Regulates and restricts the reduction of the mental health census of adult homes; establishes a workgroup to study and report on the transition of persons with serious mental illness into the most integrated setting appropriate to their needs.
Ayes (48): Adams, Addabbo, Avella, Ball, Bonacic, Boyle, Breslin, Carlucci, DeFrancisco, Diaz, Farley, Felder, Flanagan, Fuschillo, Gallivan, Golden, Griffo, Grisanti, Hannon, Kennedy, Klein, Lanza, Larkin, Latimer, LaValle, Libous, Little, Marcellino, Marchione, Martins, Maziarz, Montgomery, Nozzolio, O'Brien, Peralta, Ranzenhofer, Ritchie, Robach, Sampson, Savino, Seward, Skelos, Smith, Stavisky, Stewart-Cousin, Valesky, Young, Zeldin
Nays (13): Dilan, Espaillat, Gianaris, Gipson, Hassell-Thomps, Hoylman, Krueger, Perkins, Rivera, Sanders, Serrano, Squadron, Tkaczyk
Excused (2): O'Mara, Parker
TITLE OF BILL: An act to limit the reduction of the mental health census of adult homes and to establish a workgroup to study and report upon the transition of persons with serious mental illness into the most integrated setting appropriate to their needs
PURPOSE: To provide legislative oversight of administrative actions to promote consumer choice, and to ensure the appropriateness and availability of housing options.
SUMMARY OF PROVISIONS:
Section 1 of the bill provides the legislative intent.
Section 2 of the bill provides definitions for the purposes of this act.
Section 3 of the bill provides that no state agency shall undertake any administrative active designed to limit or reduce the mental health census of an adult homes unless such administrative action provides for a number of outlined consumer protections, and clarifies which individuals and adult homes shall be affected.
Section 4 of the bill requires the Commissioners of Health and Mental Health to, within 30 days, convene a workgroup to address the transition of persons with serious mental illness into the most integrated setting appropriate for their needs; and to make recommendations and report by October 1, 2013.
Section 5 of the bill provides that there shall be no administrative actions to limit or reduce mental health beds at certain adult homes authorized to operate a certain capacity of their beds as assisted living beds until 120 days after the workgroup's report is issued.
Section 6 of the bill allows a transitional adult home to request to amend a previously submitted or approved compliance plan by December 1, 2013 to reflect recommendations made by the workgroup.
Section 7 of the bill provides for an immediate effective date.
JUSTIFICATION: The Department of Health adopted regulations earlier this year to limit the number of residents with serious mental illness in large adult homes. Promulgation of these regulations have raised serious concerns about where individuals will potentially be forced to move from, or prohibited from being discharged to, certain adult homes. While every effort must be made to ensure that those diagnosed with mental illness are expeditiously given the opportunity to live in the most integrated setting appropriate to their needs, it is important that individuals are provided a choice and not forced to leave their homes. Further, adequate and appropriate alternatives must be readily available before wholesale changes are made that limit current housing options. New funding and efforts to create housing alternatives are underway for this population; however they are not yet available and hospitals must be able to discharge patients to existing housing options, such as adult homes, that me less-restrictive and more-integrated than psychiatric facilities.
In response to the concerns raised, the Senate included language in its Health and Mental Hygiene Budget Bill (S.2606-C Part P) that provided some guidance with regard to administrative actions taken earlier this year. While agreement was not reached during budget negotiations on language, concerns and need for legislation remain. This bill is similar to the language included in the Senate's budget bill. It emphasizes the importance of facilitating individuals' choice, ensuring the availability of appropriate housing options, and specifying who is considered a "person with serious mental illness." It also recognizes that certain adult homes, given their authorization to operate more than half of their capacity of beds as assisted living beds, may best be subject to modified regulations --the appropriateness of which should be evaluated by stakeholders. Finally, it is important to note that this bill would not delay implementation of measures designed to ensure the State complies with federal law, but merely establishes reasonable parameters for such future actions.
This legislation would provide the important and necessary framework and oversight through which adult home residents with serious mental illness are provided the option to transition to the most integrated setting appropriate to their needs.
LEGISLATIVE HISTORY: New bill, similar to S 2606-C, Part P of 2013.
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: Immediately.
