENSED HEALTH CARE PRACTITIONER FOR AN
11 INDIVIDUAL SEEKING TO ENROLL IN THE COMPACT AND AT OTHER SUCH TIMES AS
12 PROVIDED HEREIN. THE PLAN OF CARE SHALL BE DEVELOPED AS A RESULT OF AN
13 ASSESSMENT AND SHALL INCORPORATE ANY INFORMATION PROVIDED BY AN INDIVID-
14 UAL'S PERSONAL PHYSICIAN OR, AS APPROPRIATE, OTHER PHYSICIANS TREATING
15 THE INDIVIDUAL. IT SHALL FAIRLY, ACCURATELY, AND APPROPRIATELY ADDRESS
16 THE INDIVIDUAL'S LONG TERM CARE AND SUPPORT SERVICE NEEDS, AND SHALL
17 SPECIFY THE TYPE, FREQUENCY, AND DURATION OF ALL SERVICES REQUIRED TO
18 MEET THOSE NEEDS AND THE PROVIDERS APPROPRIATE TO FURNISH THOSE
19 SERVICES. A PLAN OF CARE SHALL BE COMPLETED AT THE SAME TIME THE ASSESS-
20 MENT IS PERFORMED, AND SHALL BE UPDATED ANNUALLY ON THE BASIS OF THE
21 ANNUAL ASSESSMENT OR WHENEVER A CHANGE IN THE CONDITION OF THE BENEFICI-
22 ARY OR PARTICIPANT WARRANTS AN UPDATE. THE COST OF THE PLAN OF CARE
23 SHALL BE PAID BY AN INDIVIDUAL SEEKING TO ENROLL IN THE COMPACT.
24 15. "PLEDGE AMOUNT" MEANS THE AMOUNT PLEDGED BY A PARTICIPANT FOR THE
25 COST OF QUALIFIED LONG TERM CARE SERVICES. THE PLEDGE AMOUNT SHALL BE
26 THE LESSER OF: (A) THE "MAXIMUM PLEDGE AMOUNT," WHICH SHALL BE THE
27 AMOUNT EQUAL TO THIRTY-SIX MONTHS OF PAYMENT FOR NURSING HOME SERVICES
28 IN THE REGION IN WHICH THE PARTICIPANT RESIDES, AS APPLICABLE AT THE
29 TIME OF APPLICATION TO THE COMPACT; OR
30 (B) THE "DOLLAR PLEDGE AMOUNT" WHICH SHALL BE AN AMOUNT EQUAL TO FIFTY
31 PERCENT OF A PARTICIPANT'S COUNTABLE ASSETS. IN THE CASE OF A PARTIC-
32 IPANT WHOSE COUNTABLE ASSETS ARE LESS THAN FORTY THOUSAND DOLLARS, THE
33 DOLLAR PLEDGE AMOUNT SHALL BE LIMITED TO THE AMOUNT IN EXCESS OF A
34 DEDUCTIBLE AMOUNT OF TWENTY THOUSAND DOLLARS, AND THE COMMISSIONER SHALL
35 CALCULATE SUCH DOLLAR PLEDGE AMOUNT BY SUBTRACTING SUCH DEDUCTIBLE
36 AMOUNT OF TWENTY THOUSAND DOLLARS FROM THE PARTICIPANT'S COUNTABLE
37 ASSETS AND THE REMAINDER AMOUNT SHALL EQUAL THE DOLLAR PLEDGE AMOUNT;
38 PROVIDED THAT THE COMMISSIONER SHALL ANNUALLY INCREASE OR DECREASE SUCH
39 FORTY THOUSAND DOLLAR ASSET AMOUNT AND SUCH TWENTY THOUSAND DOLLAR
40 DEDUCTIBLE AMOUNT AT THE SAME PERCENTAGE RATE AS THE INCREASE OR
41 DECREASE IN THE REGIONAL RATE FOR NURSING HOME SERVICES FOR THE REGION
42 IN WHICH THE ELIGIBLE INDIVIDUAL RESIDES.
43 16. "REGION" MEANS THE FOLLOWING REGIONS: LONG ISLAND, NEW YORK CITY,
44 NORTHERN METROPOLITAN NEW YORK, NORTHEASTERN NEW YORK, UTICA REGION,
45 CENTRAL NEW YORK, ROCHESTER REGION AND WESTERN NEW YORK.
46 17. "REGIONAL RATE" MEANS THE RATE SET ANNUALLY BY THE COMMISSIONER AT
47 EQUAL TO THE AVERAGE OF ALL RATES, EXCLUSIVE OF MEDICAID RATES, PAID FOR
48 THE SAME OR SIMILAR SERVICES WITHIN A REGION. THE COMMISSIONER SHALL
49 COMPUTE AND ANNUALLY UPDATE REGIONAL RATES FOR EACH REGION OF THE STATE
50 FOR ANY YEAR NOT LATER THAN THE LAST WEEK OF DECEMBER OF THE YEAR
51 PRECEDING SUCH YEAR.
52 S 262. COMPACT FOR LONG TERM CARE CREATED; PURPOSES. THE COMPACT FOR
53 LONG TERM CARE IS HEREBY CREATED. ITS PURPOSE SHALL BE TO PROVIDE COOR-
54 DINATED PUBLIC AND PRIVATE COVERAGE FOR THE EXPENSES OF PROVIDING QUALI-
55 FIED LONG TERM CARE SERVICES TO ELIGIBLE INDIVIDUALS PURSUANT TO A PLAN
56 OF CARE, A PURPOSE HEREBY DECLARED TO BE IN EVERY RESPECT AN APPROPRIATE
S. 2185 5
1 PUBLIC PURPOSE CONDUCTED FOR THE BENEFIT OF THE PEOPLE OF THE STATE OF
2 NEW YORK.
3 S 263. REQUIREMENT FOR CONSULTATION. ANY PROVISION OF ANY OTHER LAW TO
4 THE CONTRARY NOTWITHSTANDING, AND IN ADDITION TO ANY OTHER REQUIREMENT
5 IMPOSED BY THIS TITLE, THE COMMISSIONER SHALL CONSULT WITH THE DIRECTOR
6 AND WITH THE SUPERINTENDENT OF INSURANCE PRIOR TO TAKING ANY MATERIAL
7 ACTION CONCERNING POLICY OR PROGRAM MATTERS REQUIRED OR PERMITTED BY
8 THIS TITLE, PROVIDED HOWEVER THAT THE FAILURE TO RESPOND TIMELY TO A
9 REQUEST FOR CONSULTATION AND ADVICE SHALL NOT IMPAIR OR INVALIDATE ANY
10 SUCH ACTION TAKEN BY THE COMMISSIONER.
11 S 264. IMPLEMENTATION. ANY PROVISION OF ANY OTHER LAW TO THE CONTRARY
12 NOTWITHSTANDING, THE COMMISSIONER IS HEREBY AUTHORIZED TO AND SHALL
13 IMPLEMENT THE COMPACT FOR LONG TERM CARE PROGRAM AUTHORIZED BY THIS
14 TITLE AND SHALL SUBMIT SUCH WAIVER APPLICATIONS AND/OR STATE PLAN AMEND-
15 MENTS AS MAY BE NECESSARY FOR SUCH IMPLEMENTATION, PROVIDED THAT SUCH
16 PROGRAM AND THE PROVISIONS OF THIS TITLE SHALL BE IMPLEMENTED ONLY IF
17 AND FOR SO LONG AS THE COMMISSIONER SHALL BE SATISFIED THAT THEY DO NOT
18 PREVENT RECEIPT OF FEDERAL FINANCIAL PARTICIPATION UNDER THE MEDICAL
19 ASSISTANCE PROGRAM OR UNDER THE COMPACT. IN APPLYING FOR THE WAIVER, THE
20 COMMISSIONER SHALL CONSULT WITH THE ADVISORY COMMITTEE CONCERNING
21 SUBMISSION OF APPROPRIATE CRITERIA FOR ASSURING THAT A SERVICE IS PROP-
22 ERLY PROVIDED AND MEETS APPROPRIATE STANDARDS OF QUALITY AND COST.
23 S 265. SELECTION OF PROGRAM MANAGEMENT ENTITY. 1. THE COMMISSIONER IS
24 HEREBY AUTHORIZED TO AND SHALL CONTRACT WITH A PROGRAM MANAGEMENT ENTITY
25 TO ADMINISTER THE COMPACT. THE PROCESS FOR SELECTING A PROGRAM MANAGE-
26 MENT ENTITY TO MANAGE THE COMPACT PROGRAM SHALL BE GOVERNED SOLELY BY
27 THIS TITLE.
28 2. INSOFAR AS PERMITTED UNDER ANY FEDERAL WAIVERS OR STATE PLAN AMEND-
29 MENTS REQUIRED FOR IMPLEMENTATION, THE COMPACT SHALL BE MANAGED BY A
30 PROGRAM MANAGEMENT ENTITY CONTRACTED TO AND SELECTED BY THE COMMISSIONER
31 BY A REQUEST FOR PROPOSALS OR A REQUEST FOR QUALIFICATIONS ISSUED PURSU-
32 ANT TO THIS TITLE. SUCH ENTITY SHALL BE RESPONSIBLE FOR COORDINATING AND
33 MANAGING ALL ASPECTS OF THE COMPACT PROGRAM AND LIAISING WITH THE
34 DEPARTMENT OF HEALTH, INDIVIDUALS, INSURANCE COMPANIES AND OTHER ENTI-
35 TIES TO ASSURE APPROPRIATE COLLECTION AND VERIFICATION OF DATA,
36 COLLECTION OF PAYMENTS REQUIRED TO BE MADE TO THE STATE PURSUANT TO THIS
37 TITLE, VERIFICATION OF ASSESSMENTS AND CLAIMS TRACKING, AND OTHER SIMI-
38 LAR ADMINISTRATIVE RESPONSIBILITIES. THE PROGRAM MANAGEMENT ENTITY SHALL
39 NOT BE AN INSURANCE ENTITY OFFERING AN INSURANCE PLAN UNDER THE COMPACT
40 OR, UNLESS REQUIRED BY FEDERAL LAW OR REGULATION OR AS A CONDITION OF
41 FEDERAL APPROVAL OF ANY WAIVERS OR STATE PLAN AMENDMENTS NECESSARY TO
42 IMPLEMENT THE COMPACT, A STATE AGENCY OR A COVERED AUTHORITY AS SUCH
43 TERMS ARE DEFINED IN SECTION TWO-A OF THE STATE FINANCE LAW.
44 3. THE COMMISSIONER, AFTER CONSULTATION WITH THE DIRECTOR OF THE DIVI-
45 SION OF THE BUDGET, SHALL WITHIN NINETY DAYS AFTER THE EFFECTIVE DATE OF
46 THIS SECTION, REPORT TO THE GOVERNOR AND THE LEGISLATURE WITH RECOMMEN-
47 DATIONS FOR THE IMPLEMENTATION OF THE SELECTION PROCESS. SUCH REPORT
48 SHALL DETAIL:
49 (A) THE CRITERIA TO BE USED IN SELECTING THE ENTITY;
50 (B) THE PROCESS TO BE USED IN THE SELECTION, INCLUDING THE ISSUANCE OF
51 REQUESTS FOR PROPOSALS, REQUESTS FOR QUALIFICATIONS OR OTHER MEANS;
52 (C) THE NAMES OF ANY ENTITIES ENGAGED TO DEVELOP CRITERIA AND ASSIST
53 IN THE SELECTION;
54 (D) TIMELINESS FOR THE SELECTION OF THE ENTITY AND ISSUANCE OF
55 CONTRACTS;
56 (E) MARKETING PLANS FOR THE PROGRAM;
S. 2185 6
1 (F) MEANS TO MAKE THE SELECTION PROCESS AS TRANSPARENT AS POSSIBLE;
2 (G) MEANS BY WHICH TRADE AND COMPETITIVE SECRETS SHALL BE PROTECTED;
