Enacts the "people first act of 2014"; defines terms; ensures that individuals with developmental disabilities who utilize long-term care services under the medical assistance program administered by the state have meaningful access to a reasonable array of community-based and institutional program options to ensure the well-being of such individuals.
TITLE OF BILL: An act to amend the mental hygiene law, in relation to enacting the "people first act of 2013"
SUMMARY OF PROVISIONS:
Section one provides for the short title of the bill to be the "People First Act of 2013."
Section two of the bill contains legislative findings.
Section three of the bill amends section 13.15 of the Mental Hygiene Law, in order to require the Commissioner of OPWDD to conduct a geographic analysis of the supports and services in community settings available for individuals ,with developmental disabilities and to identify gaps between required supports and services by region of the state. In addition, the Commissioner is directed to develop a web-based database which will permit the prioritization of the urgency of needs (P.D.N.S.) for supports and services for those facing emergency or immediate need, those facing critical need, defined as additional services and supports with one year and planning need, for those who will require additional services and supports within five years or where the Individual's caregiver is over sixty years old. Annual reporting requirements will allow the Executive and the Legislature make informed policy choices in the delivery of supports and services to people with developmental disabilities.
Section four, of the bill makes technical, amendments. Section five is the effective date of the bill.
JUSTIFICATION: The New York State Department of Health (DOH) in partnership with the Office of People with Developmental Disabilities (OPWDD) proposed a new model for the financing of services for individuals with developmental disabilities to the federal government. The federal government no longer supports NY's current model for financing services and supports for people with developmental disabilities, The current model is based, in significant part, upon allowed costs for institutional placement, which are substantially in excess of actual costs of institutional placement, as institutional capacity has been reduced over the past 30 years, The state and the federal government had previously agreed that as institutional capacity was reduced, the funds otherwise used for institutional placement could follow the individual into the community. The use of these funds allowed NYS to create the current community-based service structure.
The state was authorized in the 2011-12 Enacted. Budget to submit a Medicaid waiver application, which OPWDD has called the "People First Waiver", in order to transition the current Medicaid "fee for service" longterm care services for individuals with developmental disabilities to a case management model.
The state is seeking authority to transition individuals served by the current service delivery system into mandatory enrollment in managed long-term care services. The core concept behind the "People First Waiver" application is an individual budget allocation built on a
standardized assessment of individual support needs. Recognizing that people with developmental disabilities want to live their lives in the community, just like everyone else, OPWDD is racing to embrace the concept of a "self-directed person-cantered system, where individuals and their circle of support have considerable authority over what supports they receive, how they are received and from whom.
At the center of any system promoting self-direction is a personal budget allocation that the individual and his circle of support may apply within the bounds of an approved service plan to secure needed supports. The Center for Medicare and Medicaid Services (CMS) requires any "individual budget amount" to be "a prospectively determined amount of funds that the state makes available for the provision of federally funded services to an (individual)". Implicit in this definition are two key concepts: the state determines the budget amount for each individual, and the individual and/or his or her circle of support is provided this information before developing a service plan.
LEGISLATIVE HISTORY: S.6420/A.9402 of 2011-12; Reported and Committed to Finance
FISCAL IMPACT: To be determined.
EFFECTIVE DATE: Immediately.
