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

                                  4838

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             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  unable

S. 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.