3 (H) MEANS BY WHICH INDIVIDUAL IDENTIFYING INFORMATION RELATING TO ANY
4 PATIENT OR CONSUMER ACQUIRED BY THE PROGRAM SHALL BE KEPT CONFIDENTIAL;
5 AND
6 (I) ANY OTHER INFORMATION THE DIRECTOR OF THE DIVISION OF THE BUDGET
7 OR THE COMMISSIONER SHALL DEEM PERTINENT.
8 IN PREPARING THE REPORT, THE DIRECTOR OF THE DIVISION OF THE BUDGET
9 AND THE COMMISSIONER SHALL CONSULT WITH THE ADVISORY COMMITTEE AND THE
10 SUPERINTENDENT OF INSURANCE, AND SHALL ADDITIONALLY CONVENE AN ADVISORY
11 GROUP OF INSURERS AUTHORIZED TO WRITE LONG TERM CARE INSURANCE IN THIS
12 STATE TO PROVIDE COMMENTS ON THE REPORT, OR IF CONVENING SUCH GROUP
13 SHALL PROVE IMPRACTICABLE OR INAPPROPRIATE, SHALL SHARE THE REPORT WITH
14 SUCH INSURERS AND INCLUDE ANY WRITTEN COMMENTS RECEIVED FROM SUCH INSUR-
15 ERS AND THE ADVISORY COMMITTEE WHEN THE REPORT IS ISSUED TO THE GOVERNOR
16 AND THE LEGISLATURE.
17 4. AFTER CONSIDERATION OF ANY COMMENTS THEY MAY RECEIVE CONCERNING THE
18 REPORT, THE COMMISSIONER AND/OR THE DIRECTOR OF THE DIVISION OF THE
19 BUDGET, AS APPROPRIATE, SHALL PROMULGATE RULES AND REGULATIONS GOVERNING
20 THE SELECTION PROCESS FOR A PROGRAM MANAGEMENT ENTITY. SUCH RULES AND
21 REGULATIONS SHALL REFLECT THE RECOMMENDATIONS IN THE REPORT INSOFAR AS
22 PRACTICABLE AND ANY RECOMMENDATIONS RECEIVED BY THE COMMISSIONER AND THE
23 DIRECTOR OF THE DIVISION OF THE BUDGET. THE PROGRAM MANAGEMENT ENTITY
24 SHALL BE SELECTED THROUGH ISSUANCE OF A REQUEST FOR PROPOSALS OR IF
25 APPROPRIATE AND APPROVED BY THE DIRECTOR OF THE DIVISION OF THE BUDGET,
26 BY ISSUANCE OF A REQUEST FOR QUALIFICATIONS, AND SUCH REQUEST FOR
27 PROPOSALS OR REQUEST FOR QUALIFICATIONS SHALL INCORPORATE THE CRITERIA
28 AND OTHER CONDITIONS AGREED UPON AS A RESULT OF THE PROCESS REQUIRED IN
29 THIS SECTION.
30 S 266. PARTICIPATION AND PLEDGE. 1. AN INDIVIDUAL WHO MEETS THE CRITE-
31 RIA FOR BECOMING A PARTICIPANT SHALL BE ENROLLED IN THE COMPACT PROGRAM.
32 IN MEETING SUCH CRITERIA, THE INDIVIDUAL SHALL HAVE THE OPTION AT THE
33 TIME OF APPLICATION TO PLEDGE EITHER THE MAXIMUM PLEDGE AMOUNT OR THE
34 DOLLAR PLEDGE AMOUNT.
35 (A) AN INDIVIDUAL WHO ELECTS TO PLEDGE THE MAXIMUM PLEDGE AMOUNT SHALL
36 PAY OR HAVE PAID ON HIS OR HER BEHALF BY ANY PERSON OR ENTITY AN AMOUNT
37 FOR THE PURCHASE OF QUALIFIED LONG TERM CARE SERVICES THAT IS EQUAL TO
38 THIRTY-SIX MONTHS OF PAYMENT AT THE REGIONAL RATE FOR NURSING HOME
39 SERVICES IN THE REGION IN WHICH THE PARTICIPANT RESIDES AS OF THE DATE
40 THE INDIVIDUAL APPLIES TO BECOME A PARTICIPANT.
41 (B) AN INDIVIDUAL WHO ELECTS TO PLEDGE THE DOLLAR PLEDGE AMOUNT SHALL
42 PAY OR HAVE PAID ON HIS OR HER BEHALF BY ANY PERSON OR ENTITY AN AMOUNT
43 FOR THE PURCHASE OF QUALIFIED LONG TERM CARE SERVICES THAT IS EQUAL TO
44 FIFTY PERCENT OF A PARTICIPANT'S COUNTABLE ASSETS. SUCH INDIVIDUAL
45 SHALL SUBMIT: (I) A VERIFIED STATEMENT OF COUNTABLE ASSETS UNDER PENALTY
46 OF PERJURY LISTING ALL COUNTABLE CURRENT ASSETS HELD BY THE INDIVIDUAL
47 AT THE TIME OF APPLICATION AND ANY ASSET TRANSFERS FOR LESS THAN FULL
48 VALUE DURING THE FIVE YEARS PRECEDING SUCH DATE OF APPLICATION, (II) THE
49 INDIVIDUAL'S FIVE MOST RECENT YEARS OF STATE AND FEDERAL INCOME TAX
50 RETURNS, AND (III) ADDITIONAL DOCUMENTATION AS THE PROGRAM MANAGEMENT
51 ENTITY, WITH THE APPROVAL OF THE COMMISSIONER UPON RECOMMENDATION OF THE
52 ADVISORY COMMITTEE, SHALL DEEM REASONABLE AND APPROPRIATE TO VERIFY
53 ASSETS, THE VALUES OF SUCH ASSETS, AND THE VALIDITY OF THE PLEDGE
54 AMOUNT.
55 (C) DOCUMENTATION CONCERNING THE PLEDGE AMOUNT, THE RESULTS OF THE
56 ASSESSMENT AND EVIDENCE OF A FULFILLED PLEDGE SHALL BE SUBMITTED TO THE
S. 2185 7
1 PROGRAM MANAGEMENT ENTITY IN A FORM AND MANNER PRESCRIBED BY THE COMMIS-
2 SIONER.
3 (D) THE FOREGOING PROVISIONS OF THIS SECTION TO THE CONTRARY NOTWITH-
4 STANDING, THE PLEDGE AMOUNT MAY BE ADJUSTED IN THE EVENT THAT AN INDI-
5 VIDUAL IS SUBJECT TO EXTRAORDINARY CIRCUMSTANCES, AS THE COMMISSIONER
6 SHALL DETERMINE, BUT THE DESCRIPTION OR DEFINITION OF EXTRAORDINARY
7 CIRCUMSTANCES SHALL BE ESTABLISHED ONLY UPON RECOMMENDATION OF THE ADVI-
8 SORY COMMITTEE.
9 2. A PARTICIPANT WHO FULFILLS HIS OR HER PLEDGE SHALL BE DEEMED A
10 BENEFICIARY AND SHALL BE ELIGIBLE FOR THE COMPACT SUBSIDY. A PARTICIPANT
11 WHO FAILS TO FULFILL HIS OR HER PLEDGE SHALL NOT BE ELIGIBLE TO BECOME A
12 BENEFICIARY, BUT SHALL NOT SURRENDER ELIGIBILITY TO APPLY FOR MEDICAID
13 OR ELIGIBILITY TO APPLY FOR THE COMPACT SUBSIDY IF SUCH PARTICIPANT
14 SHALL LATER BECOME ELIGIBLE.
15 3. NOTWITHSTANDING ANY SIMILARITY IN ELIGIBILITY REQUIREMENTS OR
16 COMMONALITY IN THE DEFINITIONS OF ASSET, INCOME OR OTHER ITEMS, AND
17 EXCEPT AS OTHERWISE PROVIDED IN THIS TITLE, A PARTICIPANT OR BENEFICI-
18 ARY, AS THE CASE MAY BE, SHALL BE EXEMPT FROM THE RESOURCE TESTS, LIENS
19 AND OTHER REQUIREMENTS AND IMPOSITIONS THAT WOULD OTHERWISE BE APPLICA-
20 BLE TO PERSONS APPLYING FOR OR RECEIVING MEDICAID.
21 4. THE PURCHASE OF QUALIFIED LONG TERM CARE SERVICES FOR THE PURPOSE