STATE OF NEW YORK ________________________________________________________________________ 1109--C 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________Introduced by Sens. MAZIARZ, GALLIVAN, GRISANTI, KENNEDY -- read twice and ordered printed, and when printed to be committed to the Committee on Mental Health and Developmental Disabilities -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- reported favorably from said committee and committed to the Committee on Finance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the mental hygiene law, in relation to enacting the "people first act of 2013" THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "people first act of 2013". S 2. Legislative findings. It is the intent of the legislature to ensure that individuals with developmental disabilities who utilize long-term care services under the medical assistance program and other long-term care related benefit programs administered by the state have meaningful access to a reasonable array of community-based and institu- tional program options and to ensure the well-being of individuals with developmental disabilities, taking into account their informed and expressed choices. Furthermore, the legislature declares that it is the policy of the state to ensure that the clinical, habilitative, and social needs of individuals with developmental disabilities who choose to reside in integrated community-based settings can have those needs met in integrated community-based settings. In order to meaningfully comply with this policy, the state must have an understanding of the existing capacity in integrated-community based settings, including direct support professionals and licensed professionals, such as physi-EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02298-08-3 S. 1109--C 2
cians, dentists, nurse practitioners, nurses, and psychiatrists, as well as residential capacity to provide for these needs. It is further the intent of the legislature to support the satisfac- tion and success of consumers through the delivery of quality services and supports. Evaluation of the services that consumers receive is a key aspect to the service system. Utilizing the information that consumers and their families provide about such services in a reliable and mean- ingful way is also critical to enable the commissioner of developmental disabilities to assess the performance of the state's developmental services system and to improve services for consumers in the future. To that end, the commissioner of developmental disabilities shall conduct a geographic analysis of supports and services in community settings and implement an improved, unified quality assessment system, in accordance with this act. S 3. Section 13.15 of the mental hygiene law is amended by adding a new subdivision (d) to read as follows: (D) (1) FOR PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: (I) "DIRECT SUPPORT PROFESSIONALS" MEANS DIRECT SUPPORT WORKERS, DIRECT CARE WORKERS, PERSONAL ASSISTANTS, PERSONAL ATTENDANTS, AND PARA- PROFESSIONALS THAT PROVIDE ASSISTANCE TO INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES IN THE FORM OF DAILY LIVING, AND PROVIDE THE HABILITATION, REHABILITATION, AND TRAINING NEEDS OF THESE INDIVIDUALS. (II) "LICENSED PROFESSIONALS" MEANS, BUT IS NOT LIMITED TO, PHYSI- CIANS, DENTISTS, DENTAL HYGIENISTS, DENTAL ASSISTANTS, NURSE PRACTITION- ERS, LICENSED PRACTICAL NURSES, REGISTERED