S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2445

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 21, 2011
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to  establishing  the
  neurological  impairment program to provide compensation of neurologi-
  cally-impaired persons

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  The  public health law is amended by adding a new article
49-A to read as follows:
                              ARTICLE 49-A
            NEUROLOGICAL IMPAIRMENT PROGRAM OF NEW YORK STATE
SECTION 4920. DEFINITIONS.
        4921. EXCLUSIVENESS OF REMEDY.
        4922. THE NEUROLOGICAL IMPAIRMENT PROGRAM OF NEW YORK STATE.
        4923. NEUROLOGICAL IMPAIRMENT TRUST FUND.
        4924. FILING OF CLAIMS.
        4925. CASE MANAGEMENT PROGRAM.
        4926. DETERMINATION OF ELIGIBILITY.
        4927. APPEALS OF DETERMINATION OF ELIGIBILITY.
        4928. COMPENSATION.
        4929. LIMITATION ON PROCESSING OF CLAIMS.
        4930. NOTICE TO OBSTETRIC PATIENTS.
        4931. NEW YORK STATE STANDARD OF CARE ASSESSMENT PROGRAM.
  S 4920. DEFINITIONS. WHEN USED IN THIS ARTICLE,  THE  FOLLOWING  TERMS
SHALL HAVE THE FOLLOWING MEANINGS:
  1.  "CASE  MANAGEMENT"  MEANS  CASE  MANAGEMENT  SERVICES FURNISHED IN
ACCORDANCE WITH THE NEUROLOGICAL IMPAIRMENT PROGRAM OF  THIS  STATE  AND
WHICH  ASSIST  ALL  ELIGIBLE  IMPAIRED  PERSONS TO ACCESS NECESSARY CASE
MANAGEMENT SERVICES IN ACCORDANCE WITH GOALS CONTAINED IN A WRITTEN CASE
MANAGEMENT PLAN.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07100-01-1

              

S. 2445                             2

  2. "CASE MANAGEMENT SERVICES" MEANS SERVICES WHICH WILL ASSIST  ELIGI-
BLE  IMPAIRED PERSONS IN OBTAINING NEEDED MEDICAL, SOCIAL, PSYCHOSOCIAL,
EDUCATIONAL AND ANY  OTHER  SERVICES  DEEMED  NECESSARY.  SUCH  SERVICES
ENHANCE  THE  QUALITY  OF  LIFE FOR ELIGIBLE IMPAIRED PERSONS AND ASSIST
SUCH  PERSONS  AND THEIR PARENT, GUARDIAN OR CARETAKER IN NAVIGATING THE
PROGRAM'S BENEFITS AS WELL AS IN ACCESSING ANY SUCH  SERVICES  NECESSARY
AND APPROPRIATE TO THE ELIGIBLE IMPAIRED PERSONS LEVEL OF IMPAIRMENT AND
NEED.
  3.  "CLAIMANT" MEANS A PERSON WHO FILES A CLAIM PURSUANT TO THIS ARTI-
CLE ON BEHALF OF AN IMPAIRED PERSON FOR COMPENSATION,  AND  INCLUDES  AN
AUTHORIZED  LEGAL REPRESENTATIVE FILING A CLAIM ON BEHALF OF AN IMPAIRED
PERSON.
  4. "COMPENSATION" MEANS BENEFITS  PROVIDED  TO  OR  ON  BEHALF  OF  AN
IMPAIRED NEWBORN OR PERSON PURSUANT TO THIS ARTICLE.
  5.  "HEALTHCARE PROVIDER" MEANS A HOSPITAL, A HEALTH CARE ORGANIZATION
ESTABLISHED PURSUANT TO ARTICLE FORTY-FOUR OF THIS CHAPTER,  A  LICENSED
PHYSICIAN,  A  LICENSED  MIDWIFE,  A  REGISTERED PROFESSIONAL NURSE OR A
LICENSED PRACTICAL NURSE.
  6. "HOSPITAL" MEANS A HOSPITAL ESTABLISHED PURSUANT TO  ARTICLE  TWEN-
TY-EIGHT OF THIS CHAPTER. FOR THE PURPOSES OF ANY CLAIM FILED UNDER THIS
ARTICLE,  A  HOSPITAL  SHALL  INCLUDE THE TRUSTEES, DIRECTORS, OFFICERS,
EMPLOYEES AND AGENTS OF THE HOSPITAL.
  7. "IMPAIRED PERSON" MEANS A NEWBORN OR CHILD WHO HAS  A  NEUROLOGICAL
MOTOR IMPAIRMENT.
  8.  "NEUROLOGICAL  IMPAIRMENT  TRUST  FUND"  OR "TRUST FUND" MEANS THE
TRUST  FUND  ESTABLISHED  PURSUANT   TO   SECTION   FORTY-NINE   HUNDRED
TWENTY-THREE OF THIS ARTICLE.
  9.  "NEUROLOGICAL  MOTOR  IMPAIRMENT" OR "IMPAIRMENT" MEANS A SUBSTAN-
TIAL, NON-PROGRESSIVE MOTOR DEFICIT, OCCURRING IN A CHILD OF THIRTY-FOUR
OR  MORE  WEEKS  GESTATIONAL  AGE,  THAT  MAY  HAVE  ORIGINATED   DURING
GESTATION,  LABOR,  DELIVERY, OR WITHIN TWENTY-EIGHT DAYS OF DELIVERY OR
BEFORE DISCHARGE OF THE NEWBORN,  WHICHEVER  OCCURRED  SOONER;  PROVIDED
THAT IMPAIRMENTS DUE TO GENETIC OR METABOLIC CONDITIONS ARE EXCLUDED.
  10.  "NURSE PRACTITIONER" MEANS A REGISTERED PROFESSIONAL NURSE CERTI-
FIED AS A NURSE PRACTITIONER UNDER ARTICLE ONE  HUNDRED  THIRTY-NINE  OF
THE EDUCATION LAW.
  11.   "PARTICIPATING  PHYSICIAN"  OR  "PHYSICIAN"  MEANS  A  PHYSICIAN
LICENSED TO PRACTICE MEDICINE IN THIS STATE. FOR PURPOSES OF  ANY  CLAIM
FILED  UNDER  THIS ARTICLE, "PHYSICIAN" SHALL ALSO INCLUDE THE EMPLOYEES
AND AGENTS OF THE  PHYSICIAN  AND  ANY  PHYSICIAN-OPERATED  PROFESSIONAL
CORPORATION.
  12.  "PHYSICIAN ASSESSOR" MEANS AN EXPERIENCED, BOARD CERTIFIED PHYSI-
CIAN CERTIFIED BY A BOARD RECOGNIZED BY THE AMERICAN  BOARD  OF  MEDICAL
SPECIALTIES  WHO,  WITHIN  TWO YEARS OF THE CLAIM, WAS IN ACTIVE MEDICAL
PRACTICE OR DEVOTED A SUBSTANTIAL PORTION OF HIS OR HER TIME TO TEACHING
AT AN ACCREDITED MEDICAL SCHOOL,  OR  WAS  ENGAGED  IN  UNIVERSITY-BASED
RESEARCH IN RELATION TO THE MEDICAL CARE AND TYPE OF TREATMENT AT ISSUE,
WHO  IS  APPROVED BY HIS OR HER SPECIALTY SOCIETY, AND WHO IS CONTRACTED
BY THE PROGRAM TO PERFORM LEVEL I OR LEVEL II ASSESSMENTS OF THE  STAND-
ARD OF CARE.
  13.  "PHYSICIAN  EXPERT"  MEANS  A  CHILD NEUROLOGIST OR DEVELOPMENTAL
PEDIATRICIAN CERTIFIED IN THE SAME SPECIALTY BY A  BOARD  RECOGNIZED  BY
THE  AMERICAN  BOARD OF MEDICAL SPECIALTIES WHO, WITHIN TWO YEARS OF THE
CLAIM, WAS IN ACTIVE MEDICAL PRACTICE OR DEVOTED A  SUBSTANTIAL  PORTION
OF  HIS  OR  HER  TIME  TO  TEACHING AT AN ACCREDITED MEDICAL SCHOOL, OR
ENGAGED IN UNIVERSITY-BASED RESEARCH IN RELATION TO THE MEDICAL CARE AND

S. 2445                             3

TYPE OF TREATMENT AT ISSUE, WHO IS APPROVED  BY  HIS  OR  HER  SPECIALTY
SOCIETY,  AND WHO IS CONTRACTED BY THE PROGRAM TO PHYSICALLY EXAMINE AND
DETERMINE WHETHER THE IMPAIRED PERSON HAS A NEUROLOGICAL  MOTOR  IMPAIR-
MENT THAT QUALIFIES FOR ELIGIBILITY IN THE PROGRAM.
  14.  "PROGRAM"  MEANS  THE NEUROLOGICAL IMPAIRMENT PROGRAM OF NEW YORK
STATE ESTABLISHED IN SECTION FORTY-NINE HUNDRED TWENTY-TWO OF THIS ARTI-
CLE.
  S 4921. EXCLUSIVENESS OF REMEDY. 1. RECOVERY OF COMPENSATION  PURSUANT
TO  THIS  ARTICLE  FOR  NEUROLOGICAL IMPAIRMENT SUSTAINED BY AN IMPAIRED
PERSON AS A RESULT OF HEALTH CARE SERVICES RENDERED  BY  A  HEALTH  CARE
PROVIDER  AT A HOSPITAL, WHETHER RESULTING IN DEATH OR NOT, SHALL BE THE
EXCLUSIVE REMEDY AGAINST A HEALTH CARE  PROVIDER  OR  HOSPITAL,  OR  ANY
OFFICER,  AGENT  OR  EMPLOYEE  OF  THE PROVIDER OR HOSPITAL.   EXCEPT AS
PROVIDED FOR BY THIS ARTICLE, A COVERED HEALTH CARE PROVIDER  OR  HOSPI-
TAL,  OR  ANY  OFFICER,  AGENT OR EMPLOYEE OF SAID PROVIDER OR HOSPITAL,
SHALL NOT BE SUBJECT TO ANY LIABILITY  FOR  THE  INJURY,  DISABILITY  OR
DEATH OF AN IMPAIRED PERSON; AND ALL CAUSES OF ACTION, INCLUDING ACTIONS
AT LAWSUITS, IN EQUITY, PROCEEDINGS, AND STATUTORY AND COMMON LAW RIGHTS
AND  REMEDIES FOR AND ON ACCOUNT OF SAID INJURY, DISABILITY OR DEATH ARE
ABOLISHED EXCEPT AS PROVIDED FOR IN THIS ARTICLE.
  2. IF ANY CLAIM IS FILED IN ANY COURT OR OTHER FORUM BY OR  ON  BEHALF
OF  ANY  CHILD  ALLEGING  NEUROLOGICAL IMPAIRMENT AS A RESULT OF MEDICAL
MALPRACTICE BY A HEALTH CARE PROVIDER OR PROVIDERS, THE COURT  OR  FORUM
SHALL,  IF REQUESTED BY THE HEALTH CARE PROVIDER OR PROVIDERS, REFER THE
CASE TO THE PROGRAM FOR A DETERMINATION OF ELIGIBILITY  AND  SHALL  STAY
ALL PROCEEDINGS PENDING A DETERMINATION OF ELIGIBILITY BY THE PROGRAM.
  3. THE DETERMINATION OF ELIGIBILITY AS DETERMINED PURSUANT TO SECTIONS
FORTY-NINE  HUNDRED  TWENTY-SIX  AND  FORTY-NINE HUNDRED TWENTY-SEVEN OF
THIS ARTICLE SHALL BE BINDING UPON THE IMPAIRED PERSON, AND UPON HIS  OR
HER  PARENTS, NEXT OF KIN, AGENT, PROXY, EXECUTOR, GUARDIAN OR ANY OTHER
PERSON OR ENTITY CLAIMING COMPENSATION AS A RESULT OF  IMPAIRMENT  UNDER
THIS  ARTICLE AS PROVIDED PURSUANT THERETO. THE PROVISIONS OF THIS ARTI-
CLE SHALL APPLY TO ALL PERSONS, REGARDLESS OF MINORITY OR LEGAL DISABIL-
ITY.
  4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  PRECLUDE  OR  IMPAIR
ANY  ACTION BY AN APPROPRIATE AGENCY OR CIVIL AUTHORITY TO IMPOSE UPON A
HEALTH CARE  PROVIDER  OR  PARTICIPATING  HOSPITAL  CRIMINAL  PENALTIES,
LICENSURE RESTRICTIONS, OR OTHER SANCTIONS FOR VIOLATION OF LAW OR REGU-
LATIONS.
  S  4922.  THE  NEUROLOGICAL  IMPAIRMENT  PROGRAM OF NEW YORK STATE. 1.
THERE IS HEREBY ESTABLISHED  WITHIN  THE  DEPARTMENT,  THE  NEUROLOGICAL
IMPAIRMENT PROGRAM OF NEW YORK STATE.
  2. THE PROGRAM SHALL EMPLOY PERMANENT STAFF.
  3. THE DIRECTOR OF THE PROGRAM SHALL BE APPOINTED BY THE GOVERNOR WITH
THE ADVICE AND CONSENT OF THE SENATE AND ASSEMBLY.
  4.  NO CIVIL ACTION SHALL BE BROUGHT IN ANY COURT AGAINST ANY EMPLOYEE
OR PERSON ENGAGED BY THE PROGRAM FOR ANY ACT DONE, FAILURE  TO  ACT,  OR
STATEMENT  OR  OPINION MADE, WITHIN THE SCOPE OF HIS OR HER DUTIES AS AN
EMPLOYEE OF SUCH PROGRAM.
  5. POWERS AND DUTIES OF  THE  PROGRAM.  THE  PROGRAM  SHALL  HAVE  THE
FOLLOWING POWERS AND DUTIES:
  (A)  TO  SCREEN  OUT PERSONS WHO COULD NOT BE ELIGIBLE FOR THE PROGRAM
AND TO REFER ALL CASES THAT COULD BE ELIGIBLE TO A PHYSICIAN EXPERT  FOR
DETERMINATION OF ELIGIBILITY;
  (B)  TO ACCEPT AND COLLECT ALL ELIGIBLE CLAIMS FOR CARE FILED WITH THE
PROGRAM PURSUANT TO THIS ARTICLE AND TO REINVESTIGATE OR  REOPEN  CLAIMS