STATE OF NEW YORK ________________________________________________________________________ 4838 2013-2014 Regular Sessions IN SENATE April 26, 2013 ___________Introduced by Sens. HANNON, GOLDEN -- read twice and ordered printed, and when printed to be committed to the Committee on Mental Health and Developmental Disabilities AN ACT to limit the reduction of the mental health census of adult homes and to establish a workgroup to study and report upon the transition of persons with serious mental illness into the most integrated setting appropriate to their needs THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Legislative intent. The legislature hereby finds that the goals of the state include providing individuals with mental illnesses the tools necessary to: (a) make informed choices and decisions; and (b) achieve equality of opportunity, full inclusion and integration in soci- ety, employment, independent living, and economic and social self-suffi- ciency. The legislature further finds that such goals are best achieved by providing individuals with mental illnesses a variety of residential options that are both integrated and appropriate to the needs of each person. Therefore, the legislature finds it appropriate and prudent to continue overseeing the regulation of adult homes as the state develops community based settings sufficient to meet the desires and needs of individuals with mental illnesses. S 2. Definitions. For the purposes of this act, the following terms shall have the following meanings: (a) "Administrative action" means any decision or action by a state agency, including but not limited to the promulgation, implementation or enforcement of regulations. (b) "Adult home" means an adult care facility established and oper- ated, pursuant to article 7 of the social services law, for the purpose of providing long-term residential care, room, board, housekeeping, personal care and supervision to five or more adults who are unrelated to the operator.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10548-01-3 S. 4838 2
(c) "Mental health census" means the number or percentage of residents in a facility who are persons with serious mental illness. (d) "Persons with serious mental illness" means persons who are in psychiatric crisis; or persons who have a designated diagnosis of mental illness under the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and whose severity and duration of mental illness results in substantial functional disability. (e) "Transitional adult home" means an adult home with a licensed capacity of greater than 80 beds and a mental health census of 25 percent or more of the resident population. Notwithstanding any provision of law or regulation to the contrary, an adult home shall not be considered a transitional adult home if it is authorized to operate 55 percent or more of its total licensed capacity as assisted living program beds, pursuant to section 461-1 of the social services law. S 3. Notwithstanding any provision of law, rule or regulation to the contrary, no state agency shall undertake any administrative action designed to limit or reduce the mental health census of an adult home unless such administrative action: (a) ensures that all persons with serious mental illness are provided with the opportunity to choose to live in the most integrated setting appropriate to their needs, as determined by individual assessments conducted by managed long term care providers or health homes; (b) facilitates informed decision making by persons with serious mental illness by requiring that current residents are presented with fair, objective and unbiased information about their housing options; (c) prohibits the discharge of an adult home resident into community based settings without department certification that appropriate alter- native housing options and supportive services are available in such resident's preferred geographic location; (d) clearly defines "persons with serious mental illness" as persons who have a designated diagnosis of mental illness under the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and whose severity and duration of mental illness directly results in substantial functional disability; provided that (1) "designated diagnosis of mental illness" shall not include a diag- nosis of Alzheimer's disease, dementia or acquired brain injury; and (2) "substantial functional disability" shall be substantiated by documentation that an individual has experienced at least two of the four following functional limitations during the past 12 months as a direct result of such mental illness: (i) marked and prolonged difficulties in self care (personal hygiene, diet, clothing, avoiding injuries, securing health care or complying with medical advice). (ii) marked and prolonged restriction of activities of daily living (maintaining a residence, using transportation, day to day money manage- ment, accessing community services). (iii) marked and prolonged difficulties in maintaining social func- tioning (establishing and maintaining social relationships, interper- sonal interactions with primary partner, children or other family members, friends, neighbors, social skills, compliance with social norms, appropriate use of leisure time). (iv) frequent and consistent deficiencies of concentration, persist- ence or pace resulting in failure to complete tasks in a timely manner (ability to complete tasks commonly found in work settings or in struc- tured activities that take place in home or school settings; individuals may exhibit limitations in these areas when they repeatedly are unableS. 4838 3
to complete simple tasks within an established time period, make frequent errors in tasks, or require assistance in the completion of tasks); (e) provides adequate timeframes to transition persons with serious mental illness into the most integrated setting appropriate to their needs, and does not impose penalties or restrictions on adult home oper- ators making good faith efforts during the transition of such residents; (f) comports with the state goal of providing persons with serious mental illness with care in the most integrated setting appropriate to their needs by permitting discharges from inpatient psychiatric centers or facilities, that are subject to the provisions of article 28 of the public health law, with in-patient psychiatric services to adult homes, where no less-restrictive and appropriate housing alternative is avail- able; (g) is subsequent to the award of assisted living program beds pursu- ant to paragraph (j) of subdivision 3 of section 461-1 of the social services law; and (h) applies only to transitional adult homes. S 4. Within thirty days of the effective date of this act, the commis- sioner of health and the commissioner of mental health, shall jointly convene a workgroup to address the transition of persons with serious mental illness into the most integrated setting appropriate to their needs. The workgroup shall be co-chaired by such commissioners, and shall include: a representative sample of adult home operators, includ- ing operators of assisted living program beds; representatives of asso- ciations of adult home operators; members of adult home resident coun- cils; advocacy organizations working on behalf of adult home residents; individuals with mental illness; providers of alternative housing accom- modations and other support services; and institutions that make refer- rals to adult homes, including hospitals and local governmental units. (a) The workgroup shall provide recommendations for legislative and regulatory actions, which shall address the following: (1) the need to promote and respect informed choice by individuals with serious mental illness, through means including the performance of independent assessments and the provision of objective information; (2) the appropriate scope of regulations, including the propriety of definitions of "persons with serious mental illness" and "transitional adult home"; (3) a reasonable time period for compliance with regulations, which shall take into account the need to discharge inpatients into less-res- trictive settings, and the availability of alternative housing accommo- dations and other support services. Alternative housing shall include, but not be limited to, supported housing, supportive housing, community residences, enriched housing and other housing alternatives that may be appropriate for impacted residents; (4) an examination of possible costs related to transitioning resi- dents of impacted adult homes, as well as strategies by which such costs may be mitigated; (5) the ability of an impacted adult home to provide appropriate accommodations and services for its residents; (6) the development of long-term quality improvement for all adult home residents; and (7) the financial impact of regulations on adult homes, and other licensure options or models of care to which transitional adult homes may transition.S. 4838 4
(b) The workgroup shall submit a report of its findings and recommen- dations to the governor, the temporary president of the senate, the speaker of the assembly, and the chairs of the senate and assembly health committees no later than October 1, 2013. S 5. Notwithstanding any provision of law, rule or regulation to the contrary, no state agency shall undertake any administrative action designed to limit or reduce the mental health census of an adult home authorized to operate 55 percent or more of its total licensed capacity of beds as assisted living program beds, pursuant to section 461-l of the social services law, until 120 days after submission of the work- group report pursuant to section four of this act. S 6. The commissioner of health shall permit a transitional adult home to request to amend a previously submitted or approved compliance plan by December 1, 2013, to reflect recommendations made by the workgroup. Such request shall be granted if, in the discretion of such commission- er, the compliance plan, as amended, would constitute an approvable plan and the amendment would not cause an undue and substantial delay in progress. S 7. This act shall take effect immediately.