22 OF FULFILLING THE PLEDGE SHALL BE RESTRICTED TO THE PURCHASE OF QUALI-
23 FIED LONG TERM CARE SERVICES IN THE STATE SO LONG AS THE INDIVIDUAL
24 MEETS THE REQUIREMENTS OF THIS TITLE WITH RESPECT TO FULFILLING THE
25 PLEDGE, AND PROVIDED FURTHER THAT A BENEFICIARY MAY ONLY RECEIVE THE
26 COMPACT SUBSIDY FOR SERVICES RECEIVED WITHIN THIS STATE.
27 5. COUNTABLE PAYMENTS MADE FOR A QUALIFIED LONG TERM CARE SERVICE IN
28 FULFILLING A PLEDGE SHALL NOT BE GREATER THAN THE AMOUNT USUALLY AND
29 CUSTOMARILY CHARGED FOR SUCH SERVICE BY A PROVIDER TO A NON-MEDICAID
30 RECIPIENT AND SHALL INCLUDE REASONABLE AND NECESSARY EXPENSES PAID FOR
31 SUCH SERVICES, PROVIDED, HOWEVER THAT THE COMMISSIONER, ON RECOMMENDA-
32 TION OF THE ADVISORY COMMITTEE, MAY ESTABLISH CRITERIA FOR ASSURING THAT
33 A SERVICE IS PROPERLY PROVIDED AND MEETS APPROPRIATE STANDARDS OF QUALI-
34 TY AND COST. THE PROGRAM MANAGEMENT ENTITY SHALL BE AUTHORIZED TO
35 UTILIZE SUCH CRITERIA IN ESTABLISHING PARAMETERS FOR PROPER AND APPRO-
36 PRIATE PAYMENT FOR SERVICES AND ASSURANCES OF QUALITY. THE COMMISSIONER
37 SHALL REQUIRE SUBMISSION TO THE PROGRAM MANAGEMENT ENTITY OF PERIODIC
38 UPDATES OF PAYMENTS MADE TOWARD FULFILLING THE PLEDGE AND REVIEW OF SUCH
39 PAYMENTS BY THE PROGRAM MANAGEMENT ENTITY FOR ELIGIBILITY. THE PROGRAM
40 MANAGEMENT ENTITY SHALL ADVISE THE PARTICIPANT OF ANY INELIGIBILITY OF
41 ANY SUCH PAYMENTS.
42 6. THE COMMISSIONER SHALL ESTABLISH A SEAMLESS PROCESS FOR TRANSITION
43 OF AN INDIVIDUAL FROM PARTICIPANT TO BENEFICIARY WHEN SUCH INDIVIDUAL
44 HAS FULFILLED THE REQUIREMENTS ESTABLISHED PURSUANT TO THIS TITLE. SUCH
45 SEAMLESS PROCESS MAY INCLUDE, FOR EXAMPLE, APPLICATION TO RECEIVE THE
46 PUBLIC SUBSIDY AS A BENEFICIARY AT THE SAME TIME THAT THE INDIVIDUAL
47 ENROLLS AS A PARTICIPANT IN THE COMPACT, SO THAT WHEN THE PLEDGE IS
48 FULFILLED, THE INDIVIDUAL AUTOMATICALLY TRANSITIONS TO THE STATUS OF
49 BENEFICIARY ELIGIBLE FOR THE COMPACT SUBSIDY. INSOFAR AS FEASIBLE, THE
50 TRANSITION SHOULD BE MANAGED BY THE PROGRAM MANAGEMENT ENTITY.
51 S 267. BENEFITS OF PARTICIPATION. 1. A BENEFICIARY WHO FULFILLS THE
52 PLEDGE SHALL BE ENTITLED TO PRESERVE HIS OR HER RESOURCES AND SHALL BE
53 ELIGIBLE TO RECEIVE THE COMPACT SUBSIDY.
54 2. A BENEFICIARY SHALL NOT BE REQUIRED TO SUBMIT TO RESOURCE REQUIRE-
55 MENTS OR LIMITATIONS, OR TO THE RECOVERY OF PAYMENTS MADE BY THE STATE
56 FROM THE ESTATES OF SUCH INDIVIDUALS, OR TO THE IMPOSITION OF LIENS ON
S. 2185 8
1 THE HOMES OF PERSONS, SUCH AS THOSE WHICH ARE IMPOSED ON BENEFICIARIES
2 OF THE MEDICAID PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-SIX OR
3 SECTION THREE HUNDRED SIXTY-NINE OF THE SOCIAL SERVICES LAW, UNLESS
4 OTHERWISE PROVIDED IN OR PURSUANT TO THIS TITLE.
5 3. A BENEFICIARY SHALL BE ELIGIBLE TO HAVE THE SUBSIDY PAID TO THE
6 PROVIDER OF SERVICES FOR THE COSTS OF QUALIFIED LONG TERM CARE SERVICES
7 FROM ANY WILLING PROVIDER SELECTED BY SUCH BENEFICIARY.
8 4. A BENEFICIARY SHALL BE ELIGIBLE TO RECEIVE QUALIFIED LONG TERM CARE
9 SERVICES AT A RATE CHARGED BY A PROVIDER OF SERVICES WHICH IS NO GREATER
10 THAN THE COMPACT RATE.
11 5. A BENEFICIARY SHALL NOT BE RESPONSIBLE FOR PAYMENT FOR SUCH QUALI-
12 FIED LONG TERM CARE SERVICES OF ANY AMOUNT GREATER THAN THE DIFFERENCE
13 BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY.
14 6. A BENEFICIARY SHALL ANNUALLY REMIT A PARTICIPATION FEE TO MAINTAIN
15 ELIGIBILITY IN THE COMPACT, EQUAL TO TWENTY-FIVE PERCENT OF SUCH BENEFI-
16 CIARY'S COUNTABLE INCOME. SUCH FEE SHALL BE REMITTED TO THE COMMISSION-
17 ER OR, IF SO DIRECTED BY THE COMMISSIONER, TO THE PROGRAM MANAGEMENT
18 ENTITY FOR TRANSMITTAL TO THE COMMISSIONER. THE COMMISSIONER, AFTER
19 CONSULTATION WITH THE ADVISORY COMMITTEE, SHALL MAKE PROVISION TO ALLOW
20 A BENEFICIARY TO MAKE PAYMENTS ON A MONTHLY OR OTHER BASIS, AT THE
21 OPTION OF THE BENEFICIARY.
22 7. A BENEFICIARY SHALL RETAIN A PROTECTED AMOUNT OF INCOME DURING THE
23 PERIOD IN WHICH THE BENEFICIARY IS RECEIVING THE COMPACT SUBSIDY, AS SET
24 FORTH IN THIS TITLE.
25 8. A BENEFICIARY SHALL BE ELIGIBLE TO HAVE THE ANNUAL COMPACT SUBSIDY
26 PAID FOR NON-INSTITUTIONAL SERVICES FROM ONE OR MORE PROVIDERS FOR UP TO
27 AN AMOUNT THAT IS LESS THAN OR EQUAL TO THE ANNUAL REGIONAL MEDICAID
28 RATE COMPUTED FOR NURSING HOME SERVICES FOR THE REGION IN WHICH THE
29 BENEFICIARY RESIDES.
30 S 268. PROTECTED INCOME. 1. THE COMMISSIONER, AFTER CONSULTATION WITH
31 THE ADVISORY COMMITTEE, SHALL ESTABLISH PROVISIONS TO WAIVE ALL OR PART
32 OF THE PARTICIPATION FEE AND ALL OR PART OF THE REQUIREMENT THAT A BENE-
33 FICIARY PAY ANY DIFFERENCE BETWEEN THE COMPACT RATE AND THE COMPACT
34 SUBSIDY IF THE BENEFICIARY'S COUNTABLE INCOME IN ANY MONTH, AFTER
35 DEDUCTION OF THE PARTICIPATION FEE AND PAYMENT OF THE DIFFERENCE BETWEEN
36 THE COMPACT RATE AND THE COMPACT SUBSIDY AMOUNT WHICH THE BENEFICIARY IS
37 REQUIRED TO PAY FOR SERVICES, SHALL BE LESS THAN THE FOLLOWING PROTECTED
38 INCOME AMOUNTS:
39 (A) FOR AN UNMARRIED BENEFICIARY RECEIVING CARE IN AN INSTITUTIONAL