S. 2445                             4

AS  THE PROGRAM DEEMS NECESSARY, INCLUDING UPON THE FILING OF A PETITION
FOR ADDITIONAL COMPENSATION;
  (C)  TO  SOLICIT,  THROUGH CONTRACT OR OTHERWISE, PHYSICIAN EXPERTS TO
DETERMINE ELIGIBILITY FOR THE PROGRAM AND TO MAINTAIN  A  LIST  OF  SUCH
PHYSICIAN EXPERTS;
  (D)  TO  MAKE REFERRALS OF ALL POTENTIALLY ELIGIBLE CLAIMS TO ONE SUCH
PHYSICIAN EXPERT FOR EVALUATION  AND  DETERMINATION  OF  ELIGIBILITY  AS
DETERMINED BY THE DEFINITION OF IMPAIRMENT;
  (E)  TO  ESTABLISH  A DATABASE OF ALL CLAIMS THAT HAVE BEEN DETERMINED
ELIGIBLE FOR COMPENSATION, AND SUMMARIES OF ALL ELIGIBLE PERSONS FOR  AN
ASSESSMENT OF THE STANDARD OF CARE;
  (F)  FOR  EACH  CLAIMANT DETERMINED TO BE ELIGIBLE PRIOR TO THE CLAIM-
ANT'S SECOND BIRTHDAY, TO REEVALUATE EACH SUCH CLAIMANT AT AGE TWO YEARS
TO DETERMINE WHETHER THE CHILD REMAINS  ELIGIBLE  FOR  COMPENSATION  AND
SERVICES.   REEVALUATIONS SHALL BE PERFORMED BY A PHYSICIAN EXPERT. SUCH
REEVALUATION WILL PERMIT THE EARLY ENTRY INTO THE  PROGRAM  OF  CHILDREN
WHO  APPEAR  TO  HAVE  SUBSTANTIAL NEUROLOGICAL MOTOR IMPAIRMENT BUT FOR
WHOM, BY THE AGE OF TWO YEARS, THAT IMPAIRMENT NO  LONGER  SUBSTANTIALLY
LIMITS DAILY FUNCTIONS;
  (G)  TO  ADOPT, PROMULGATE, AMEND AND RESCIND RULES AND REGULATIONS TO
CARRY OUT THE PROVISIONS AND PURPOSES OF THIS ARTICLE,  INCLUDING  RULES
FOR  THE  APPROVAL  OF  ATTORNEY'S  FEES  FOR  REPRESENTATION BEFORE THE
PROGRAM;
  (H) TO ESTABLISH A LIST OF CONDITIONS  THAT  MEET  THE  DEFINITION  OF
IMPAIRMENT  AND  A  LIST OF THOSE CONDITIONS WHICH DO NOT MEET THE DEFI-
NITION OF IMPAIRMENT AND ARE EXCLUDED. SUCH LIST SHALL BE  REVISED  WHEN
APPROPRIATE.  THE  PROGRAM  SHALL  REVIEW THE LIST AT LEAST ANNUALLY AND
SHALL MAKE THE LIST AVAILABLE TO THE PUBLIC;
  (I) TO AUTHORIZE THE COMMISSIONER OF  TAXATION  AND  FINANCE  AND  THE
COMPTROLLER TO MAKE PAYMENTS FROM THE TRUST FUND TO PROVIDE COMPENSATION
PURSUANT TO THIS ARTICLE;
  (J)  TO  COLLECT  ASSESSMENTS,  INCLUDING  ANY  AUTHORIZED ASSESSMENTS
REMAINING UNPAID, FOR DEPOSIT IN THE TRUST FUND IN ACCORDANCE  WITH  THE
PROVISIONS OF THIS ARTICLE;
  (K)  TO  EMPLOY  SUCH EMPLOYEES AS IT MAY DEEM NECESSARY AND PRESCRIBE
THEIR DUTIES;
  (L) TO ENTER INTO ANY AGREEMENTS AND CONTRACTS  AS  ARE  NECESSARY  OR
PROPER IN THE JUDGMENT OF THE PROGRAM TO ADMINISTER THE PROGRAM, INCLUD-
ING  WITHOUT LIMITATION CONTRACTS WITH ANY ARTICLE FORTY-THREE INSURANCE
LAW PLANS AND SUCH OTHER ADMINISTRATORS AS THE PROGRAM SHALL  DESIGNATE,
AND  AGREEMENTS WITH HEALTH CARE PROVIDERS, PEDIATRICIANS, LOCAL GOVERN-
MENTS  AND  OTHER  PUBLIC  CORPORATIONS,  SCHOOL  DISTRICTS  AND  SCHOOL
DISTRICT COMMITTEES, EARLY INTERVENTION OFFICIALS DESIGNATED UNDER TITLE
II-A  OF ARTICLE TWO OF THIS CHAPTER, AND OTHERS, PROVIDING FOR DISTRIB-
UTION OF MATERIALS AND INFORMATION  CONCERNING  THE  BENEFITS  AVAILABLE
UNDER  THE PROGRAM, ENSURING WIDE ACCESS TO ITS BENEFITS, AND COORDINAT-
ING RECEIPT OF BENEFITS AND SERVICES AVAILABLE UNDER OTHER PROGRAMS;
  (M) TO SEEK REFUNDS AND TO TAKE ANY LEGAL ACTION NECESSARY TO AVOID OR
RECOVER THE PAYMENT OF IMPROPER CLAIMS OR OTHER FUNDS IT IS OWED;
  (N) TO GRANT EXTENSIONS TO THE TIME LIMITATIONS  OF  THIS  ARTICLE  IN
EXCEPTIONAL CASES;
  (O)  TO PREPARE WRITTEN INFORMATION ABOUT THE PROGRAM'S ACTIVITIES AND
PROCEDURES AND THE BENEFITS AVAILABLE TO  IMPAIRED  PERSONS  UNDER  THIS
ARTICLE;
  (P) TO ENCOURAGE ALL PEDIATRICIANS, FAMILY PRACTITIONERS AND HOSPITALS
THAT  PROVIDE  PEDIATRIC  CARE TO PROVIDE THE INFORMATION REFERRED TO IN