NURSES, PSYCHIATRISTS, PSYCHOLOGISTS, LICENSED MASTER SOCIAL WORKERS, OR LICENSED CLINICAL SOCIAL WORKERS, LICENSED TO PRACTICE PURSUANT TO THE EDUCATION LAW AND OTHER QUALIFIED MENTAL HEALTH PROFESSIONALS. (III) "SUPPORTS AND SERVICES" MEANS DIRECT SUPPORT PROFESSIONALS, LICENSED PROFESSIONALS, AND RESIDENTIAL SERVICES, INCLUDING, BUT NOT LIMITED TO, PRIVATE RESIDENCES, COMMUNITY-INTEGRATED LIVING ARRANGE- MENTS, SUPPORTED RESIDENTIAL PROGRAMS, SUPERVISED RESIDENTIAL PROGRAMS, OR SUPPORTIVE HOUSING PROGRAMS. (2) SUBJECT TO AVAILABLE APPROPRIATIONS THEREFOR, THE COMMISSIONER SHALL CONDUCT A GEOGRAPHIC ANALYSIS OF SUPPORTS AND SERVICES IN COMMUNI- TY SETTINGS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES. THIS ANALY- SIS SHALL ALSO IDENTIFY GAPS BETWEEN REQUIRED SUPPORTS AND SERVICES BY REGION OF THE STATE. (3) IN ORDER TO PERFORM THE GEOGRAPHIC ANALYSIS OR TO GATHER DATA FOR PURPOSES OF PERFORMING THE GEOGRAPHIC ANALYSIS, THE COMMISSIONER MAY WORK IN COOPERATION AND AGREEMENT WITH OTHER OFFICES, DEPARTMENTS OR AGENCIES OF THE STATE, LOCAL OR FEDERAL GOVERNMENT, OR OTHER ORGANIZA- TIONS AND INDIVIDUALS, WHICH MAY INCLUDE PROVIDERS OF SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REPRESENTATIVES FROM EMPLOYEE ORGANIZATIONS REPRESENTING DIRECT CARE WORKERS, CONSUMER REPRESENTATIVES INCLUDING PERSONS WITH DEVELOPMENTAL DISABILITIES, OR THEIR PARENTS OR GUARDIANS. (4) IN CONDUCTING THIS ACTIVITY, THE COMMISSIONER, SUBJECT TO AVAIL- ABLE APPROPRIATIONS THEREFOR, SHALL DEVELOP AND UTILIZE A WEB-BASED DATA-BASE WHICH PRIORITIZES THE URGENCY OF NEED FOR SUPPORTS AND SERVICES. THE INFORMATION COLLECTED SHOULD ALLOW THE COMMISSIONER TO CATEGORIZE NEEDS FOR DEVELOPMENTAL DISABILITY SERVICES WITHIN A FRAME- WORK THAT ENCOMPASSES THREE LEVELS OF URGENCY OF NEEDS. THESE LEVEL OF SUPPORT NEEDS SHOULD INCLUDE: EMERGENCY NEED, FOR THOSE PERSONS WITH DEVELOPMENTAL DISABILITIES IN NEED OF IMMEDIATE SUPPORT EITHER DAYS. 1109--C 3
SUPPORT OR IN-HOME OR OUT-OF-HOME PLACEMENT; CRITICAL NEED FOR THOSE INDIVIDUALS WHO WILL HAVE A NEED FOR SUPPORTS OR SERVICES WITHIN ONE YEAR; AND PLANNING FOR NEED, FOR THOSE INDIVIDUALS WHOSE SUPPORT NEEDS ARE ONE TO FIVE YEARS AWAY, OR WHERE THE CAREGIVER IS AGE SIXTY OR OLDER. (5) SUCH AN ANALYSIS SHOULD INCLUDE THE STATEWIDE NUMBER OF INDIVID- UALS SEEKING SERVICES, INCLUDING AWAITING PLACEMENT BROKEN DOWN INTO THE TOTAL NUMBER OF INDIVIDUALS FROM WITHIN EACH REGIONAL SERVICES OFFICE'S GEOGRAPHIC AREA WHO AWAIT RESIDENTIAL PLACEMENT, DAY SERVICE SUPPORT, HOME AND COMMUNITY-BASED WAIVER SUPPORT, EMPLOYMENT SUPPORT, BEHAVIORAL HEALTH SERVICES AND SUPPORTS, OR OTHER COMMUNITY-BASED SUPPORT. SUCH INFORMATION SHOULD BE GROUPED BY THE AGE OF THE INDIVIDUAL AWAITING COMMUNITY SERVICES AND SUPPORTS AND THE AGE OF THEIR CAREGIVER, IF ANY. SUCH INFORMATION SHOULD ALSO INCLUDE WAITLIST AND PLACEMENT INFORMATION SUCH AS: (I) THE TYPE OF SUPPORTS AND SERVICES SUCH INDIVIDUALS ARE EXPECTED TO REQUIRE DIVIDED INTO CERTIFIED OUT-OF-HOME, SUPERVISED, SUPPORTIVE PLACEMENT NEEDS AND OTHER NON-PLACEMENT NEEDS AND THE NUMBER OF SUCH PERSONS WHO ARE MEDICALLY FRAIL REQUIRING INTENSIVE MEDICAL CARE; (II) NON-CERTIFIED RESIDENTIAL PLACEMENTS OUTSIDE THE PARENT'S OR PARENTS' OR OTHER CAREGIVER'S HOME; (III) THE NUMBER OF INDIVIDUALS EXPECTED TO REQUIRE HOME AND COMMUNITY SERVICES WAIVER-FUNDED HABILITATION SERVICES AT HOME; (IV) THE TOTAL NUMBER OF INDIVIDUALS, WHO HAVE BEEN IDENTIFIED AS IN NEED OF SUPPORTS