40 SETTING SUCH AS A NURSING HOME, ADULT HOME, ASSISTED LIVING FACILITY OR
41 OTHER SIMILAR FACILITY, AN AMOUNT EQUAL TO THE INSTITUTIONAL PROTECTED
42 AMOUNT;
43 (B) FOR AN UNMARRIED BENEFICIARY RECEIVING CARE AT HOME, AN AMOUNT
44 EQUAL TO THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE;
45 (C) FOR A MARRIED COUPLE OF WHOM ONE IS A BENEFICIARY RECEIVING CARE
46 IN AN INSTITUTIONAL SETTING SUCH AS A NURSING HOME, ADULT HOME, ASSISTED
47 LIVING FACILITY OR OTHER SIMILAR FACILITY, AN AMOUNT EQUAL TO THE INSTI-
48 TUTIONAL PROTECTED AMOUNT FOR THE BENEFICIARY AND AN AMOUNT EQUAL TO THE
49 MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE FOR THE SPOUSE WHO IS NOT A
50 BENEFICIARY;
51 (D) FOR A MARRIED COUPLE OF WHOM ONE IS A BENEFICIARY RECEIVING CARE
52 AT HOME, AN AMOUNT EQUAL TO ONE AND ONE-HALF TIMES THE MINIMUM MONTHLY
53 MAINTENANCE NEEDS ALLOWANCE;
54 (E) FOR A MARRIED COUPLE, BOTH OF WHOM ARE BENEFICIARIES RECEIVING
55 CARE IN AN INSTITUTIONAL SETTING SUCH AS A NURSING HOME, ADULT HOME,
S. 2185 9
1 ASSISTED LIVING FACILITY OR OTHER SIMILAR FACILITY, AN AMOUNT EQUAL TO
2 AN INSTITUTIONAL PROTECTED AMOUNT FOR EACH BENEFICIARY; AND
3 (F) FOR A MARRIED COUPLE, BOTH OF WHOM ARE BENEFICIARIES RECEIVING
4 CARE AT HOME, AN AMOUNT EQUAL TO ONE AND ONE-HALF TIMES THE MINIMUM
5 MONTHLY MAINTENANCE NEEDS ALLOWANCE.
6 2. THE COMMISSIONER SHALL ANNUALLY ADJUST SUCH INSTITUTIONAL PROTECTED
7 AMOUNT BY THE PERCENTAGE INCREASE OR DECREASE IN THE COST OF LIVING
8 INDEX, USING THE YEAR IN WHICH THIS TITLE SHALL HAVE BECOME LAW AS THE
9 BASE YEAR.
10 3. AS USED IN THIS SECTION, "MINIMUM MONTHLY MAINTENANCE NEEDS ALLOW-
11 ANCE" HAS THE SAME MEANING AS SUCH TERM IN PARAGRAPH (H) OF SUBDIVISION
12 TWO OF SECTION THREE HUNDRED SIXTY-SIX-C OF THE SOCIAL SERVICES LAW AND
13 "INSTITUTIONAL PROTECTED AMOUNT" MEANS THE SUM OF ONE HUNDRED DOLLARS,
14 WHICH AMOUNT SHALL BE ADJUSTED BY THE COMMISSIONER ANNUALLY BY THE SAME
15 PERCENTAGE AS THE PERCENTAGE INCREASE IN THE FEDERAL CONSUMER PRICE
16 INDEX.
17 4. WHEN MAKING THE COMPUTATION TO DETERMINE IF A BENEFICIARY'S INCOME
18 WOULD FALL BELOW THE APPROPRIATE PROTECTED INCOME AMOUNT, THE COMMIS-
19 SIONER SHALL SUBTRACT FROM THE BENEFICIARY'S MONTHLY COUNTABLE INCOME
20 THE DIFFERENCE BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY THAT THE
21 BENEFICIARY IS REQUIRED TO PAY, AND THEN THE PARTICIPATION FEE. IF THE
22 REMAINING COUNTABLE INCOME AFTER SUCH SUBTRACTION IS LESS THAN THE
23 PROTECTED AMOUNT APPROPRIATE TO SUCH BENEFICIARY, THE COMMISSIONER
24 SHALL, AFTER CONSULTATION WITH THE ADVISORY COMMITTEE, ESTABLISH
25 PROVISIONS FOR: (A) A REDUCTION IN THE AMOUNT OF THE PARTICIPATION FEE
26 TO BE PAID BY THE BENEFICIARY, (B) A REDUCTION IN PAYMENT FOR SERVICES
27 BY THE BENEFICIARY OF ANY DIFFERENCE TO BE PAID BY THE BENEFICIARY
28 BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY, AND (C) THE PERIOD OF
29 TIME DURING WHICH REDUCTION OR REDUCTIONS SHALL BE EFFECTIVE, IN ORDER
30 TO ASSURE THAT THE BENEFICIARY SHALL ALWAYS RETAIN THE PROTECTED AMOUNT
31 OF INCOME. ANY SUCH REDUCTION SHALL NOT BE EFFECTIVE FOR A PERIOD GREAT-
32 ER THAN TWELVE MONTHS IN ANY THIRTY-SIX MONTH PERIOD.
33 5. ANY OTHER PROVISION OF THIS TITLE TO THE CONTRARY NOTWITHSTANDING,
34 THE COMMISSIONER MAY ADDITIONALLY, AFTER CONSULTATION WITH AND UPON
35 RECOMMENDATION OF THE ADVISORY COMMITTEE, ESTABLISH AS AN ADDITIONAL
36 BASIS FOR A REDUCTION OF THE PAYMENT FOR SERVICES BY THE BENEFICIARY OF
37 ANY DIFFERENCE BETWEEN THE COMPACT RATE AND THE COMPACT SUBSIDY AND OF
38 THE PARTICIPATION FEE TO BE PAID BY THE BENEFICIARY, A FINDING THAT A
39 BENEFICIARY LACKS THE RESOURCES AFTER PAYMENT OF NECESSARY EXPENSES TO
40 REMAIN IN HIS OR HER PLACE OF RESIDENCE AFTER PAYMENT OF SUCH PARTIC-
41 IPATION FEE AND/OR PAYMENT FOR SERVICES, IRRESPECTIVE OF WHETHER THE
42 BENEFICIARY'S COUNTABLE INCOME EXCEEDS THE PROTECTED INCOME AMOUNT. THE
43 ADVISORY COMMITTEE SHALL PROVIDE THE COMMISSIONER WITH A DEFINITION OF
44 NECESSARY EXPENSES AS USED IN THIS SECTION PRIOR TO THE COMMISSIONER
45 TAKING ANY ACTION AUTHORIZED BY THIS SUBDIVISION. INSOFAR AS PRACTICA-
46 BLE, SUCH DEFINITION SHALL BE QUANTIFIABLE, AND THE COMMISSIONER SHALL
47 ESTABLISH A FORMULA BY RULE AND REGULATION FOR DETERMINING NECESSARY
48 EXPENSES BASED ON SUCH DEFINITION AND FOR DETERMINING WHETHER A BENEFI-
49 CIARY LACKS THE RESOURCES AFTER PAYMENT OF SUCH NECESSARY EXPENSES TO
50 REMAIN IN HIS OR HER PLACE OF RESIDENCE.
51 S 269. IMPOSITION OF LIEN IN CERTAIN CASES. NOTHING CONTAINED IN THIS
52 TITLE SHALL PREVENT THE IMPOSITION OF A LIEN OR RECOVERY AGAINST THE
53 PROPERTY OF AN INDIVIDUAL ON ACCOUNT OF EXPENSES INCORRECTLY PAID UNDER
54 THE COMPACT SUBSIDY.
S. 2185 10
1 S 270. PROHIBITED ACTS. NO PERSON ENGAGED IN THE DEVELOPMENT, MARKET-
2 ING, ADVERTISING OR SALE OF ANY INSURANCE PLAN DESIGNED TO SATISFY THE
3 PLEDGE AMOUNT SHALL:
4 1. GIVE LEGAL ADVICE OR OTHERWISE ENGAGE IN THE PRACTICE OF LAW.