S. 2445                             5

THIS ARTICLE TO THE PARENTS OR GUARDIANS OF  THEIR  PEDIATRIC  PATIENTS;
AND
  (Q)  TO HAVE AND EXERCISE ALL POWERS NECESSARY TO EFFECT ANY OR ALL OF
THE PURPOSES OF THIS ARTICLE.
  S 4923. NEUROLOGICAL IMPAIRMENT TRUST FUND. THE PROGRAM  SHALL  ESTAB-
LISH AND MAINTAIN A TRUST FUND, TO BE KNOWN AS THE "NEUROLOGICAL IMPAIR-
MENT  TRUST FUND", OF WHICH THE PROGRAM SHALL BE THE TRUSTEE. ALL REVEN-
UES COLLECTED BY THE PROGRAM PURSUANT TO THIS ARTICLE SHALL BE DEPOSITED
BY THE PROGRAM INTO THE TRUST FUND AND SHALL BE AVAILABLE FOR USE BY THE
PROGRAM FOR ITS ORDINARY AND NECESSARY OPERATIONS' EXPENSES AND FOR  THE
PAYMENT  OF  COMPENSATION TO IMPAIRED PERSONS PURSUANT TO THE PROVISIONS
OF THIS ARTICLE. FUNDS AND EXPENSES FOR THIS PROGRAM  SHALL  BE  DERIVED
FROM  FUNDS  APPROPRIATED  AS NECESSARY TO MEET THE REQUIREMENTS OF THIS
ARTICLE.
  S 4924. FILING OF CLAIMS. 1. A CLAIM MAY BE FILED UNDER  THIS  ARTICLE
BY EITHER A CLAIMANT OR BY A HEALTH CARE PROVIDER BY SUBMITTING A STAND-
ARDIZED  CLAIM FORM TO THE PROGRAM, SETTING FORTH THE FOLLOWING INFORMA-
TION AND ATTACHING DOCUMENTATION WHERE REQUIRED:
  (A) THE NAME AND ADDRESS OF THE PERSON OR ENTITY FILING THE CLAIM;  IF
THE  CLAIM  IS FILED ON BEHALF OF AN IMPAIRED PERSON, THE CLAIMANT SHALL
IDENTIFY THE CHILD'S LEGAL REPRESENTATIVE AND THE BASIS FOR HIS  OR  HER
REPRESENTATION OF THE IMPAIRED PERSON;
  (B)  THE  NAME,  ADDRESS  AND DATE OF BIRTH OF THE IMPAIRED NEWBORN OR
CHILD AND THE NAME AND ADDRESS OF HIS  OR  HER  PARENTS  AND  ANY  LEGAL
REPRESENTATIVES;
  (C)  THE  NAME  AND ADDRESS OF ANY PHYSICIAN, MIDWIFE OR NURSE PRACTI-
TIONER WHO PARTICIPATED IN THE MANAGEMENT OF THE LABOR  AND/OR  DELIVERY
AND  CARE OF THE IMPAIRED NEWBORN, THE NAME OF THE HOSPITAL IN WHICH THE
DELIVERY AND/OR NEONATAL MANAGEMENT OCCURRED AND THE NAME OF  ANY  OTHER
PHYSICIAN  OR  NURSE  PRACTITIONER WHO IS PROVIDING OR HAS PROVIDED CARE
FOR THE IMPAIRED CHILD;
  (D) THE NAMES AND ADDRESSES OF ANY PHYSICIAN, MIDWIFE OR NURSE PRACTI-
TIONER WHO PARTICIPATED IN THE  MANAGEMENT  OF  CARE  FOR  THE  IMPAIRED
PERSON,  THE  NAMES OF THE HOSPITALS IN WHICH ANY CARE WAS PROVIDED, AND
THE NAME OF ANY OTHER PHYSICIAN OR NURSE PRACTITIONER WHO  IS  PROVIDING
OR HAS PROVIDED CARE FOR THE IMPAIRED PERSON;
  (E)  A  DESCRIPTION  OF THE IMPAIRMENT FOR WHICH THE CLAIM IS MADE AND
THE APPLICABLE DIAGNOSIS OR ETIOLOGY OF THE IMPAIRMENT;
  (F) THE TIME AND PLACE THE IMPAIRMENT WAS THOUGHT TO HAVE OCCURRED;
  (G) A STATEMENT OF THE CIRCUMSTANCES SURROUNDING  THE  IMPAIRMENT  AND
GIVING RISE TO THE CLAIM, INCLUDING THE ROLE OF ANY HEALTH CARE PROVIDER
ASSOCIATED WITH THE IMPAIRMENT;
  (H)  A SCHEDULE, WITH DOCUMENTATION, OF EXPENSES AND SERVICES INCURRED
TO DATE, TOGETHER WITH A DESCRIPTION OF ANY PAYMENT THAT HAS  BEEN  MADE
FOR SUCH SERVICES, AND THE IDENTITY OF THE PAYER; AND
  (I)  A SCHEDULE, WITH DOCUMENTATION, OF ANY SOURCE OF REIMBURSEMENT OR
CARE, SUCH AS HEALTH  INSURANCE  OR  A  GOVERNMENT  PROGRAM,  WHICH  MAY
CONSTITUTE AN EXCLUSION FROM COMPENSATION, AS PROVIDED IN THIS ARTICLE.
  2.  A CLAIMANT OR HEALTH CARE PROVIDER SHALL ALSO PROVIDE THE PROGRAM,
AT THE TIME THE PETITION IS SUBMITTED, WITH THE FOLLOWING MATERIALS  AND
INFORMATION, TO THE EXTENT AVAILABLE:
  (A) ALL RELEVANT MEDICAL RECORDS OF THE IMPAIRED PERSON, AND IDENTIFI-
CATION  OF  ANY UNAVAILABLE RECORDS KNOWN TO THE CLAIMANT OR HEALTH CARE
PROVIDER AND THE REASONS FOR THEIR UNAVAILABILITY; AND
  (B) ALL  APPROPRIATE  ASSESSMENTS,  EVALUATIONS,  DIAGNOSES,  DETERMI-
NATIONS  OF  ETIOLOGY AND PROGNOSES AND SUCH OTHER RECORDS NECESSARY FOR

S. 2445                             6

THE DETERMINATION OF THE COMPENSATION TO BE PAID TO THE IMPAIRED NEWBORN
OR CHILD.
  3.  THE CLAIMANT'S FAILURE TO PROVIDE ALL OF THE INFORMATION DESCRIBED
IN SUBDIVISIONS ONE AND TWO  OF  THIS  SECTION  SHALL  NOT  DEPRIVE  THE
PROGRAM OF JURISDICTION OVER THE CLAIM PENDING RECEIPT BY THE PROGRAM OF
INFORMATION SUFFICIENT TO REVIEW THE CLAIM.
  4. NOTWITHSTANDING ANY LAW TO THE CONTRARY, THE CLAIMANT AND, UPON THE
SUBMISSION OF A PETITION, THE PROGRAM SHALL HAVE THE RIGHT TO OBTAIN ALL
RELEVANT MEDICAL RECORDS OF THE IMPAIRED PERSON, AND UPON A REQUEST BY A
CLAIMANT OR THE PROGRAM PURSUANT TO THIS ARTICLE, A HEALTH CARE PROVIDER
SHALL  HAVE  THE  DUTY  TO  PROVIDE  FOR  COPYING AT NO CHARGE, ALL SUCH
RECORDS WITHIN THE PROVIDER'S POSSESSION.
  5. UPON RECEIPT OF A PETITION FROM A CLAIMANT, THE PROGRAM SHALL NOTI-
FY ANY HEALTH CARE PROVIDER IDENTIFIED IN THE PETITION AND ANY PHYSICIAN
OR HOSPITAL INVOLVED IN THE LABOR OR DELIVERY OF THE CHILD  WHO  IS  NOT
IDENTIFIED  IN  THE PETITION.   UPON RECEIPT OF A PETITION FROM A HEALTH
CARE PROVIDER, THE PROGRAM SHALL NOTIFY ANY PARENTS OR  LEGAL  REPRESEN-
TATIVES  IDENTIFIED IN THE PETITION AND SHALL MAKE REASONABLE EFFORTS TO
IDENTIFY AND NOTIFY ANY PARENT OR LEGAL REPRESENTATIVE WHO IS NOT  IDEN-
TIFIED IN THE PETITION. SUCH PHYSICIAN, HOSPITAL, PARENT OR LEGAL REPRE-
SENTATIVE  SHALL  HAVE  FORTY-FIVE  DAYS FROM THE DATE OF SUCH NOTICE TO
SUBMIT ANY COMMENTS OR OTHER INFORMATION RELEVANT TO THE CLAIM,  AND  TO
ELECT  TO  BE NOTIFIED OF ANY APPEAL HELD ON THE DETERMINATION OF ELIGI-
BILITY.
  6. BEFORE RECEIVING THE FIRST CLAIM, THE PROGRAM SHALL PREPARE AND, AS
APPROPRIATE, UPDATE A DOCUMENT DESCRIBING THE BENEFITS  AVAILABLE  UNDER
THIS  ARTICLE,  THE  PROCEDURES  FOR  OBTAINING SUCH BENEFITS, AND OTHER
PROGRAMS AVAILABLE TO ASSIST IMPAIRED PERSONS. THE  PROGRAM  SHALL  SEND
THIS DOCUMENT TO ALL CLAIMANTS AND MAKE IT AVAILABLE TO THE PUBLIC.
  7.  THE  PROGRAM  SHALL ESTABLISH A CLAIMS ASSISTANCE UNIT WHICH SHALL
PROVIDE INFORMATION TO CLAIMANTS  ABOUT  THE  PROGRAM'S  ACTIVITIES  AND
PROCEDURES,  A  DESCRIPTION  OF  THE  ELIGIBILITY  PROCESS, THE BENEFITS
AVAILABLE TO CLAIMANTS AND THE REQUIREMENTS OF THIS  SECTION,  INCLUDING
THE PHYSICAL EXAMINATION OF THE INFANT WHICH MAY BE NECESSARY TO RECEIVE
COMPENSATION UNDER THE PROGRAM. THE PROGRAM SHALL ESTABLISH AT LEAST ONE
TOLL-FREE TELEPHONE NUMBER FOR CENTRALIZED ASSISTANCE, INCLUDING ANSWER-
ING QUESTIONS AND REFERRAL TO LOCAL SOURCES OF ASSISTANCE MADE AVAILABLE
UNDER  ANY  CONTRACTS OR AGREEMENTS AUTHORIZED PURSUANT TO THIS ARTICLE.
ANY CLAIMANT WHO HAS FILED A PETITION THAT THE PROGRAM  FINDS  DOES  NOT
CONTAIN ALL INFORMATION NECESSARY TO PROCESS THE CLAIM SHALL BE REFERRED
TO THE CLAIMS ASSISTANCE UNIT FOR GUIDANCE.
  8.  A  CLAIM  SEEKING ADDITIONAL COMPENSATION ON BEHALF OF AN IMPAIRED
NEWBORN OR CHILD FOR WHICH COMPENSATION HAS ALREADY BEEN AWARDED MAY  BE
FILED ON BEHALF OF THE IMPAIRED PERSON AT ANY POINT DURING THE REMAINDER
OF HIS OR HER LIFE. SUCH CLAIM SHALL PROVIDE THE FOLLOWING DOCUMENTATION
IN  ADDITION TO THE INFORMATION SPECIFIED IN SUBDIVISIONS ONE AND TWO OF
THIS SECTION:
  (A) A STATEMENT AND SUPPORTING DOCUMENTATION REGARDING THE  REASON  OR
REASONS WHY ADDITIONAL COMPENSATION IS BEING SOUGHT;
  (B)  A SCHEDULE, WITH DOCUMENTATION, OF EXPENSES AND SERVICES INCURRED
FOR THE CALENDAR YEAR PRIOR TO THE DATE OF THE  PETITION,  ANY  PAYMENTS
MADE FOR SUCH SERVICES, AND THE IDENTITY OF THE PAYER; AND
  (C)  A  SCHEDULE,  WITH  DOCUMENTATION,  OF  ANY  PRESENT  SOURCES  OF
REIMBURSEMENT FOR  CARE,  SUCH  AS  HEALTH  INSURANCE  OR  A  GOVERNMENT
PROGRAM.