AND SERVICES WHO HAVE RECEIVED THESE SUPPORTS AND SERVICES AND ANY GAP BETWEEN REQUIRED SUPPORTS AND SERVICES AND THE SUPPORTS AND SERVICES PROVIDED; (V) THE NUMBER OF EMERGENCY NEED RESIDENTIAL PLACEMENTS FOR THE PAST YEAR AND OTHER SUPPORTS AND SERVICES PROVIDED ON AN EMERGENCY BASIS; (VI) THE NUMBER OF INDIVIDUALS WHO ARE CURRENTLY RECEIVING SUPPORTS AND SERVICES, INCLUDING RESIDENTIAL SERVICES, WHOSE CURRENT LIVING SITU- ATION IS NOT ADEQUATE TO MEET THEIR NEEDS AND WHO ARE AWAITING AN ALTER- NATIVE PLACEMENT OR ALTERNATIVE SUPPORT AND SERVICE DELIVERY OPTIONS; (VII) PROJECTED FUNDING REQUIREMENTS FOR INDIVIDUALS IDENTIFIED AS IN NEED OF SERVICES PURSUANT TO PARAGRAPH FOUR OF THIS SUBDIVISION; (VIII) AN UPDATED FIVE YEAR PROJECTION OF INDIVIDUALS WHO WILL REQUIRE EITHER ADDITIONAL IN-HOME SUPPORTS AND SERVICES AND/OR OUT-OF-HOME RESI- DENTIAL PLACEMENTS; AND (IX) ANY OTHER INFORMATION DEEMED NECESSARY BY THE COMMISSIONER. (6) THE COMMISSIONER SHALL PREPARE ANNUALLY FOR THE GOVERNOR, THE LEGISLATURE AND THE JUSTICE CENTER FOR THE PROTECTION OF PEOPLE WITH SPECIAL NEEDS A WRITTEN EVALUATION REPORT CONCERNING THE DELIVERY OF SUPPORTS AND SERVICES IN THE COMMUNITY. ON OR BEFORE MARCH FIRST, IN EACH YEAR, THE COMMISSIONER SHALL SUBMIT A COPY OF SUCH REPORT, AND SUCH RECOMMENDATION AS HE OR SHE DEEMS APPROPRIATE, TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE RESPECTIVE MINORITY LEADERS OF EACH SUCH HOUSE, AND THE CHAIR OF THE STATE COMMISSION ON QUALITY OF CARE FOR THE MENTALLY DISABLED. THE FIRST SUCH REPORT SHALL BE DUE BY NO LATER THAN MARCH FIRST, TWO THOUSAND FIFTEEN. THE REPORT SHALL ALSO BE MADE AVAILABLE TO THE PUBLIC AND SHALL BE PUBLISHED ON THE OFFICE'S WEBSITE IN AN APPROPRIATE LOCATION AT THE SAME TIME AS ITS SUBMISSION TO STATE OFFICIALS. S 4. Subdivision (c) of section 16.01 of the mental hygiene law, as added by chapter 234 of the laws of 1998, paragraph 1 as amended by chapter 37 of the laws of 2011, is amended to read as follows:S. 1109--C 4
(c) (1) Notwithstanding any other provision of law, the commissioner, or his OR HER designee, may require from any hospital, as defined under article twenty-eight of the public health law, any information, report, or record necessary for the purpose of carrying out the functions, powers and duties of the commissioner related to the investigation of deaths and complaints of abuse, mistreatment, or neglect concerning persons with developmental disabilities who receive services, or had prior to death received services, in a facility as defined in section 1.03 of this chapter, or are receiving medicaid waiver services from the office for people with developmental disabilities in a non-certified setting, and have been treated at such hospitals. (2) Any information, report, or record requested by the commissioner or his OR HER designee pursuant to this subdivision shall be limited to that information that the commissioner determines necessary for the completion of this investigation. (3) The information, report or record received by the commissioner or his OR HER designee pursuant to this subdivision shall be subject to section two thousand eight hundred five-m, section eighteen, as added by chapter four hundred ninety-seven of the laws of nineteen hundred eight- y-six, and article twenty-seven-F of the public health law, section 33.13 of this chapter, and any applicable federal statute or regulation. S 5. This act shall take effect immediately.