5 2. ASSUME, USE OR ADVERTISE THE TITLE OF LAWYER OR ATTORNEY AT LAW, OR
6 EQUIVALENT TERMS IN THE ENGLISH LANGUAGE OR ANY OTHER LANGUAGE, OR
7 REPRESENT OR ADVERTISE OTHER TITLES OR CREDENTIALS, INCLUDING BUT NOT
8 LIMITED TO "NOTARY PUBLIC", "ACCREDITED REPRESENTATIVE OF THE DEPARTMENT
9 OF HEALTH" OR "COMPACT CONSULTANT", THAT COULD CAUSE AN INDIVIDUAL TO
10 BELIEVE THAT THE PERSON POSSESSES SPECIAL PROFESSIONAL SKILLS OR IS
11 AUTHORIZED TO PROVIDE ADVICE ON MATTERS RELATED TO THE COMPACT; PROVIDED
12 THAT A NOTARY PUBLIC LICENSED BY THE SECRETARY OF STATE MAY USE THE
13 TITLE "NOTARY PUBLIC".
14 3. STATE OR IMPLY THAT THE PERSON CAN OR WILL OBTAIN SPECIAL FAVORS
15 FROM OR HAS SPECIAL INFLUENCE WITH THE DEPARTMENT OF HEALTH, THE ADMIN-
16 ISTRATIVE ENTITY OR ANY OTHER GOVERNMENTAL ENTITY.
17 4. DEMAND OR RETAIN ANY FEES OR COMPENSATION FOR SERVICES NOT
18 PERFORMED OR COSTS THAT ARE NOT ACTUALLY INCURRED.
19 5. ADVISE, DIRECT OR PERMIT A CUSTOMER TO ANSWER QUESTIONS ON A
20 GOVERNMENT DOCUMENT, OR IN A DISCUSSION WITH A GOVERNMENT OFFICIAL, IN A
21 SPECIFIC WAY WHERE SUCH PERSON KNOWS OR HAS REASONABLE CAUSE TO BELIEVE
22 THAT THE ANSWERS ARE FALSE OR MISLEADING.
23 6. DISCLOSE ANY INFORMATION TO, OR FILE ANY FORMS OR DOCUMENTS WITH
24 THE DEPARTMENT OF HEALTH, ANY OTHER STATE DEPARTMENT OR THE ADMINISTRA-
25 TIVE ENTITY WITHOUT THE KNOWLEDGE OR CONSENT OF THE CUSTOMER.
26 7. FAIL TO PROVIDE AN INDIVIDUAL WITH COPIES OF DOCUMENTS FILED WITH A
27 GOVERNMENTAL ENTITY OR REFUSE TO RETURN ORIGINAL DOCUMENTS SUPPLIED BY,
28 PREPARED ON BEHALF OF OR PAID FOR BY THE INDIVIDUAL, UPON THE REQUEST OF
29 THE INDIVIDUAL. ORIGINAL DOCUMENTS MUST BE RETURNED PROMPTLY UPON
30 REQUEST, EVEN IF THERE IS A FEE DISPUTE WITH THE INDIVIDUAL.
31 8. MAKE ANY MISREPRESENTATION OR FALSE STATEMENT, DIRECTLY OR INDI-
32 RECTLY.
33 9. MAKE ANY GUARANTEE OR PROMISE TO AN INDIVIDUAL, UNLESS THERE IS A
34 BASIS IN FACT FOR SUCH REPRESENTATION, AND THE GUARANTEE OR PROMISE IS
35 IN WRITING.
36 S 271. FRAUDULENT PRACTICES. 1. ANY APPLICANT WHO IS FOUND BY THE
37 COMMISSIONER, AFTER NOTICE AND A HEARING, TO HAVE KNOWINGLY MADE A FALSE
38 STATEMENT OR REPRESENTATION CONCERNING A FACT MATERIAL TO THE FULFILLING
39 OF A PLEDGE AMOUNT, AS PROVIDED IN THIS ARTICLE, OR DELIBERATELY
40 CONCEALED SUCH A FACT, SHALL BE DISQUALIFIED FROM THE COMPACT PROGRAM
41 PROVIDED FOR IN THIS ARTICLE. SUCH INDIVIDUAL SHALL NOT BE DEEMED TO BE
42 A PARTICIPANT OR BENEFICIARY OR TO HAVE FULFILLED HIS OR HER PLEDGE
43 AMOUNT, BUT SHALL NOT SURRENDER HIS OR HER ELIGIBILITY TO APPLY FOR
44 MEDICAID.
45 2. NO PERSON SHALL KNOWINGLY MAKE A FALSE STATEMENT OR REPRESENTATION
46 OF A MATERIAL FACT, OR DELIBERATELY CONCEAL A MATERIAL FACT, OR OTHER-
47 WISE SEEK BENEFITS BY IMPERSONATION OR OTHER FRAUDULENT DEVICE, IN THEIR
48 WRITTEN APPLICATION FOR BENEFITS UNDER THIS TITLE.
49 3. NO PERSON SHALL, WITH INTENT TO DEFRAUD, PRESENT FOR ALLOWANCE OR
50 PAYMENT ANY FRAUDULENT CLAIM FOR FURNISHING SERVICES OR MERCHANDISE
51 UNDER THIS TITLE, OR KNOWINGLY SUBMIT FALSE INFORMATION FOR THE PURPOSE
52 OF OBTAINING GREATER COMPENSATION THAN THAT TO WHICH SUCH INDIVIDUAL IS
53 LEGALLY ENTITLED FOR FURNISHING SERVICES OR MERCHANDISE UNDER THIS
54 TITLE, OR KNOWINGLY SUBMIT FALSE INFORMATION FOR THE PURPOSE OF OBTAIN-
55 ING AUTHORIZATION FOR FURNISHING SERVICES OR MERCHANDISE UNDER THIS
56 TITLE.
S. 2185 11
1 4. ANY PERSON WHO RECEIVES A BENEFIT PROVIDED FOR UNDER THIS TITLE
2 BASED UPON AN APPLICATION WHICH VIOLATES SUBDIVISION TWO OR THREE OF
3 THIS SECTION SHALL BE GUILTY OF A CLASS A MISDEMEANOR. SUCH A FINDING
4 SHALL NOT PREVENT AN ACTION TO RECOVER THE VALUE OF THE BENEFIT PROVIDED
5 FOR UNDER THIS TITLE AGAINST THE INDIVIDUAL FOUND TO HAVE VIOLATED THIS
6 SECTION.
7 S 271-A. PAYMENTS AND DEFAULTS. 1. PAYMENTS TO SERVICE PROVIDERS FOR
8 SERVICES PROVIDED TO PARTICIPANTS SHALL BE MADE BY OR ON BEHALF OF
9 PARTICIPANTS OR A PERSON OR ENTITY ACTING ON BEHALF OF THE PARTICIPANT.
10 2. PAYMENTS TO SERVICE PROVIDERS FOR SERVICES PROVIDED TO BENEFICI-
11 ARIES SHALL BE MADE BY THE PROGRAM MANAGEMENT ENTITY. A BENEFICIARY
12 SHALL BE RESPONSIBLE TO PAY ANY DIFFERENCE BETWEEN THE COMPACT RATE AND
13 THE COMPACT SUBSIDY TO THE PROGRAM MANAGEMENT ENTITY. PAYMENTS TO
14 SERVICES PROVIDERS SHALL BE MADE NO LESS FREQUENTLY THAN PAYMENTS TO
15 PROVIDERS BY MEDICAID PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN OF
16 THE SOCIAL SERVICES LAW.
17 3. A BENEFICIARY WHO KNOWINGLY FAILS TO PAY THE DIFFERENCE BETWEEN THE
18 COMPACT RATE AND THE COMPACT SUBSIDY AS REQUIRED IN THIS TITLE, UNLESS
19 SUCH BENEFICIARY IS EXCUSED PURSUANT TO THE HARDSHIP PROVISIONS OF THIS
20 TITLE, SHALL BE LIABLE TO THE PROGRAM MANAGEMENT ENTITY, WHICH MAY EXER-
21 CISE ANY AND ALL APPROPRIATE REMEDIES FOR COLLECTION OF THE DEBT. A
22 DEBT UNPAID FOR A PERIOD OF NINETY DAYS, EXCEPT IN THE CASE IN WHICH
23 HARDSHIP HAS BEEN DETERMINED, SHALL RESULT IN SUCH BENEFICIARY BEING
24 DECLARED IN DEFAULT AND NO LONGER ENROLLED IN THE COMPACT.
25 4. A PARTICIPANT WHO HAS FULFILLED HIS OR HER PLEDGE SHALL BE PRESUMED
26 ELIGIBLE TO RECEIVE SERVICES AS A BENEFICIARY FOR A PERIOD OF SIXTY DAYS
27 FROM THE DATE OF DETERMINATION. IF A PARTICIPANT DETERMINED TO BE
28 PRESUMPTIVELY ELIGIBLE TO RECEIVE THE COMPACT SUBSIDY AS A BENEFICIARY
29 IS SUBSEQUENTLY DETERMINED TO BE INELIGIBLE FOR SUCH ASSISTANCE, THE
30 COMMISSIONER MAY RECOUP FROM SUCH INDIVIDUAL ANY SUMS EXPENDED FOR
31 ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
32 5. A PARTICIPANT WHO KNOWINGLY DEFAULTS ON PAYMENT OF THE PLEDGE, OR A
33 BENEFICIARY WHO KNOWINGLY DEFAULTS ON PAYMENT OF THE DIFFERENCE BETWEEN
34 THE COMPACT RATE AND THE COMPACT SUBSIDY, AND WHO IS THEREFORE NO LONGER
35 ENROLLED IN THE PROGRAM, SHALL NOT BE ELIGIBLE TO RECEIVE PROTECTION OF
36 ASSETS OR INCOME OTHERWISE AFFORDED TO PARTICIPANTS AND BENEFICIARIES
37 UNDER THE COMPACT. NOTHING CONTAINED IN THIS TITLE SHALL BE DEEMED TO
38 SHIELD OR OTHERWISE EXCUSE A BENEFICIARY OR A PARTICIPANT FROM PAYMENT
39 OF A DEBT LAWFULLY INCURRED TO A SERVICE PROVIDER.
40 6. UPON RECOMMENDATION OF THE ADVISORY COMMITTEE, THE COMMISSIONER MAY
41 ESTABLISH RULES, INCLUDING REQUIREMENTS FOR WRITTEN AGREEMENTS, GOVERN-
42 ING THE PAYMENT AND COLLECTION OF DEBT BY PARTICIPANTS AND BENEFICIARIES
43 TO SERVICE PROVIDERS AND TO THE PROGRAM MANAGEMENT ENTITY AS WELL AS