S. 2445                             7

  S  4925.  CASE  MANAGEMENT  PROGRAM. 1. CASE MANAGEMENT SERVICES. CASE
MANAGEMENT SERVICES AS DEFINED IN SECTION FORTY-NINE HUNDRED  TWENTY  OF
THIS ARTICLE SHALL NOT:
  (A)  BE UTILIZED TO RESTRICT THE CHOICE OF AN ELIGIBLE IMPAIRED PERSON
IN OBTAINING  NECESSARY  CASE  MANAGEMENT  SERVICES  FROM  ANY  PROVIDER
PARTICIPATING  IN  THE PROGRAM WHO IS QUALIFIED TO PROVIDE SUCH SERVICES
AND WHO UNDERTAKES TO PROVIDE SUCH SERVICES, INCLUDING  AN  ORGANIZATION
WHICH PROVIDES SUCH SERVICES;
  (B)  DUPLICATE  CASE  MANAGEMENT SERVICES CURRENTLY PROVIDED UNDER THE
MEDICAL ASSISTANCE PROGRAM OR UNDER ANY OTHER PROGRAM THAT THE  ELIGIBLE
IMPAIRED  PERSON  IS  ENROLLED  OR  WHICH  SUCH ELIGIBLE IMPAIRED PERSON
ACCESSES;
  (C) BE UTILIZED BY PROVIDERS OF CASE MANAGEMENT SERVICES TO  CREATE  A
DEMAND FOR UNNECESSARY SERVICES OR PROGRAMS, PARTICULARLY THOSE SERVICES
OR PROGRAMS WITHIN THEIR SCOPE OF AUTHORITY; AND
  (D)  BE PROVIDED TO ANY AND ALL ELIGIBLE IMPAIRED PERSONS ALSO RECEIV-
ING INSTITUTIONAL CARE REIMBURSED UNDER THE MEDICAL  ASSISTANCE  PROGRAM
OR  TO  ANY AND ALL ELIGIBLE IMPAIRED PERSONS IN RECEIPT OF CASE MANAGE-
MENT SERVICES UNDER A FEDERAL HOME AND COMMUNITY BASED WAIVER.
  2. CASE MANAGEMENT FUNCTIONS. CASE  MANAGEMENT  FUNCTIONS  ARE  TO  BE
DETERMINED  ON THE BASIS OF THE ELIGIBLE IMPAIRED PERSON'S ENTRANCE INTO
THE PROGRAM. A SEPARATE CASE RECORD MUST BE ESTABLISHED FOR EACH  ELIGI-
BLE  IMPAIRED  PERSON  RECEIVING  CASE MANAGEMENT SERVICES AND EACH CASE
MANAGEMENT FUNCTION PROVIDED, INCLUDING BUT NOT LIMITED  TO  INTAKE  AND
SCREENING  WHICH  CONSISTS  OF  INITIATING  CONTACT  WITH  THE  ELIGIBLE
IMPAIRED PERSON AND PROVIDING INFORMATION CONCERNING ALL CASE MANAGEMENT
SERVICES AVAILABLE UNDER THE PROGRAM.
  3. ASSESSMENT AND REASSESSMENT. THE CASE MANAGER SHALL SECURE  THROUGH
BOTH  THE  PROGRAM  AND  THE  DEPARTMENT, AND WITH THE ELIGIBLE IMPAIRED
PERSON'S PERMISSION OR PERMISSION  OF  THE  ELIGIBLE  IMPAIRED  PERSON'S
PARENT, GUARDIAN OR CARETAKER:
  (A)  AN  ASSESSMENT  OF  THE  ELIGIBLE IMPAIRED PERSON'S SERVICE NEEDS
INCLUDING MEDICAL,  SOCIAL,  PSYCHOSOCIAL,  EDUCATIONAL  AND  ANY  OTHER
SERVICES DEEMED NECESSARY;
  (B)  INFORMATION IDENTIFYING THE BARRIERS TO CARE AND EXISTING GAPS IN
SERVICE RELATIVE TO THE ELIGIBLE IMPAIRED PERSON'S NEED; AND
  (C) A  DESCRIPTION  OF  FACTORS  RELATIVE  TO  THE  ELIGIBLE  IMPAIRED
PERSON'S CARE.
  4.  CASE  MANAGEMENT PLAN AND COORDINATION. THE CASE MANAGEMENT ACTIV-
ITIES REQUIRED TO ESTABLISH A COMPREHENSIVE WRITTEN CASE MANAGEMENT PLAN
AND TO EFFECTUATE THE COORDINATION OF SERVICES INCLUDE:
  (A) IDENTIFICATION OF THE NATURE, AMOUNT, TYPE, FREQUENCY  AND  POTEN-
TIAL  DURATION  OF  THE CASE MANAGEMENT SERVICES REQUIRED BY AN ELIGIBLE
IMPAIRED PERSON;
  (B) SELECTION OF THE NATURE, AMOUNT,  TYPE,  FREQUENCY  AND  POTENTIAL
DURATION OF SERVICES TO BE PROVIDED TO THE ELIGIBLE IMPAIRED PERSON WITH
THE  PARTICIPATION  OF  THE  ELIGIBLE IMPAIRED PERSON, AND/OR HIS OR HER
PARENT, GUARDIAN OR CARETAKER, AND PROVIDERS OF SERVICES;
  (C) SPECIFICATION OF THE LONG-TERM AND SHORT-TERM GOALS TO BE ACHIEVED
THROUGH THE CASE MANAGEMENT PROCESS;
  (D) COLLABORATION WITH HEALTH CARE  PROVIDERS  AND  OTHER  FORMAL  AND
INFORMAL  SERVICE PROVIDERS, INCLUDING DISCHARGE PLANNERS AND OTHER CASE
MANAGERS AS APPROPRIATE,  THROUGH  CASE  CONFERENCES  TO  ENCOURAGE  THE
EXCHANGE OF CLINICAL INFORMATION AND TO ASSURE:
  (I)  INTEGRATION OF CLINICAL CARE PLANS THROUGHOUT THE CASE MANAGEMENT
PROCESS,

S. 2445                             8

  (II) CONTINUITY OF CASE MANAGEMENT SERVICES,
  (III)  AVOIDANCE OF DUPLICATION OF SERVICES, INCLUDING CASE MANAGEMENT
SERVICES, AND
  (IV) ESTABLISHMENT  OF  A  COMPREHENSIVE  CASE  MANAGEMENT  PLAN  THAT
ADDRESSES  THE  MEDICAL, SOCIAL, PSYCHOSOCIAL, EDUCATIONAL AND ANY OTHER
NEEDS DEEMED NECESSARY BY THE ELIGIBLE IMPAIRED PERSON;
  (E) IMPLEMENTATION OF THE CASE MANAGEMENT  PLAN  BY  THE  PROGRAM,  IN
CONJUNCTION AND CONSULTATION WITH THE DEPARTMENT, INCLUDES:
  (I) SECURING THE SERVICES DETERMINED IN THE CASE MANAGEMENT PLAN TO BE
APPROPRIATE  FOR  AN  ELIGIBLE IMPAIRED PERSON THROUGH REFERRAL TO THOSE
AGENCIES  OR  PERSONS  WHO  ARE  QUALIFIED  TO  PROVIDE  THE  IDENTIFIED
SERVICES,
  (II)  ASSISTING  THE  ELIGIBLE  IMPAIRED  PERSON  WITH REFERRAL AND/OR
APPLICATION FORMS REQUIRED FOR THE ACQUISITION OF SERVICES,
  (III) ADVOCATING FOR THE ELIGIBLE IMPAIRED PERSON WITH  ALL  PROVIDERS
OF SERVICES, AND
  (IV) DEVELOPING ALTERNATIVE SERVICES TO ASSURE CONTINUITY IN THE EVENT
OF SERVICE DISRUPTION;
  (F)  CRISIS  INTERVENTION  BY  A CASE MANAGER OR HEALTH CARE PROVIDER,
WHEN NECESSARY, INCLUDES:
  (I) ASSESSMENT OF THE NATURE OF THE ELIGIBLE IMPAIRED PERSON'S IMPAIR-
MENT AND CIRCUMSTANCES,
  (II) DETERMINATION OF THE ELIGIBLE IMPAIRED PERSON'S EMERGENCY SERVICE
NEEDS, AND
  (III) REVISION OF THE CASE MANAGEMENT PLAN, INCLUDING ANY  CHANGES  IN
ACTIVITIES  OR  OBJECTIVES  REQUIRED TO ACHIEVE THE ESTABLISHED GOAL, AS
DETERMINED THROUGH THE CASE MANAGEMENT PROCESS; AND
  (G) MONITORING AND FOLLOW-UP OF CASE MANAGEMENT SERVICES INCLUDE:
  (I) VERIFYING THAT QUALITY SERVICES, AS IDENTIFIED IN THE CASE MANAGE-
MENT PLAN, ARE BEING RECEIVED BY THE ELIGIBLE IMPAIRED PERSON,
  (II) ASSURING THAT THE RECIPIENT IS ADHERING TO  THE  CASE  MANAGEMENT
PLAN,
  (III)  ASCERTAINING  THE  ELIGIBLE IMPAIRED PERSON'S SATISFACTION WITH
THE SERVICES PROVIDED AND ADVISING THE PREPARER OF THE  CASE  MANAGEMENT
PLAN  OF  THE  FINDINGS IF THE PLAN HAS BEEN FORMULATED BY A HEALTH CARE
PROVIDER,
  (IV) COLLECTING DATA AND DOCUMENTING IN THE CASE RECORD  THE  PROGRESS
OF THE ELIGIBLE IMPAIRED PERSON,
  (V)  ASCERTAINING  WHETHER THE SERVICES TO WHICH THE ELIGIBLE IMPAIRED
PERSON HAS BEEN REFERRED ARE AND CONTINUE TO BE APPROPRIATE  TO  HIS  OR
HER NEEDS, AND MAKING NECESSARY REVISIONS TO THE CASE MANAGEMENT PLAN,
  (VI)  MAKING  ALTERNATE  ARRANGEMENTS  WHEN  SERVICES  ARE POTENTIALLY
UNAVAILABLE TO THE ELIGIBLE IMPAIRED PERSON, AND
  (VII) ASSISTING THE ELIGIBLE IMPAIRED PERSON AND/OR HIS OR HER PARENT,
GUARDIAN, CARETAKER AND/OR ANY AND ALL PROVIDERS OF SERVICES TO  RESOLVE
DISAGREEMENTS,  QUESTIONS  OR  PROBLEMS  WITH IMPLEMENTATION OF THE CASE
MANAGEMENT PLAN.
  5. COUNSELING AND EXIT  PLANNING.  THE  FOLLOWING  MEASURES  SHALL  BE
INCLUDED  WITHIN  ANY  COUNSELING AND EXIT PLANNING PROVIDED BY THE CASE
MANAGEMENT PLAN AND DEVELOPED IN CONJUNCTION WITH THE  PROGRAM  AND  THE
DEPARTMENT:
  (A)  ASSURING THAT THE ELIGIBLE IMPAIRED PERSON OBTAINS, ON AN ONGOING
BASIS, THE MAXIMUM BENEFIT FROM THE SERVICES RECEIVED;
  (B) DEVELOPING SUPPORT GROUPS FOR THE ELIGIBLE IMPAIRED PERSON, HIS OR
HER PARENT, GUARDIAN OR CARETAKER AND INFORMAL PROVIDERS OF SERVICES;

S. 2445                             9

  (C) MEDIATING WITH THE ELIGIBLE IMPAIRED PERSON, HIS  OR  HER  PARENT,
GUARDIAN OR CARETAKER AND/OR INFORMAL PROVIDERS OF SERVICES ANY PROBLEMS
WITH SERVICE PROVISION THAT MAY OCCUR; AND
  (D) FACILITATING THE ELIGIBLE IMPAIRED PERSON'S ACCESS TO OTHER APPRO-
PRIATE CARE AS NEEDED.
  6.  PROCEDURAL  REQUIREMENTS  FOR  THE  ASSESSMENT  AND  PROVISION  OF
SERVICES.
  (A) AN ASSESSMENT  PROVIDES  VERIFICATION  OF  THE  ELIGIBLE  IMPAIRED
PERSON'S  LEVEL  OF  IMPAIRMENT, HIS OR HER CONTINUING NEED FOR SERVICES
AND THE SERVICE PRIORITIES  AND  EVALUATION  OF  THE  ELIGIBLE  IMPAIRED
PERSON'S ABILITY TO BENEFIT FROM SUCH SERVICES.
  (B)  AN  ASSESSMENT  MUST BE COMPLETED BY A CASE MANAGER WITHIN THIRTY
DAYS OF THE DATE OF ENTRY INTO THE PROGRAM. THE  REFERRAL  FOR  SERVICES
MAY  INCLUDE A PLAN OF CARE CONTAINING SIGNIFICANT INFORMATION DEVELOPED
BY THE PROGRAM WHICH SHOULD BE INCLUDED AS AN INTEGRAL PART OF THE  CASE
MANAGEMENT PLAN.
  (C)  AN  UPDATED ASSESSMENT OF THE ELIGIBLE IMPAIRED PERSON'S NEED FOR
CASE MANAGEMENT AND OTHER SERVICES DEEMED NECESSARY MUST BE COMPLETED BY
THE CASE MANAGER EVERY SIX MONTHS, OR SOONER IF REQUIRED BY  CHANGES  IN
THE ELIGIBLE IMPAIRED PERSON'S LEVEL OF IMPAIRMENT, CONDITION OR CIRCUM-
STANCES.
  7.  CASE  MANAGEMENT  PLAN.  A  WRITTEN  CASE MANAGEMENT PLAN SHALL BE
COMPLETED BY THE CASE MANAGER FOR EACH ELIGIBLE IMPAIRED  PERSON  WITHIN
THIRTY DAYS OF THE DATE OF ENTRY INTO THE PROGRAM.
  (A) THE CASE MANAGEMENT PLAN SHALL BE REVIEWED AND UPDATED BY THE CASE
MANAGER  AS  REQUIRED BY CHANGES IN THE ELIGIBLE IMPAIRED PERSON'S LEVEL
OF IMPAIRMENT, CONDITION OR CIRCUMSTANCES, BUT NOT LESS FREQUENTLY  THAN
EVERY  SIX  MONTHS SUBSEQUENT TO THE INITIAL PLAN AND INITIAL ENTRY INTO
THE PROGRAM.
  (B) THE CASE MANAGEMENT PLAN SHALL SPECIFY:
  (I) THOSE ACTIVITIES WHICH THE ELIGIBLE IMPAIRED PERSON IS EXPECTED TO
UNDERTAKE WITHIN A GIVEN PERIOD OF TIME  TOWARD  THE  ACCOMPLISHMENT  OF
EACH CASE MANAGEMENT GOAL;
  (II) THE NAME OF THE PERSON OR AGENCY, INCLUDING THE INDIVIDUAL AND/OR
PARENT, GUARDIAN OR CARETAKER, WHO WILL PERFORM NEEDED TASKS;
  (III)  THE TYPE OF TREATMENT PROGRAM OR SERVICE PROVIDERS TO WHICH THE
RECIPIENT WILL BE REFERRED;
  (IV) THE METHOD OF PROVISION AND THOSE ACTIVITIES TO BE PERFORMED BY A
SERVICE PROVIDER OR  OTHER  PERSON  TO  ACHIEVE  THE  ELIGIBLE  IMPAIRED
PERSON'S RELATED GOAL AND OBJECTIVE; AND
  (V)  THE TYPE, AMOUNT, FREQUENCY AND POTENTIAL DURATION OF SERVICES TO
BE DELIVERED OR TASKS TO BE PERFORMED.
  8. CONTINUITY OF SERVICE. (A) CASE MANAGEMENT SERVICES MUST BE ONGOING
FROM THE TIME THE ELIGIBLE IMPAIRED PERSON IS ACCEPTED  BY  THE  PROGRAM
THROUGHOUT HIS OR HER LIFETIME UNLESS:
  (I)  THE  COORDINATION OF SERVICES PROVIDED THROUGH CASE MANAGEMENT IS
NOT REQUIRED OR IS NO LONGER REQUIRED BY THE ELIGIBLE IMPAIRED PERSON;
  (II) THE ELIGIBLE IMPAIRED PERSON MOVES OUT OF STATE; OR
  (III) THE ELIGIBLE IMPAIRED PERSON AND/OR HIS OR HER PARENT,  GUARDIAN
OR  CARETAKER,  ON  THE  ELIGIBLE  IMPAIRED  PERSON'S BEHALF, REFUSES TO
ACCEPT CASE MANAGEMENT SERVICES.
  (B) CONTACT WITH THE  ELIGIBLE  IMPAIRED  PERSON  AND/OR  HIS  OR  HER
PARENT,  GUARDIAN  OR CARETAKER ON THE ELIGIBLE IMPAIRED PERSON'S BEHALF
MUST BE MAINTAINED BY  THE  CASE  MANAGER  AT  LEAST  MONTHLY,  OR  MORE
FREQUENTLY  AS  SPECIFIED IN THE PROVIDER AGREEMENT WITH THE PROGRAM AND
THE DEPARTMENT.

S. 2445                            10

  9. QUALIFICATIONS OF  PROVIDERS  OF  CASE  MANAGEMENT  SERVICES.  CASE
MANAGEMENT  SERVICES  SHALL  BE  PROVIDED  BY  SOCIAL SERVICES AGENCIES,
FACILITIES, PERSONS, AND GROUPS POSSESSING  THE  CAPABILITY  TO  PROVIDE
SUCH SERVICES AND WHICH ARE APPROVED BY THE PROGRAM, IN CONJUNCTION WITH
THE COMMISSIONERS OF DEVELOPMENTAL DISABILITIES AND MENTAL HEALTH PURSU-
ANT TO CASE MANAGEMENT PROVIDER QUALIFICATIONS, INCLUDING:
  (A) FACILITIES LICENSED OR CERTIFIED UNDER STATE LAW OR REGULATION;
  (B)  HEALTH CARE OR SOCIAL WORK PROFESSIONALS LICENSED OR CERTIFIED IN
ACCORDANCE WITH STATE LAW;
  (C) STATE AND LOCAL GOVERNMENTAL AGENCIES; AND
  (D) HOME HEALTH AGENCIES CERTIFIED UNDER STATE LAW.
  10. CASE MANAGERS. EACH CASE MANAGER SHALL HAVE TWO YEARS  EXPERIENCE,
INCLUDING  THE  PERFORMANCE  OF  ASSESSMENTS AND THE DEVELOPMENT OF CASE
MANAGEMENT PLANS. VOLUNTARY OR PART-TIME EXPERIENCE WHICH CAN  BE  VERI-
FIED  WILL BE ACCEPTED ON A PRO RATA BASIS. THE FOLLOWING MAY BE SUBSTI-
TUTED FOR THIS REQUIREMENT:
  (A) ONE YEAR OF CASE MANAGEMENT EXPERIENCE AND A DEGREE IN A HEALTH OR
HUMAN SERVICES FIELD;
  (B) ONE YEAR OF CASE MANAGEMENT EXPERIENCE AND AN ADDITIONAL  YEAR  OF
EXPERIENCE  IN  OTHER  ACTIVITIES  RELATED  TO PERSONS WITH NEUROLOGICAL
IMPAIRMENT;
  (C) A BACHELOR'S OR MASTER'S DEGREE WHICH INCLUDES THE PERFORMANCE  OF
ASSESSMENTS AND DEVELOPMENT OF CASE MANAGEMENT PLANS; OR
  (D)  MEETING  THE REGULATORY REQUIREMENTS OF A STATE AGENCY FOR A CASE
MANAGER.
  11. REQUIREMENTS FOR THE PROVISION OF SERVICES. THOSE ENTITIES SEEKING
TO PROVIDE CASE MANAGEMENT SERVICES THROUGH THE PROGRAM AND THE  DEPART-
MENT TO ELIGIBLE IMPAIRED PERSONS MUST:
  (A) ESTABLISH A WRITTEN MEMORANDUM OF UNDERSTANDING OR REFERRAL AGREE-
MENT  DESCRIBING THEIR CURRENT OR PROJECTED RELATIONSHIP WITH THE SOCIAL
SERVICES DISTRICT OR DISTRICTS WHERE CASE MANAGEMENT  SERVICES  WILL  BE
PROVIDED. A COPY OF THE PROPOSED MEMORANDUM OF UNDERSTANDING OR REFERRAL
AGREEMENT  MUST ACCOMPANY THE PROPOSAL SUBMITTED TO BOTH THE PROGRAM AND
THE DEPARTMENT. SUCH PROPOSALS AND AGREEMENTS  OR  MEMORANDA  OF  UNDER-
STANDING  SHALL  BECOME  THE  BASIS FOR A PROVIDER AGREEMENT BETWEEN THE
PROGRAM AND THE DEPARTMENT AND THE PROVIDER OF CASE MANAGEMENT SERVICES;
  (B) SUBMIT TO THE  PROGRAM  AND  THE  DEPARTMENT  A  WRITTEN  PROPOSAL
SETTING FORTH THEIR PLAN FOR PROVISION OF CASE MANAGEMENT SERVICES. SUCH
PROPOSAL SHALL BECOME THE BASIS FOR A WRITTEN PROVIDER AGREEMENT BETWEEN
THE PROVIDER OF SERVICES AND THE DEPARTMENT;
  (C)  SUBMIT  TO  THE PROGRAM AND DEPARTMENT A WRITTEN PROPOSAL SETTING
FORTH ITS PLAN AND RATES  OR  FEES  FOR  PROVISION  OF  CASE  MANAGEMENT
SERVICES.  SUCH  PROPOSAL  WILL  BECOME THE BASIS FOR A WRITTEN PROVIDER
AGREEMENT BETWEEN THE PROGRAM AND THE DEPARTMENT.
  (I) ALL PROPOSALS FOR PROVISION OF CASE MANAGEMENT SERVICES BECOME THE
PROPERTY OF THE PROGRAM AND THE DEPARTMENT AND MUST BE FOR A  PERIOD  OF
NOT  MORE  THAN FIVE YEARS AND SHALL BE COMPLETED ON FORMS PRESCRIBED BY
THE DEPARTMENT.
  (II) AT THE DISCRETION OF THE PROGRAM AND THE DEPARTMENT, ANY PROPOSAL
SUBMITTED MAY BE  REFERRED  TO  OTHER  APPROPRIATE  STATE  AGENCIES  FOR
CONSULTATION PRIOR TO FINAL APPROVAL BY THE PROGRAM AND THE DEPARTMENT.
  (III)  ALL  PROPOSALS  ARE SUBJECT TO REVIEW AND FINAL APPROVAL BY THE
DEPARTMENT, THE DEPARTMENT OF TAXATION AND FINANCE AND THE  DIVISION  OF
THE BUDGET.