44 NOTIFICATION GUIDELINES TO THE BENEFICIARY, OR A PERSON OR ENTITY ACTING
45 ON BEHALF OF THE BENEFICIARY TO ENSURE THAT PAYMENTS MISSED IN ERROR CAN
46 BE CORRECTED WITHOUT PUNISHMENT TO THE BENEFICIARY.
47 S 272. APPEALS. 1. ANY PERSON OR AN INDIVIDUAL AUTHORIZED TO ACT ON
48 BEHALF OF ANY SUCH PERSON MAY APPEAL TO THE COMMISSIONER FROM DECISIONS
49 OF THE PROGRAM MANAGEMENT ENTITY UPON GROUNDS SPECIFIED IN THIS SECTION.
50 ANY APPEAL PURSUANT TO THIS SECTION SHALL BE REQUESTED WITHIN SIXTY DAYS
51 AFTER THE DATE OF THE ACTION OR FAILURE TO ACT COMPLAINED OF.
52 2. THE COMMISSIONER SHALL SPECIFY THE GROUNDS AND THE FORUM FOR SUCH
53 APPEALS IN REGULATIONS.
54 (A) SUCH GROUNDS AND FORUMS SHALL INCLUDE PROVISION OF FAIR HEARING
55 FOR THE FOLLOWING AND SIMILAR ISSUES: (I) COMPUTATION OF THE VALUE OF
56 ASSETS OR INCOME; (II) WHETHER EXPENSES ARE ELIGIBLE EXPENSES FOR
S. 2185 12
1 PAYMENT OF THE PLEDGE, AND WHETHER THE PLEDGE WAS FULFILLED; (III)
2 AMOUNT OF PARTICIPATION FEE OR CO-PAY; (IV) DENIAL OF PAYMENT FOR A
3 SERVICE PROVIDED TO A BENEFICIARY.
4 (B) SUCH GROUNDS AND FORUMS SHALL ALSO INCLUDE PROVISION FOR THIRD
5 PARTY REVIEW AND ARBITRATION FOR SUCH ISSUES AS: (I) THE ASSESSMENT AND
6 PLAN OF CARE; (II) PAYMENTS TO PROVIDERS; AND (III) QUALITY OF PROVIDER
7 SERVICES.
8 3. DECISIONS OF THE COMMISSIONER PURSUANT TO THIS SECTION SHALL BE
9 BINDING UPON THE PROGRAM MANAGEMENT ENTITY. SUCH GROUNDS FOR APPEAL
10 SHALL NOT INCLUDE DENIALS FOR ISSUES AND CIRCUMSTANCES RELATED TO THE
11 LANGUAGE, PROCESSING OR APPROVAL OF COVERAGE UNDER A LONG TERM CARE
12 INSURANCE POLICY WHICH ARE OTHERWISE THE SUBJECT OF EXTERNAL APPEALS OF
13 ADVERSE DETERMINATIONS OF HEALTH CARE PLANS PURSUANT TO SECTIONS TWO
14 HUNDRED ONE, THREE HUNDRED ONE, ELEVEN HUNDRED NINE, THIRTY-TWO HUNDRED
15 ONE, THIRTY-TWO HUNDRED SIXTEEN, THIRTY-TWO HUNDRED SEVENTEEN,
16 THIRTY-TWO HUNDRED SEVENTEEN-A, THIRTY-TWO HUNDRED TWENTY-ONE, FORTY-TWO
17 HUNDRED THIRTY-FIVE, FORTY-THREE HUNDRED THREE, FORTY-THREE HUNDRED
18 FOUR, FORTY-THREE HUNDRED FIVE, FORTY-THREE HUNDRED TWENTY-ONE,
19 FORTY-THREE HUNDRED TWENTY-TWO AND FORTY-THREE HUNDRED TWENTY-FOUR,
20 ARTICLE FORTY-SEVEN AND ARTICLE FORTY-NINE OF THE INSURANCE LAW AND
21 CHAPTER FIVE HUNDRED EIGHTY-SIX OF THE LAWS OF NINETEEN HUNDRED NINETY-
22 EIGHT.
23 4. ANY AGGRIEVED PARTY TO AN APPEAL, OTHER THAN THE PROGRAM MANAGEMENT
24 ENTITY, MAY APPLY FOR REVIEW AS PROVIDED IN ARTICLE SEVENTY-EIGHT OF THE
25 CIVIL PRACTICE LAW AND RULES.
26 S 273. TREATMENT OF ASSETS. 1. A PARTICIPANT'S HOMESTEAD SHALL NOT BE
27 DEEMED A COUNTABLE ASSET IF THE HOMESTEAD WAS PURCHASED MORE THAN FIVE
28 YEARS PRIOR TO THE DATE THAT AN INDIVIDUAL APPLIES TO BECOME A PARTIC-
29 IPANT IN THE COMPACT. A HOMESTEAD PURCHASED WITHIN FIVE YEARS OF SUCH
30 DATE SHALL BE DEEMED A COUNTABLE ASSET, UNLESS SUCH HOMESTEAD IS A
31 REPLACEMENT FOR A HOMESTEAD SOLD WITHIN ONE YEAR PRIOR TO THE PURCHASE
32 DATE, IN WHICH CASE AN AMOUNT EQUAL TO THE DIFFERENCE BETWEEN THE SALE
33 PRICE OF THE OLD HOMESTEAD AND THE PURCHASE PRICE OF THE NEW HOMESTEAD
34 SHALL BE DEEMED A COUNTABLE ASSET. AS USED IN THIS SECTION, "HOMESTEAD"
35 MEANS THE PRIMARY RESIDENCE OCCUPIED BY A BENEFICIARY OR PARTICIPANT
36 AND/OR MEMBERS OF HIS OR HER FAMILY. FAMILY MEMBERS MAY INCLUDE THE
37 BENEFICIARY'S OR PARTICIPANT'S SPOUSE, MINOR CHILDREN, CERTIFIED BLIND
38 OR CERTIFIED DISABLED CHILDREN, A CARETAKER CHILD, AND OTHER DEPENDENT
39 RELATIVES. HOMESTEAD SHALL BE DEEMED TO MEAN AND INCLUDE THE HOME, LAND
40 AND INTEGRAL PARTS SUCH AS GARAGES AND OUTBUILDINGS, AND MAY BE A CONDO-
41 MINIUM, COOPERATIVE APARTMENT OR MANUFACTURED HOME. HOMESTEAD SHALL NOT
42 BE DEEMED TO MEAN AND INCLUDE VACATION HOMES, SUMMER HOMES OR OTHER
43 PREMISES NOT USED AS A PRIMARY RESIDENCE. THE FOREGOING TO THE CONTRARY
44 NOTWITHSTANDING, TO THE EXTENT THAT A HOMESTEAD PURCHASED MORE THAN FIVE
45 YEARS PRIOR TO THE DATE THAT AN INDIVIDUAL APPLIES TO BECOME A PARTIC-
46 IPANT IN THE COMPACT IS DEEMED A RESOURCE UNDER THE RULES OF THE PART-
47 NERSHIP FOR LONG-TERM CARE ESTABLISHED PURSUANT TO SECTION THREE HUNDRED
48 SIXTY-SEVEN-F OF THE SOCIAL SERVICES LAW, IT SHALL ALSO BE DEEMED A
49 RESOURCE UNDER THE COMPACT.
50 2. ANY OTHER PROVISION OF ANY OTHER LAW OR OF THIS TITLE TO THE
51 CONTRARY NOTWITHSTANDING, THE COMMISSIONER, ACTING ON RECOMMENDATION OF
52 THE ADVISORY COMMITTEE, MAY EXEMPT CERTAIN INCOME AND RESOURCES OF AN
53 INDIVIDUAL AND OF THE INDIVIDUAL'S SPOUSE FROM INCLUSION AS A COUNTABLE
54 ASSET.
55 3. (A) WITH RESPECT TO ANNUITIES, (I) THE PRINCIPAL AMOUNT OF ANY
56 ANNUITY SHALL BE DEEMED A COUNTABLE ASSET IF SUCH ANNUITY IN PERMANENT
S. 2185 13
1 PAYOUT STATUS WAS PURCHASED WITHIN FIVE YEARS OF THE DATE AN INDIVIDUAL
2 APPLIES TO BECOME A PARTICIPANT, PROVIDED HOWEVER THAT ANY PAYOUT
3 AMOUNTS SHALL NOT BE TREATED AS INCOME FOR PURPOSES OF THE INCOME CALCU-
4 LATION; (II) THE PRINCIPAL AMOUNT OF ANY ANNUITY SHALL NOT BE DEEMED A
5 COUNTABLE ASSET IF A LEVEL PAYMENT SCHEDULE HAS BEEN IN FORCE FOR THREE
6 YEARS OR MORE PRIOR TO THE DATE AN INDIVIDUAL APPLIES TO BECOME A
7 PARTICIPANT, AND NEITHER THE INDIVIDUAL NOR A PERSON ACTING ON SUCH
8 INDIVIDUAL'S BEHALF HAS THE ABILITY TO WITHDRAW AMOUNTS IN EXCESS OF
9 SCHEDULED PAYMENTS, PROVIDED HOWEVER THAT IN SUCH CASE, ANY PAYOUT
10 AMOUNTS SHALL BE COUNTED AS INCOME FOR PURPOSES OF THE INCOME CALCU-
11 LATION; AND (III) AN ANNUITY NOT IN PERMANENT PAYOUT STATUS FOR FIVE
12 YEARS PRIOR TO THE DATE AN INDIVIDUAL APPLIES TO BECOME A PARTICIPANT IN
13 THE COMPACT PROGRAM SHALL BE DEEMED A COUNTABLE ASSET.
14 (B) THE VALUE OF AN ASSET TRANSFERRED INTO AN IRREVOCABLE TRUST FOR
15 LESS THAN FULL CONSIDERATION WITHIN FIVE YEARS PRIOR TO THE DATE OF
16 APPLICATION TO THE COMPACT PROGRAM SHALL BE DEEMED A COUNTABLE ASSET.
17 (C) PRE-PAID FUNERALS PURCHASED FOR AN INDIVIDUAL WHO BECOMES A
18 PARTICIPANT OR A BENEFICIARY, A SPOUSE OR FOR CHILDREN WITH DISABILITIES
19 SHALL NOT BE INCLUDED AS A COUNTABLE ASSET, IF MADE PRIOR TO THE DATE ON
20 WHICH THE PARTICIPANT FULFILLS THE PLEDGE AMOUNT.
21 (D) THE VALUE OF ANY DEBTS, INCLUDING BUT NOT LIMITED TO OUTSTANDING
22 DEBT ON CREDIT CARDS, AUTO PAYMENTS, MONTHLY MORTGAGE PAYMENTS, HOME
23 EQUITY LOANS, REVERSE MORTGAGES AND ANY OTHER SUCH SIMILAR DEBT INSTRU-
24 MENTS SHALL BE DEDUCTED WHEN CALCULATING THE TOTAL VALUE OF COUNTABLE
25 ASSETS.