S. 2445                            11

  12.  REFERRAL  AGREEMENTS  AND  MEMORANDA OF UNDERSTANDING.   REFERRAL
AGREEMENTS AND MEMORANDA OF UNDERSTANDING BETWEEN PROVIDERS OF SERVICES,
THE PROGRAM AND THE DEPARTMENT SHALL:
  (A) INCLUDE ALL TERMS OF THE AGREEMENT IN ONE INSTRUMENT, AND BE DATED
AND SIGNED BY AUTHORIZED REPRESENTATIVES OF THE PARTIES TO THE AGREEMENT
SUBSEQUENT TO THE PROGRAM AND DEPARTMENT'S APPROVAL;
  (B)  DEFINE  THOSE  SPECIFIC  FUNCTIONS AND ACTIVITIES TO BE PERFORMED
THROUGH THE CASE MANAGEMENT PROCESSES;
  (C) DESCRIBE THE AMOUNT, DURATION, SCOPE AND METHOD OF PROVIDING  SUCH
CASE  MANAGEMENT  SERVICES  UNDER  THE AGREEMENT INCLUDING THE PROJECTED
FREQUENCY AND TYPES OF CONTACT THAT WILL BE SUSTAINED WITH THE  ELIGIBLE
IMPAIRED  PERSON,  IN  CONSULTATION  WITH HIS OR HER PARENT, GUARDIAN OR
CARETAKER;
  (D) SPECIFY THE LOCATIONS OF THE FACILITIES, IF NECESSARY, TO BE  USED
IN PROVIDING CASE MANAGEMENT SERVICES;
  (E)  SPECIFY THE QUALIFICATIONS REQUIRED FOR CASE MANAGERS SERVING ANY
AND ALL  ELIGIBLE  IMPAIRED  PERSONS,  INCLUDING  COPIES  OF  THEIR  JOB
DESCRIPTIONS;
  (F)  CONTAIN  ASSURANCES  THAT  ELIGIBLE  IMPAIRED  PERSONS  AND THEIR
PARENT, GUARDIAN OR CARETAKER WILL BE INFORMED OF SERVICES AVAILABLE  TO
ADDRESS EMERGENCIES THAT OCCUR OUTSIDE OF USUAL WORKING HOURS;
  (G)  SPECIFY THE REQUIREMENTS FOR CASE MANAGEMENT PROGRAM RESPONSIBIL-
ITY, RECORDKEEPING AND  REPORTS,  AND  ANY  FORMATS  PRESCRIBED  BY  THE
DEPARTMENT FOR SUCH RECORDKEEPING AND REPORTS;
  (H) PROVIDE FOR ACCESS BY STATE AND FEDERAL OFFICIALS TO FINANCIAL AND
OTHER  RECORDS  SPECIFIED  BY  THE  DEPARTMENT WHICH PERTAIN TO THE CASE
MANAGEMENT PROCESS;
  (I) CONTAIN ASSURANCES THAT NO RESTRICTIONS WILL BE  IMPOSED  UPON  AN
ELIGIBLE  IMPAIRED  PERSON'S  CHOICE  OF  PROVIDER  OF  CASE  MANAGEMENT
SERVICES OFFERED UNDER THE  PROGRAM  AND  THAT  EACH  ELIGIBLE  IMPAIRED
PERSON WILL BE ADVISED THAT THE REFUSAL OF SUCH SERVICES INCLUDED IN THE
CASE  MANAGEMENT PLAN DOES NOT CARRY THE THREAT OF FISCAL OR OTHER SANC-
TIONS;
  (J) OUTLINE THE PROVIDER'S CONTINGENCY PLAN FOR ASSURING SMOOTH  TRAN-
SITION  OF  ELIGIBLE IMPAIRED PERSONS TO OTHER AVAILABLE SOURCES OF CASE
MANAGEMENT IF THE PROVIDER IS UNABLE TO CONTINUE PROVIDING SERVICES,  IF
THE  AGREEMENT  BETWEEN  THE PROVIDER, THE PROGRAM AND THE DEPARTMENT IS
NOT RENEWED, OR IF THE AGREEMENT IS TERMINATED;
  (K) INCLUDE A COPY OF THE FORMS WHICH WILL BE UTILIZED  IN  COMPLETING
ASSESSMENTS AND PREPARING CASE MANAGEMENT PLANS; AND
  (L)  CONTAIN ASSURANCES THAT AN ANNUAL EVALUATION OF THE EFFECTIVENESS
OF CASE MANAGEMENT SERVICES WILL BE COMPLETED.
  13. PROVIDER AGREEMENT. UPON  APPROVAL  OF  A  SUBMITTED  PROPOSAL,  A
PROVIDER  AGREEMENT  WILL BE ESTABLISHED BETWEEN THE PROVIDER OF SERVICE
AND THE PROGRAM, IN CONSULTATION  WITH  THE  DEPARTMENT.  SUCH  PROVIDER
AGREEMENTS MUST INCLUDE A COPY OF:
  (A) THE PROVIDER'S PROPOSAL;
  (B)  THE REFERRAL AGREEMENT OR MEMORANDUM OF UNDERSTANDING BETWEEN THE
PROVIDER OF SERVICE AND THE PROGRAM, IF DEEMED NECESSARY;
  (C) A WORK PLAN OUTLINING THE CASE MANAGEMENT PROCESS AS IT APPLIES TO
THE ELIGIBLE IMPAIRED PERSON; AND
  (D) THE FORMS TO BE UTILIZED  IN  THE  PROVISION  OF  CASE  MANAGEMENT
SERVICES.
  14.  AGREEMENT PERIOD. A PROVIDER AGREEMENT SHALL NOT REMAIN IN EFFECT
FOR A PERIOD EXCEEDING TWELVE MONTHS. THIS PROVISION MAY  BE  WAIVED  AT
THE  DISCRETION  OF  THE  PROGRAM AND THE DEPARTMENT IF THE PROVISION OF

S. 2445                            12

SERVICE TO THE ELIGIBLE IMPAIRED PERSON FOR A LONGER PERIOD OF  TIME  IS
JUSTIFIED.
  (A) ANY PROVIDER AGREEMENT WHICH IS NOT BEING PROPERLY FULFILLED SHALL
BE TERMINATED IN ACCORDANCE WITH THE TERMS OF THE AGREEMENT.
  (B) AGREEMENTS TO BE RENEWED MUST BE RENEGOTIATED IN A TIMELY MANNER.
  15.  ANNUAL  EVALUATION.  AN ANNUAL EVALUATION OF EACH CASE MANAGEMENT
PROGRAM SHALL BE PERFORMED BY THE PROVIDER AND SHALL BE  TRANSMITTED  TO
THE  PROGRAM  AND  THE DEPARTMENT AS REQUIRED BY THE PROVIDER AGREEMENT.
THE ANNUAL EVALUATION MUST BE RECEIVED BY THE DEPARTMENT AT LEAST NINETY
DAYS PRECEDING THE ANNUAL ANNIVERSARY OF  THE  EFFECTIVE  DATE  OF  EACH
PROVIDER AGREEMENT.  THE ANNUAL EVALUATION SHALL:
  (A)  RESTATE  THE GOALS AND OBJECTIVES OF THE CASE MANAGEMENT SERVICES
THAT HAVE BEEN PROVIDED, AS LISTED IN THE APPROVED PROVIDER PROPOSAL;
  (B) RESTATE THE SCOPE OF CASE MANAGEMENT PROVIDED;
  (C) USING EVALUATION HYPOTHESES, DEMONSTRATE THE EXTENT TO  WHICH  THE
PROVIDER  HAS  ACHIEVED  THE GOALS AND OBJECTIVES LISTED IN THE APPROVED
PROVIDER PROPOSAL;
  (D) SET FORTH THE TYPES AND SOURCES OF DATA COLLECTED AND USED IN  THE
EVALUATION; AND
  (E)  RECOMMEND  ANY  CASE  MANAGEMENT  SERVICE  CHANGES BASED UPON THE
CONCLUSIONS OF THE EVALUATION.
  16. MONITORING OF PROGRAM  PERFORMANCE  AND  PROVIDER  AGREEMENTS.  TO
ASSURE  THAT  THE QUALITY OF SERVICES PROVIDED IS IN ACCORDANCE WITH THE
REQUIREMENTS OF THIS SECTION, THE FOLLOWING  PERFORMANCE  MONITORING  IS
REQUIRED:
  (A) THE PROGRAM PERFORMANCE OF ANY STATE AGENCY ESTABLISHING AN AGREE-
MENT  WITH  THE DEPARTMENT FOR THE PROVISION OF CASE MANAGEMENT SERVICES
SHALL BE MONITORED BY THE PROGRAM AND THE DEPARTMENT.
  (B) THE PROGRAM PERFORMANCE OF ANY OTHER  ENTITIES  ENTERING  INTO  AN
AGREEMENT  WITH THE DEPARTMENT SHALL BE MONITORED BY THE PROGRAM AND THE
DEPARTMENT.
  (C) PROGRAM PERFORMANCE MONITORING INCLUDES  ON-SITE  VISITS,  AT  SIX
MONTH INTERVALS, TO PROVIDERS OF CASE MANAGEMENT SERVICES. THE SIX-MONTH
ON-SITE MONITORING REQUIREMENT MAY BE WAIVED BY THE DEPARTMENT TO PERMIT
ANNUAL  ON-SITE  MONITORING OF PROVIDERS WHEN, AFTER TWO YEARS OF OPERA-
TION, NO  SIGNIFICANT  DEFICIENCIES  HAVE  BEEN  IDENTIFIED  IN  REPORTS
PREPARED. IN ORDER FOR THE DEPARTMENT TO GRANT A WAIVER, THE APPROPRIATE
PROVIDER  SHALL  SUBMIT TO THE DEPARTMENT A WRITTEN REQUEST FOR A WAIVER
AND COPIES OF THE FOUR MOST RECENT  MONITORING  REPORTS  PREPARED.  UPON
RECEIPT  OF  SUCH  REQUEST  AND  REPORTS,  THE DEPARTMENT WILL DETERMINE
WHETHER THERE ARE SIGNIFICANT OPERATIONAL DEFICIENCIES IDENTIFIED IN THE
MONITORING REPORTS. IF NO SIGNIFICANT DEFICIENCIES ARE  IDENTIFIED,  THE
WAIVER SHALL BE GRANTED AND DEEMED IN FULL FORCE AND EFFECT.
  (D) REPORTS, BASED UPON MONITORING BY A SOCIAL SERVICES DISTRICT OR BY
A  STATE AGENCY, AND ANY OTHER EVALUATIONS REQUIRED BY A PROVIDER AGREE-
MENT SHALL BE FORWARDED TO THE PROGRAM  AND  THE  DEPARTMENT  COMMENCING
WITH  THE  SIXTH  MONTH  FOLLOWING  THE  EFFECTIVE DATE OF EACH PROVIDER
AGREEMENT AND ANNUALLY THEREAFTER AND MUST BE RECEIVED  BY  THE  PROGRAM
AND THE DEPARTMENT NO LATER THAN NINETY DAYS PRIOR TO THE ANNIVERSARY OF
THE PROVIDER AGREEMENT.
  (E)  THE  DEPARTMENT  SHALL  MONITOR  THE  PERFORMANCE OF ALL PROVIDER
AGREEMENTS.
  (F) PROVIDER AGREEMENTS SHALL BE REVIEWED BY THE DEPARTMENT  AT  LEAST
ANNUALLY  TO  VERIFY  CONFORMITY WITH THE TERMS OF SUCH AGREEMENTS. SUCH
MONITORING MAY INCLUDE:

S. 2445                            13

  (I) THE REVIEW OF PERIODIC REPORTS, INCLUDING THOSE  PROGRAM  PERFORM-
ANCE REPORTS PURSUANT TO THIS SUBDIVISION;
  (II)  ANY  OTHER EVALUATIONS OR INFORMATION REQUIRED BY THE DEPARTMENT
OR REQUIRED BY THE PROVIDER AGREEMENT; AND
  (III) ON-SITE VISITS TO PROVIDERS OF SERVICE.
  (G) AUTHORIZATION FOR CASE MANAGEMENT  SERVICES.  AUTHORIZATION  BY  A
PROVIDER  CONTRACTED  WITH THE PROGRAM, IN CONSULTATION WITH THE COMMIS-
SIONER IS REQUIRED PRIOR TO THE PROVISION OF CASE MANAGEMENT SERVICES.
  (H) THE PROVISIONS OF THIS SECTION APPLY TO CASE  MANAGEMENT  SERVICES
PROVIDED ON OR AFTER JANUARY FIRST, TWO THOUSAND TWELVE.
  S  4926. DETERMINATION OF ELIGIBILITY. 1. IN ORDER TO DETERMINE ELIGI-
BILITY FOR CARE UNDER THE PROGRAM, THE MEDICAL RECORDS OF  THE  IMPAIRED
NEWBORN  OR  CHILD  SHALL BE REVIEWED AND THE PERSON PHYSICALLY SEEN AND
EVALUATED IF DEEMED NECESSARY, BY A PHYSICIAN  EXPERT  ASSIGNED  TO  THE
CLAIM BY THE PROGRAM.
  2.  WITHIN  ONE  HUNDRED  EIGHTY  DAYS  OF RECEIVING THE CLAIM AND ALL
NECESSARY ACCOMPANYING DOCUMENTATION AND RECORDS SET FORTH  IN  SUBDIVI-
SION ONE OF THIS SECTION, THE PHYSICIAN EXPERT SHALL DETERMINE WHETHER:
  (A) THE IMPAIRED NEWBORN OR CHILD IS ELIGIBLE FOR THE PROGRAM, AND
  (B) IF SO, THE COMPENSATION TO BE PROVIDED.
  3.  A COPY OF THE DETERMINATION SHALL BE MAILED PROMPTLY TO THE CLAIM-
ANT AND, UPON REQUEST, TO ANY HEALTH CARE PROVIDER NAMED  IN  THE  PETI-
TION.
  S  4927.  APPEALS  OF DETERMINATION OF ELIGIBILITY. 1. IF REQUESTED BY
THE CLAIMANT OR HEALTH CARE PROVIDER, THE PROGRAM MAY CONVENE A PANEL OF
THREE PHYSICIAN EXPERTS TO REVIEW APPEALS OF DETERMINATION BY  A  PHYSI-
CIAN  EXPERT  PURSUANT  TO SECTION FORTY-NINE HUNDRED TWENTY-SIX OF THIS
ARTICLE THAT THE CLAIMANT IS INELIGIBLE FOR THE PROGRAM. THE  REVIEW  OF
AN  APPEAL  SHALL  BE  COMMENCED  NOT LATER THAN ONE HUNDRED TWENTY DAYS
AFTER THE DETERMINATION OF INELIGIBILITY IS  PROVIDED  TO  THE  CLAIMANT
PURSUANT TO SECTION FORTY-NINE HUNDRED TWENTY-SIX OF THIS ARTICLE.
  2.  THE  PROGRAM  SHALL  PROVIDE NOTICE OF THE DATE, TIME AND PLACE OF
SUCH REVIEW TO THE CLAIMANT AND TO ANY PERSON  WHO  REQUESTS  NOTICE.  A
CLAIMANT MAY PRESENT INFORMATION FOR THIS REVIEW.
  3.  THE  PROGRAM MAY REQUIRE THE CLAIMANT AND ANY HEALTH CARE PROVIDER
WHO PROVIDED PRENATAL, DELIVERY, POSTPARTUM, NEONATAL OR PEDIATRIC  CARE
TO  THE  IMPAIRED  PERSON TO SPEAK AT THE APPEAL, PROVIDED THAT ANY SUCH
PERSON SHALL HAVE THE RIGHT TO BE REPRESENTED BY COUNSEL.
  4. THE PHYSICIAN EXPERT APPEAL PANEL SHALL PROVIDE ITS WRITTEN  DETER-
MINATION  TO THE PROGRAM WITHIN THIRTY DAYS OF THE HEARING. THE DECISION
SHALL BE DEEMED BINDING WHEN AT LEAST TWO OF THE THREE MEMBERS AGREE.
  5. SUCH REPORT SHALL INDICATE WHETHER THE NEWBORN OR CHILD IS ELIGIBLE
FOR THE PROGRAM, AND IF SO, THE LEVEL OF  COMPENSATION  TO  BE  PROVIDED
SHALL BE COMMUNICATED TO THE PROGRAM AND THE DEPARTMENT.
  S  4928.  COMPENSATION.  1. (A) COMPENSATION PROVIDED PURSUANT TO THIS
ARTICLE SHALL COVER, TO THE EXTENT NOT EXCLUDED IN  SUBDIVISION  TWO  OF
THIS SECTION, MEDICALLY-NECESSARY AND REASONABLE EXPENSES RELATED TO THE
IMPAIRMENT FOR MEDICAL AND HOSPITAL CARE, SERVICES AND SUPPLIES, REHABI-
LITATIVE AND REMEDIAL CARE, RESIDENTIAL AND CUSTODIAL CARE AND SERVICES,
DRUGS,  SPECIAL  EQUIPMENT, AND HEALTH INSURANCE CO-PAYMENTS AND DEDUCT-
IBLES, SUBJECT TO ELIGIBILITY IN SECTION FORTY-NINE  HUNDRED  TWENTY-SIX
OF THIS ARTICLE.
  (B)  COMPENSATION  PROVIDED PURSUANT TO THIS ARTICLE ALSO MAY INCLUDE,
TO THE EXTENT NOT EXCLUDED IN SUBDIVISION TWO OF THIS  SECTION,  AND  AS
APPROVED  BY  THE  CASE  MANAGER,  REASONABLE  EXPENSES  FOR: ADDITIONAL
MEDICAL CARE, SERVICES AND SUPPLIES; CARE BY OTHER  PROFESSIONALS,  SUCH

S. 2445                            14

AS  SOCIAL WORKERS, COUNSELORS, MENTAL HEALTH PROFESSIONALS, HOME HEALTH
CARE WORKERS, CUSTODIANS AND MEDICAL PROFESSIONALS; APPROPRIATE  MODIFI-
CATIONS  TO  HOUSING  TO  ASSURE  THAT THE IMPAIRED NEWBORN RESIDES IN A
SUITABLE ENVIRONMENT; EDUCATIONAL AND VOCATIONAL TRAINING; AND TRANSPOR-
TATION, SUBJECT TO SUBDIVISIONS TWO AND THREE OF THIS SECTION.
  (C) COMPENSATION PROVIDED PURSUANT TO THIS ARTICLE MAY INCLUDE REASON-
ABLE  EXPENSES  INCURRED  IN  CONNECTION  WITH THE FILING OF THE INITIAL
CLAIM INCLUDING REASONABLE ATTORNEY'S FEES AS DETERMINED IN REGULATION.
  2. COMPENSATION SHALL EXCLUDE CARE, SERVICES OR ITEMS,  OR  REIMBURSE-
MENT,  WHICH  THE IMPAIRED PERSON HAS RECEIVED OR IS ENTITLED TO RECEIVE
FROM:
  (A) ANY COMMERCIAL OR SELF-INSURING  ENTITY,  CORPORATION  SUBJECT  TO
ARTICLE  FORTY-THREE OF THE INSURANCE LAW, PREPAID HEALTH PLAN OR HEALTH
MAINTENANCE ORGANIZATION;
  (B) ANY FEDERAL, STATE OR LOCAL  GOVERNMENT  PROGRAM,  EXCEPT  TO  THE
EXTENT  SUCH  EXCLUSION  MAY  BE PROHIBITED BY FEDERAL LAW AND EXCEPT AS
PROVIDED IN SUBDIVISION FIVE OF THIS SECTION,  PROVIDED,  HOWEVER,  THAT
COMPENSATION  MAY  INCLUDE  CARE,  SERVICES  OR ITEMS, OR REIMBURSEMENT,
WHICH ARE  IN  SUPPLEMENTATION  OF  ANY  CARE,  SERVICES  OR  ITEMS,  OR
REIMBURSEMENT, WHICH THE NEWBORN HAS RECEIVED, OR IS ENTITLED TO RECEIVE
FROM  ANY  SUCH  GOVERNMENT  PROGRAM  TO THE EXTENT PERMITTED UNDER SUCH
PROGRAM; AND
  (C) ANY PERSON AS A RESULT OF OR IN SETTLEMENT OF A  CIVIL  ACTION  OR
PROSPECTIVE CIVIL ACTION BY OR ON BEHALF OF THE IMPAIRED PERSON RELATING
TO THE IMPAIRMENT, INCLUDING AN ACTION DESCRIBED IN THIS SECTION.
  3.  COMPENSATION  SHALL NOT INCLUDE ANY MONETARY AWARD ATTRIBUTABLE TO
NON-ECONOMIC DAMAGES OR LOSS OF FUTURE EARNINGS.
  4. (A) COMPENSATION MAY BE IN THE FORM OF A  DOCUMENTED  CASH  PAYMENT
FOR EXPENSES PREVIOUSLY INCURRED; PERIODIC PAYMENTS MADE FOR EXPENSES AS
INCURRED;  A HEALTH INSURANCE POLICY; THE PROVISION OF CARE, SERVICES OR
ITEMS BY A PROVIDER PURSUANT TO A CONTRACT  WITH  THE  PROGRAM;  A  CASH
PAYMENT  TO  ESTABLISH,  OR  TO  ADD  TO, A TRUST FOR THE BENEFIT OF THE
IMPAIRED NEWBORN OR CHILD; PERIODIC PAYMENTS FOR THE SUPPLEMENTAL  NEEDS
OF  THE  IMPAIRED  NEWBORN WHICH ARE NOT PROVIDED BY GOVERNMENT ENTITLE-
MENTS, WITH A RECOGNITION OF THE SPECIAL NEEDS  OF  AN  IMPAIRED  PERSON
WHO,  BECAUSE  OF THE NATURE OF THE DISABILITIES OF THE IMPAIRED PERSON,
MAY BE DEPENDENT ON GOVERNMENT ENTITLEMENTS FOR LIFE; A  COMBINATION  OF
THE  FOREGOING;  OR SUCH OTHER FORM OF COMPENSATION THAT WILL ENSURE THE
PROVISION OF THE CARE, SERVICES AND ITEMS SET FORTH IN  SUBDIVISION  ONE
OF THIS SECTION.
  (B)   COMPENSATION   FOR  EXPENSES  SHALL  BE  LIMITED  TO  REASONABLE
REIMBURSEMENT FOR SIMILAR CARE, SERVICES AND ITEMS PROVIDED IN THE  SAME
COMMUNITY TO OTHER PERSONS WITH IMPAIRMENTS.
  5.  (A) COMPENSATION FOR THE FOLLOWING PERSONS SHALL BE REDUCED TO THE
EXTENT THAT THE MEDICAL ASSISTANCE PROGRAM PROVIDES EQUIVALENT OR BETTER
COVERAGE OF MEDICAL CARE, SERVICES AND SUPPLIES THAN WOULD  BE  PROVIDED
AS COMPENSATION BY THE PROGRAM WITHOUT REGARD TO COVERAGE BY THE MEDICAL
ASSISTANCE PROGRAM:
  (I) ANY IMPAIRED NEWBORN WHO IS DEEMED TO HAVE BEEN FOUND ELIGIBLE FOR
MEDICAL  ASSISTANCE ON THE DATE OF BIRTH AND TO REMAIN ELIGIBLE FOR SUCH
ASSISTANCE FOR A PERIOD OF ONE YEAR, BY REASON OF BEING BORN TO A  WOMAN
WHO  IS  ELIGIBLE  FOR  AND RECEIVING SUCH ASSISTANCE ON THE DATE OF THE
IMPAIRED NEWBORN'S BIRTH AND WHO REMAINS OR, IF PREGNANT,  WOULD  REMAIN
ELIGIBLE  FOR  SUCH ASSISTANCE, AND FOR SO LONG AS SUCH IMPAIRED NEWBORN
REMAINS ELIGIBLE FOR SUCH ASSISTANCE; AND