26 (E) THE PRINCIPAL AMOUNT OF A MORTGAGE ON A HOMESTEAD SHALL NOT BE
27 DEDUCTED IF THE HOMESTEAD IS NOT DEEMED A COUNTABLE ASSET, PROVIDED
28 HOWEVER THAT PAYMENTS MADE TO REDUCE OR ELIMINATE ANY SUCH MORTGAGE
29 SHALL BE DEDUCTED WHEN CALCULATING THE TOTAL VALUE OF COUNTABLE ASSETS.
30 IF THE HOMESTEAD IS DEEMED A COUNTABLE ASSET, THE PRINCIPAL AMOUNT OF
31 THE MORTGAGE SHALL BE DEDUCTED WHEN CALCULATING THE TOTAL VALUE OF
32 COUNTABLE ASSETS.
33 (F) IN ADDITION TO THE FOREGOING, THE FOLLOWING SHALL NOT BE CONSID-
34 ERED AS INCOME OR ASSETS:
35 (I) ANY GIFT OR GIFTS MADE BY AN INDIVIDUAL OR AN INDIVIDUAL'S SPOUSE
36 THAT TOTAL LESS THAN TWELVE THOUSAND DOLLARS IN ANY CALENDAR YEAR. THE
37 COMMISSIONER SHALL ANNUALLY ADJUST SUCH AMOUNT BY THE SAME PERCENTAGE AS
38 THE PERCENTAGE INCREASE IN THE FEDERAL CONSUMER PRICE INDEX;
39 (II) EXPENDITURES TO AN EDUCATIONAL INSTITUTION OR MEDICAL FACILITY ON
40 BEHALF OF A SPOUSE OR CHILD, PROVIDED HOWEVER THAT THESE SHALL BE
41 REASONABLE EXPENDITURES FOR THE PURPOSE OF MEDICAL TREATMENT OR EDUCA-
42 TION;
43 (III) GIFTS THAT QUALIFY AS A CHARITABLE DEDUCTION ON THE INDIVIDUAL'S
44 FEDERAL INCOME TAX RETURN; AND
45 (IV) THE AMOUNT RECEIVED FROM A REVERSE MORTGAGE IF EXPENDED WITHIN
46 THIRTY DAYS OF THE TIME IN WHICH RECEIVED. AN AMOUNT FROM A REVERSE
47 MORTGAGE THAT IS HELD FOR LONGER THAN SUCH THIRTY DAY PERIOD SHALL BE
48 CONSIDERED AS COUNTABLE INCOME, UNLESS USED FOR THE PURCHASE OF LONG
49 TERM CARE SERVICES AS DEFINED IN THIS TITLE.
50 (G) THE COMMISSIONER, AFTER CONSULTING WITH THE ADVISORY COMMITTEE,
51 SHALL ESTABLISH CRITERIA TO DETERMINE WHETHER EXPENDITURES AND GIFTS
52 MADE PURSUANT TO THIS SUBDIVISION ARE DISALLOWABLE TRANSACTIONS.
53 S 274. SPECIAL PROVISIONS REGARDING COUPLES. 1. THE REQUIREMENTS OF
54 THIS TITLE CONCERNING DISCLOSURE OF ASSETS SHALL BE DEEMED TO MEAN AND
55 INCLUDE DISCLOSURE OF ALL ASSETS, INCLUDING ALL ASSETS OF A MARRIED
56 COUPLE, WITHOUT DISTINCTION AS TO OWNERSHIP BY OR BETWEEN SPOUSES.
S. 2185 14
1 NOTWITHSTANDING THE FOREGOING, IF THERE IS A PRE OR POST-NUPTIAL AGREE-
2 MENT WHICH HAS BEEN EFFECTIVE THREE OR MORE YEARS PRIOR TO THE DATE OF
3 ENROLLMENT IN THE COMPACT PROGRAM, THE VALUE OF THE ASSETS OF THE SPOUSE
4 NOT ENROLLED IN THE COMPACT SHALL NOT BE DEEMED A COUNTABLE ASSET AND
5 SHALL NOT REQUIRE DISCLOSURE TO THE COMMISSIONER OR PROGRAM MANAGEMENT
6 ENTITY.
7 2. IF ONE SPOUSE ENROLLS IN THE COMPACT PROGRAM AND THE OTHER DOES
8 NOT, AND
9 (A) THE ENROLLING SPOUSE BECOMES A BENEFICIARY AFTER MEETING THE MAXI-
10 MUM PLEDGE AMOUNT, THE COUPLE'S ASSETS SHALL BE EXEMPT FROM CONSIDER-
11 ATION AS A COUNTABLE ASSET.
12 (B) THE ENROLLING SPOUSE BECOMES A PARTICIPANT PLEDGING A DOLLAR
13 PLEDGE AMOUNT, ONE-HALF OF THE TOTAL VALUE OF THE COUPLE'S ASSETS SHALL
14 BE EXCLUDED FROM CONSIDERATION AS A COUNTABLE ASSET BEFORE ANY OTHER
15 CALCULATIONS AS TO THE AMOUNT REQUIRED TO MEET A DOLLAR PLEDGE AMOUNT.
16 (C) THE NON-ENROLLING SPOUSE SUBSEQUENTLY APPLIES TO BECOME A PARTIC-
17 IPANT IN THE COMPACT, SUCH INDIVIDUAL MAY PLEDGE EITHER THE MAXIMUM
18 PLEDGE AMOUNT OR THE DOLLAR PLEDGE AMOUNT. FOR PURPOSES OF DETERMINING
19 THE DOLLAR PLEDGE AMOUNT IN SUCH CASE, THE COUNTABLE ASSETS OF SUCH
20 INDIVIDUAL SHALL MEAN, BEFORE ANY OTHER CALCULATIONS AS TO THE AMOUNT
21 REQUIRED TO MEET A DOLLAR PLEDGE AMOUNT, AN AMOUNT EQUAL TO FIFTY
22 PERCENT OF THE REMAINING ASSETS OF THE COUPLE LESS ANY AMOUNT STILL
23 REQUIRED TO MEET THE PLEDGE AMOUNT OF THE INITIAL ENROLLING SPOUSE.
24 3. A TRANSFER OR BEQUEST OF A PROTECTED AMOUNT SHALL NOT BE DEEMED A
25 COUNTABLE ASSET OF THE NON-ENROLLING SPOUSE, NOR SHALL INCOME OR GROWTH
26 ON SUCH INCOME BE COUNTED IF SUCH INCOME WAS PART OF A PROTECTED AMOUNT
27 AND HAS BEEN KEPT IN A SEPARATE ACCOUNT. FOR PURPOSES OF THIS SECTION, A
28 PROTECTED AMOUNT IS THE AMOUNT REMAINING AFTER A PLEDGE HAS BEEN MET.
29 4. A SURVIVING SPOUSE WHO APPLIES TO BECOME A PARTICIPANT, OR WHO IS A
30 PARTICIPANT OR BENEFICIARY IN THE COMPACT PROGRAM SHALL NOT BE REQUIRED
31 TO EXERCISE A RIGHT OF ELECTION UNDER SECTION 5-1.1-A OF THE ESTATES,
32 POWERS AND TRUSTS LAW.
33 S 275. ADVISORY COMMITTEE. 1. THE COMMISSIONER SHALL CONVENE AN ADVI-
34 SORY COMMITTEE TO THE COMPACT PROGRAM, CONSISTING OF ELEVEN PERSONS AS
35 FOLLOWS: TWO FROM THE ELDER LAW SECTION OF THE NEW YORK STATE BAR ASSO-
36 CIATION TO INCLUDE THE CHAIR OF SUCH SECTION OR A DESIGNEE APPOINTED BY
37 THE CHAIR WHO SHALL SERVE EX OFFICIO; TWO FROM STATEWIDE ADVOCACY GROUPS
38 PRIMARILY CONCERNED WITH SENIOR ISSUES; FOUR FROM PROVIDERS OF SERVICES,
39 INCLUDING TWO REPRESENTING INSTITUTIONAL PROVIDERS OF SERVICES AND TWO
40 REPRESENTING NON-INSTITUTIONAL PROVIDERS; TWO FROM INSURERS SELLING LONG
41 TERM CARE INSURANCE IN THE STATE WHO SHALL BE PERSONS WITH AT LEAST FIVE
42 YEARS EXPERIENCE IN THE DEVELOPMENT OF LONG TERM CARE INSURANCE PRODUCTS
43 AND WHO ARE OR WHO SHALL HAVE BEEN, SO FAR AS SHALL BE PRACTICABLE, IN
44 EXECUTIVE POSITIONS; AND ONE WITH AT LEAST FIVE YEARS ACTUARIAL EXPERI-
45 ENCE IN LONG TERM CARE INSURANCE MATTERS. MEMBERS SHALL RECEIVE NO
46 COMPENSATION FOR THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND
47 NECESSARY EXPENSES INCURRED IN PERFORMANCE OF THEIR DUTIES HEREUNDER.
48 2. THE PURPOSE OF SUCH ADVISORY COMMITTEE SHALL BE TO PROVIDE ADVICE,
49 CONSULTATION AND RECOMMENDATIONS ON SPECIFIC ISSUES CONCERNING THE
50 COMPACT PROGRAM AND ON THE FURTHER DEVELOPMENT OF THE PROGRAM, INCLUDING
51 BUT NOT LIMITED TO SUCH ISSUES AS THE DEFINITION OF HARDSHIP AND THE
52 TREATMENT OF PERSONS EXPERIENCING HARDSHIP UNDER THE COMPACT, THE TREAT-
53 MENT OF ASSETS OF PERSONS WHO ARE LIVING SEPARATELY BUT NOT DIVORCED,
54 LOSS OF INCOME OR ASSETS AFTER A PARTICIPANT HAS AGREED TO A PLEDGE
55 AMOUNT, SPOUSAL PROTECTIONS, AND ANY OTHER ISSUES WHICH THE COMMISSIONER
56 OR THE ADVISORY COMMITTEE SHALL DEEM NECESSARY OR APPROPRIATE TO THE
S. 2185 15
1 OPERATION OF THE COMPACT. THE ADVISORY COMMITTEE SHALL ADDITIONALLY
2 CONSIDER ISSUES RELATED TO CONTINUITY OF CARE BY PROVIDERS AND ANY
3 ISSUES RELATED TO SHIFTING OR FAILING TO PROVIDE SERVICES OR DROPPING
4 PARTICIPANTS FROM COVERAGE WHEN THEY BECOME BENEFICIARIES. IN PROMULGAT-
5 ING REGULATIONS PURSUANT TO THIS TITLE, THE COMMISSIONER SHALL CONSULT
6 THE ADVISORY COMMITTEE, PROVIDED HOWEVER THAT FAILURE TO RESPOND TIMELY
7 BY THE ADVISORY COMMITTEE SHALL NOT BE DEEMED A DEFECT IN THE PROMULGA-