S. 2445                            15

  (II) ANY IMPAIRED NEWBORN WHO HAS BEEN INSTITUTIONALIZED NOT LESS THAN
THIRTY DAYS AND WHO WOULD BE ELIGIBLE FOR SUPPLEMENTAL  SECURITY  INCOME
BENEFITS  IF  NOT  INSTITUTIONALIZED  AND  FOR  SO LONG AS SUCH IMPAIRED
NEWBORN REMAINS ELIGIBLE FOR MEDICAL ASSISTANCE.
  (B)  IN  DETERMINING  THE  CONTINUING  ELIGIBILITY  FOR AND PAYMENT OF
MEDICAL ASSISTANCE WITH RESPECT TO SUCH A  CHILD,  THE  AVAILABILITY  OF
BENEFITS  UNDER  THE PROGRAM SHALL NOT BE CONSIDERED INCOME OR RESOURCES
AVAILABLE TO THE CHILD, NOR A LEGAL LIABILITY OF A THIRD-PARTY.
  S 4929. LIMITATION ON PROCESSING OF CLAIMS. ANY CLAIM FOR COMPENSATION
FOR AN ELIGIBLE IMPAIRED PERSON BASED ON A PETITION FILED MORE THAN  TEN
YEARS AFTER THE BIRTH OF THE NEWBORN SHALL BE TIME BARRED.
  S  4930. NOTICE TO OBSTETRIC PATIENTS. 1. OBSTETRIC HOSPITALS MAY POST
NOTICE OF THIS PROGRAM AT APPROPRIATE LOCATIONS.  WRITTEN  INFORMATIONAL
PAMPHLETS  DESCRIBING  THE  PROGRAM  MAY  BE PROVIDED AT ANY TIME TO THE
PARENTS OR GUARDIANS AND SHALL INCLUDE A CLEAR AND  CONCISE  EXPLANATION
OF  THE  BENEFITS AVAILABLE TO THE PATIENT UNDER THE PROGRAM, THE AVAIL-
ABILITY OF GOVERNMENTAL ASSISTANCE PROGRAMS FOR CHILDREN WITH  DISABILI-
TIES  AND THE TOLL-FREE TELEPHONE NUMBER OF THE PROGRAM'S CLAIMS ASSIST-
ANCE UNIT.
  2. IF A HOSPITAL AT WHICH A PATIENT DELIVERS A  CHILD  HAS  REASON  TO
BELIEVE  THAT  A  CHILD HAS AN IMPAIRMENT, IT WILL MAKE EVERY ATTEMPT TO
NOTIFY THE PROGRAM'S CLAIMS ASSISTANCE UNIT, AND THE EARLY  INTERVENTION
OFFICIAL APPOINTED PURSUANT TO TITLE II-A OF ARTICLE TWO OF THIS CHAPTER
IN  THE  LOCALITY  IN WHICH THE CHILD RESIDES, EACH OF WHICH SHALL OFFER
THE LEGALLY RESPONSIBLE PARENTS OR GUARDIANS THE OPPORTUNITY TO  DISCUSS
BENEFITS,  RESOURCES  AND  SERVICES  AVAILABLE, AND ASSIST THE PARENT OR
PARENTS IN APPLYING FOR THEM.
  S 4931. NEW YORK STATE STANDARD OF CARE ASSESSMENT PROGRAM.  1.  THERE
IS  HEREBY  ESTABLISHED  WITHIN THE NEUROLOGICAL IMPAIRED PROGRAM OF NEW
YORK STATE, THE STANDARD OF CARE ASSESSMENT PROGRAM.
  2. NO CIVIL ACTION SHALL BE BROUGHT IN ANY COURT AGAINST ANY EMPLOYEE,
PHYSICIAN, NURSE OR OTHER EXPERT ENGAGED BY  THE  PROGRAM  FOR  ANY  ACT
DONE,  FAILURE TO ACT, OR STATEMENT OR OPINION MADE, WITHIN THE SCOPE OF
HIS OR HER DUTIES AS AN EMPLOYEE OF SUCH PROGRAM.
  3. A LIST OF PHYSICIAN ASSESSORS WILL  BE  ASSEMBLED,  MAINTAINED  AND
CONTRACTED FOR THE PURPOSE OF MAKING DETERMINATIONS OF NEGLIGENCE.
  4.  PHYSICIANS  AND NURSES SHALL BE PAID A FLAT FEE PER CASE FOR THEIR
WORK EITHER AS A LEVEL I OR LEVEL  II  ASSESSOR  AS  DETERMINED  THROUGH
REGULATION.
  5.  THE  DECISIONS  OF  INDIVIDUAL ASSESSORS SHALL BE EXAMINED PERIOD-
ICALLY FOR FAIRNESS, QUALITY AND APPROPRIATENESS  BY  THE  STATE  AGENCY
THAT ADMINISTERS THE PROGRAM OR OTHER AGENCY AS DEEMED BY REGULATION.
  6.  QUALIFICATIONS OF PHYSICIAN ASSESSORS. (A) PHYSICIANS MAY SERVE AS
EITHER A LEVEL I OR LEVEL II ASSESSOR BUT NEVER BOTH IN THE SAME CLAIM.
  (B) THE DECISIONS OF INDIVIDUAL ASSESSORS SHALL  BE  EXAMINED  PERIOD-
ICALLY  FOR  FAIRNESS,  QUALITY  AND APPROPRIATENESS BY THE STATE AGENCY
THAT ADMINISTERS THE PROGRAM OR OTHER AGENCY AS DEEMED BY REGULATION.
  7. DUTIES  OF  PHYSICIAN  ASSESSORS.  THE  PHYSICIAN  ASSESSORS  SHALL
PERFORM THE FOLLOWING DUTIES:
  (A)  WITHIN THIRTY DAYS OF THE NOTICE OF AN ELIGIBILITY DETERMINATION,
A LEVEL I STANDARD OF  CARE  ASSESSMENT  SHALL  COMMENCE.  ALL  RELEVANT
RECORDS SHALL BE OBTAINED FROM THE INSTITUTION OR INSTITUTIONS WHERE THE
CHILD WAS BORN AND RECEIVED ITS NEONATAL CARE.
  (B) THE LEVEL I ASSESSMENT SHALL CONCLUDE WITH A DETERMINATION OF:

S. 2445                            16

  (I)  WHETHER  THE  STANDARD OF CARE WAS MET BY EACH OF THE HEALTH CARE
PROVIDERS WHO PARTICIPATED IN THE OBSTETRICAL CARE AND NEONATAL  MANAGE-
MENT;
  (II)  WHETHER SYSTEMS FAILURES AT THE SITE OF THE DELIVERY OR NEONATAL
CARE CONTRIBUTED ADVERSELY TO THE CHILD'S OUTCOME.
  (C) EACH CASE SHALL RECEIVE AN INITIAL ASSESSMENT BY A LEVEL  I  PANEL
CONSISTING  OF  TWO  BOARD CERTIFIED OBSTETRICIANS AND A BOARD CERTIFIED
NEONATOLOGIST WHO SHALL DETERMINE WITHIN NINETY DAYS:
  (I) WHETHER THE STANDARD OF CARE WAS MET BY  EACH  OF  THE  INDIVIDUAL
PRACTITIONERS  WHO PROVIDED CARE TO THE PATIENT'S MOTHER DURING THE ANTE
PARTUM, INTRAPARTUM AND DELIVERY PERIODS AS WELL AS THOSE CARING FOR THE
NEONATE DURING THE FIRST TWENTY-EIGHT DAYS OF HIS OR HER BIRTH;
  (II) WHETHER SYSTEMS FAILURES AT THE SITE OF THE DELIVERY OR  NEONATAL
CARE CONTRIBUTED ADVERSELY TO THE CHILD'S OUTCOME.
  (D)  THE PANEL SHALL LIMIT ITS REVIEW TO THE RECORDS IT HAS BEEN SENT.
IF THIS MATERIAL IS DEEMED TO BE INSUFFICIENT TO  MAKE  A  DETERMINATION
REGARDING THE STANDARD OF CARE RENDERED, THE CASE SHALL BE REFERRED TO A
PANEL OF LEVEL II ASSESSORS.
  (E)  IF ALL THREE MEMBERS OF THE LEVEL I PANEL ARE UNANIMOUS IN DECID-
ING THAT THE STANDARD OF CARE WAS MET BY  THE  INDIVIDUAL  PRACTITIONERS
AND  PARTICIPATING  HOSPITALS  WHERE  THE  CARE WAS RENDERED, THE REVIEW
PROCESS CONCLUDES.
  (F) IF THE LEVEL I PANEL FINDS THAT THE STANDARD OF CARE HAS NOT  BEEN
MET,  OR  IS  DIVIDED  IN THEIR OPINION ON THIS MATTER, THE CASE WILL BE
REFERRED TO A SECOND LEVEL OF REVIEW. THE PANEL OF  LEVEL  II  ASSESSORS
WILL  CONSIST OF THREE SUBSPECIALTY BOARDED PHYSICIANS OR ADVANCED PRAC-
TICE NURSES WHOSE AREA OF EXPERTISE WILL  BE  DECIDED  BY  THE  LEVEL  I
SCREENING  PANELISTS. THIS SECOND PANEL CANNOT CONTAIN ANY OF THE PHYSI-
CIANS FROM THE LEVEL I PANEL.
  (G) WITHIN THIRTY DAYS OF THE FINDINGS OF THE LEVEL I PANEL, THE LEVEL
II PANEL WILL REVIEW THE RECORDS THAT HAVE BEEN SUBMITTED AND NOTIFY THE
INVOLVED HEALTH CARE PROVIDERS THAT A LEVEL II ASSESSMENT IS IN PROCESS.
THE LEVEL II ASSESSMENT SHALL BE COMPLETED  WITHIN  ONE  HUNDRED  TWENTY
DAYS.  LEVEL  II  ASSESSORS  CAN  REQUEST  ADDITIONAL RECORDS FOR REVIEW
AND/OR INTERVIEW ANY INDIVIDUALS THAT WERE  INVOLVED  IN  THE  PATIENT'S
OBSTETRICAL OR NEONATAL CARE.
  (H)  IF  TWO  OR  MORE OF THE LEVEL II PANEL FIND THAT THE STANDARD OF
CARE HAS BEEN MET, THE REVIEW PROCESS CONCLUDES.
  (I) IF TWO OR MORE OF THE LEVEL II PANEL FIND  THAT  THE  STANDARD  OF
CARE  HAS NOT BEEN MET, THE HEALTH CARE PROVIDERS SHALL BE SENT A REPORT
DETAILING THE ACTS OF NEGLIGENCE THAT HAVE BEEN IDENTIFIED.
  (J) IF TWO OR MORE OF THE LEVEL II  PANEL  OF  ASSESSORS  DECIDE  THAT
SYSTEMS FAILURES CONTRIBUTED ADVERSELY TO THE CHILD'S OUTCOME THE SENIOR
LEADERSHIP  OF THE INSTITUTION INVOLVED SHALL BE SENT A REPORT DETAILING
THE NEGLIGENT OFFENSES THAT HAVE BEEN IDENTIFIED.
  (K) IF TWO OR MORE OF THE LEVEL II  PANEL  OF  ASSESSORS  DECIDE  THAT
FAILURE TO MEET THE STANDARD OF CARE BY ANY OF THE HEALTH CARE PROVIDERS
OR  HOSPITALS  CONSTITUTES  NEGLIGENCE  THAT  CONTRIBUTED  TO  THE  POOR
OUTCOME, A REPORT SHALL BE SENT TO THE OFFICE  OF  PROFESSIONAL  MEDICAL
CONDUCT  AND  THE  NY PATIENT OCCURRENCE, REPORTING AND TRACKING SYSTEM.
ALL STATUTORY AND REGULATORY REQUIREMENTS OF SAID PHYSICIAN AND HOSPITAL
REVIEW PROGRAMS SHALL BE AND REMAIN IN EFFECT RELEVANT TO  A  NEGLIGENCE
NOTIFICATION BY THE LEVEL II PANEL.
  (L) IN EACH CASE, THE FAMILY SHALL BE NOTIFIED IN WRITING OF THE FINAL
DETERMINATIONS OF THE STANDARD OF CARE ASSESSMENTS.

S. 2445                            17

  (M)  DETAILED  SUMMARIES OF THE CASES IN WHICH NEGLIGENCE WAS FOUND TO
BE PRESENT SHALL BE KEPT IN A DATABASE.  A  CASEBOOK  SHALL  BE  CREATED
ANNUALLY  WHICH  SHALL  INCLUDE  DE-IDENTIFIED  SELECTED CASES FROM THAT
DATABASE. THE CASES SHALL BE CHOSEN TO ILLUSTRATE SPECIFIC  ISSUES,  AND
SHALL  BE ACCOMPANIED BY COMMENTARY THAT HIGHLIGHTS THOSE ASPECTS OF THE
CASE THAT SHOULD HAVE BEEN MANAGED DIFFERENTLY. THIS CASEBOOK  SHALL  BE
CIRCULATED  ELECTRONICALLY  TO ALL OBSTETRICAL CAREGIVERS THROUGHOUT THE
STATE.
  S 2. This act shall take effect January 1,  2012;  provided,  however,
that effective immediately, the addition, amendment and/or repeal of any
rule  or  regulation necessary for the implementation of this act on its
effective date are authorized and directed to be made and  completed  on
or before such effective date.