8 TION OF SUCH REGULATIONS. THE ADVISORY COMMITTEE MAY REQUEST AND SHALL
9 RECEIVE FROM THE COMMISSIONER SUCH DATA AND ANALYSIS, OR MAY MAKE SUCH
10 ANALYSIS OF SUCH DATA, AS SHALL ENABLE IT TO FULFILL ITS MISSION PURSU-
11 ANT TO THIS TITLE.
12 3. THE COMMITTEE SHALL ANNUALLY, OR MORE OFTEN IF THE COMMITTEE SHALL
13 SO DECIDE, REVIEW THE METHODOLOGY FOR SETTING THE AMOUNT OF THE COMPACT
14 SUBSIDY AND SHALL MAKE SUCH RECOMMENDATIONS FOR CHANGE TO THE COMMIS-
15 SIONER AS IT SHALL DEEM APPROPRIATE AND IN KEEPING WITH THE SPIRIT AND
16 INTENT OF THIS TITLE.
17 4. THE COMMITTEE SHALL ANNUALLY, OR MORE OFTEN IF THE COMMITTEE SHALL
18 SO DECIDE, REVIEW THE CONDUCT OF PROVIDERS OF SERVICE TO PARTICIPANTS
19 AND BENEFICIARIES AND MAY RECOMMEND TO THE COMMISSIONER THE ESTABLISH-
20 MENT OF REQUIREMENTS CONCERNING SUCH CONDUCT TO PREVENT ABUSES. IF THE
21 COMMITTEE SHALL MAKE SUCH RECOMMENDATION, THE COMMISSIONER IS HEREBY
22 AUTHORIZED TO AND SHALL PRESCRIBE SUCH REQUIREMENTS BY RULE AND REGU-
23 LATION.
24 5. IN ADDITION TO THE ADVISORY COMMITTEE, THE COMMISSIONER AFTER
25 CONSULTATION WITH THE DIRECTOR SHALL ESTABLISH A TEN MEMBER CONSUMER
26 ISSUES AND INTEGRITY COMMITTEE, WHOSE PURPOSE SHALL BE TO EXAMINE THE
27 IMPLEMENTATION AND EFFECTIVENESS OF THE COMPACT WITH RESPECT TO CONSUMER
28 ISSUES. MEMBERS OF THE COMMITTEE SHALL INCLUDE PERSONS WITH DISABILI-
29 TIES, SENIORS, ADVOCATES FOR PERSONS WITH DISABILITIES AND SENIORS, AND
30 INDIVIDUALS FROM THE ACADEMIC COMMUNITY WITH EXPERTISE IN LONG TERM CARE
31 POLICY, HEALTH POLICY AND SOCIAL POLICY. THE COMMITTEE SHALL ADDRESS
32 ISSUES REFERRED TO IT BY THE COMMISSIONER OR BY THE ADVISORY COMMITTEE,
33 AND MAY ENGAGE IN STUDIES OF ISSUES AT ITS OWN DISCRETION. THE COMMIS-
34 SIONER SHALL DESIGNATE A CHAIR FOR THE COMMITTEE. THE CONSUMER ISSUES
35 AND INTEGRITY COMMITTEE SHALL MEET IN A PUBLIC SETTING AT LEAST FOUR
36 TIMES PER YEAR AND AT SUCH OTHER TIMES AS THE COMMISSIONER OR THE CHAIR
37 OF THE COMMITTEE SHALL DEEM APPROPRIATE.
38 S 276. REQUIREMENT FOR CONFIDENTIALITY. EXCEPT AS OTHERWISE PROVIDED
39 IN THIS SECTION, ALL INFORMATION GATHERED FROM AN INDIVIDUAL SEEKING
40 ENROLLMENT IN THE COMPACT PROGRAM SHALL BE CONFIDENTIAL, WITH THE
41 FOLLOWING EXCEPTIONS:
42 1. REQUESTS FOR INFORMATION BASED UPON LEGITIMATE CRIMINAL JUSTICE
43 PURPOSES, AS SUCH TERM SHALL BE DEFINED IN REGULATION BY THE COMMISSION-
44 ER;
45 2. JUDICIAL SUBPOENAS;
46 3. REQUESTS FOR INFORMATION BY THE VICTIM OR CLAIMANT OR HIS OR HER
47 AUTHORIZED REPRESENTATIVE; AND
48 4. FOR PURPOSES NECESSARY AND PROPER FOR THE ADMINISTRATION OF THIS
49 TITLE.
50 ANY PERSON WHO KNOWINGLY AND INTENTIONALLY PERMITS THE RELEASE OF ANY
51 SUCH DATA AND INFORMATION NOT PERMITTED BY THIS TITLE SHALL BE GUILTY OF
52 A CLASS A MISDEMEANOR. THE COMMISSIONER SHALL PROMULGATE RULES AND REGU-
53 LATIONS INSURING THE TIMELINESS, COMPLETENESS, CONFIDENTIALITY AND
54 DISPOSITION OF SUCH DATA AND INFORMATION.
55 S 277. EDUCATION AND INFORMATION. THE PROGRAM MANAGEMENT ENTITY, IN
56 CONSULTATION WITH THE SUPERINTENDENT OF INSURANCE, THE DIRECTOR AND THE
S. 2185 16
1 COMMISSIONER, IS HEREBY AUTHORIZED AND DIRECTED, WITHIN AMOUNTS APPRO-
2 PRIATED THEREFOR AND OTHER FUNDS MADE AVAILABLE PURSUANT TO THIS
3 SECTION, TO ESTABLISH AN EDUCATION AND OUTREACH PROGRAM CONCERNING THE
4 COMPACT PROGRAM OR TO COORDINATE SUCH EDUCATION AND OUTREACH PROGRAM
5 WITH ANY SIMILAR PUBLICLY SPONSORED PROGRAM FOR THE PURPOSE OF INFORMING
6 AND EDUCATING THE GENERAL PUBLIC OF THE AVAILABILITY AND ADVANTAGES OF
7 THE COMPACT PROGRAM BY MEANS INCLUDING BUT NOT LIMITED TO THE FOLLOWING:
8 EDUCATIONAL AND INFORMATIONAL MATERIALS IN PRINT, AUDIO, VISUAL, ELEC-
9 TRONIC OR OTHER MEDIA; PUBLIC SERVICE ANNOUNCEMENTS, ADVERTISEMENTS,
10 MEDIA CAMPAIGNS, WORKSHOPS, MASS MAILINGS, CONFERENCES OR PRESENTATIONS;
11 ESTABLISHMENT OF A TOLL-FREE TELEPHONE HOTLINE AND ELECTRONIC SERVICES
12 TO PROVIDE INFORMATION; AND MEETINGS CONDUCTED BY ARRANGEMENT WITH THE
13 COMMISSIONER AND THE DIRECTOR WITH ESTATE PLANNERS, ELDER LAW ATTORNEYS
14 AND OTHER PROFESSIONALS CONCERNING LONG TERM CARE INSURANCE, INCLUDING
15 THOSE POLICIES AVAILABLE THROUGH THE PARTNERSHIP FOR LONG TERM CARE
16 PROGRAM. IN EXERCISING ANY POWERS UNDER THIS SECTION, THE PROGRAM
17 MANAGEMENT ENTITY MAY CONSULT WITH APPROPRIATE AGENCIES, ORGANIZATIONS,
18 CONSUMERS AND PROVIDERS OF LONG TERM CARE INSURANCE OR ORGANIZATIONS
19 REPRESENTING THEM. IN ADDITION TO STATE FUNDS APPROPRIATED FOR PROGRAMS
20 UNDER THIS SECTION, THE COMMISSIONER AND THE DIRECTOR MAY ACCEPT FUNDING
21 FROM PUBLIC SOURCES FOR PROGRAMS UNDER THIS SECTION AND MAY UNDERTAKE
22 JOINT OR COOPERATIVE PROGRAMS WITH OTHER PUBLIC AGENCIES OR PRIVATE
23 NOT-FOR-PROFIT CORPORATIONS WHICH ARE NEITHER PROVIDERS NOR REGULATORS
24 OF LONG TERM CARE INSURANCE OR AFFILIATES OR UNITS OF SUCH AGENCIES OR
25 CORPORATIONS.
26 S 2. The insurance law is amended by adding a new section 3229-a to
27 read as follows:
28 S 3229-A. LONG TERM CARE INSURANCE PLANS QUALIFYING TO PROVIDE COVER-
29 AGE UNDER THE NEW YORK STATE COMPACT FOR LONG TERM CARE. ANY OTHER
30 PROVISION OF ANY OTHER LAW TO THE CONTRARY NOTWITHSTANDING, ANY TAX
31 QUALIFIED LONG TERM CARE INSURANCE PLANS MAY BE USED TO MAKE PAYMENTS
32 FOR SERVICES PROVIDED TO ALLOW PARTICIPANTS TO MEET PLEDGE AMOUNTS
33 PURSUANT TO THE NEW YORK STATE COMPACT FOR LONG TERM CARE PROGRAM ESTAB-
34 LISHED PURSUANT TO TITLE FOUR OF ARTICLE TWO OF THE ELDER LAW. THE
35 SUPERINTENDENT SHALL ADDITIONALLY APPROVE INSURANCE PLANS THAT PROVIDE
36 OR INCLUDE TOTAL BENEFITS IN AN AMOUNT WHICH WILL ALLOW THE INDIVIDUAL
37 TO MEET THE PARTICIPATION FEE AND THE CO-PAY REQUIREMENTS OF THE
38 COMPACT. FOR PURPOSES OF THIS SECTION, THE TERM "TAX QUALIFIED" HAS THE
39 SAME MEANING AS UNDER SECTION 7702B(B) OF THE INTERNAL REVENUE CODE OF
40 1986, AS AMENDED.
41 S 3. Severability. If any clause, sentence, paragraph, section or part
42 of this act shall be adjudged by any court of competent jurisdiction to
43 be invalid, such judgment shall not affect, impair or invalidate the
44 remainder thereof, but shall be confined in its operation to the clause,
45 sentence, paragraph, section or part thereof directly involved in the
46 controversy in which such judgment shall have been rendered.
47 S 4. This act shall take effect on the ninetieth day after it shall
48 have become a law.
