S647-2011 Actions

• Jan 4, 2012: REFERRED TO HEALTH
• Jan 5, 2011: REFERRED TO HEALTH

S647-2011 Memo

BILL NUMBER:S647

TITLE OF BILL:
An act
to amend the public health law, in relation to creating adult day
services respite demonstration programs

PURPOSE OR GENERAL IDEA OF THE BILL:
The commissioner of health, in conjunction with the director of the
state office for the aging, is authorized to submit amendments to the
state plan for medical assistance to develop and implement an adult
day services respite demonstration program to test a new model of
respite to allow clients access to the services that best fit their
needs.

The demonstration program will test a system of reimbursement that
reflects the level of service received by the participant rather than
the funding source, which will better use already-existing Medicaid
and private dollars. Client access to community-based Adult Day
services will be delivered in the least restrictive setting; this is
one step that can help encourage the right-sizing of the long term
care system while saving dollars and serving more individuals.

SUMMARY OF PROVISIONS:
Adds a new section 2801-h to the public health law creating adult day
services respite demonstration programs.

Section 2801-h-1 contains definitions to be used in the legislation.

Section 2801-h-2 authorizes the commissioner of health, in conjunction
with the director of the state office for the aging to establish the
respite day demonstration program to extend the period a caregiver
can remain active in the care of elderly or disabled individuals,
avoiding the need for more costly institutional placement.

Section 2801-h-3 establishes 10 demonstration programs with at least
one in each of six regions of the state.

Section 2801-h-4 defines what an operator of the demonstration program
must ensure in relation to the registrants care plan.

Section 2801-h-5 defines the three levels of reimbursement for the
respite day demonstration programs.

Section 2801-h-6 describes the evaluation and reporting requirements
of the demonstration.

Section 2801-h-7 authorizes the commissioner to apply for a state plan
waiver from the federal government.

JUSTIFICATION:
Currently, New Yorkers lack options when it comes to adult an
respite. There is a moratorium on medical day services and social
adult day programs are underfunded, leaving this important
community long-term care option inaccessible for individuals and
caregivers.


Insufficient funding for social adult day services forces
participants into higher and more costly levels of care than they
and encourages
premature entry into public funding streams in order to access any
level of adult day services.  This model will demonstrate the
effectiveness of a new approach
that will allow an individual to receive services based
on their needs, rather than a one size fits all approach.

The adult day respite demonstration programs model is based on the
understanding that the needs of persons with chronic disabilities and
their caregivers change over time. Consumer needs are efficiently and
effectively met when they receive appropriate services according to
their needs. Community goals are best satisfied when the option
exists for programs to provide multiple levels of care and a range of
services in one setting. At the same time, not every program should
be expected or asked to provide all services to all people at all
levels of need.

A level of service system for adult day service delivery will:

1. Identify the level of service need for each client through a
uniform Assessment;

2. Describe the services that are to be provided by the adult day
services program to address those needs;

3. Identify the basic regulations and/or additional regulations with
which the program must comply;

4. Allow payment to vary according to the level of service provided to
the client;

This proposal divides services for individuals into three general
levels. All individuals will be assessed and routinely re-assessed to
determine if they are receiving an appropriate level of service. The
minimum service level to participate in adult day services is Level I.
Individuals will receive the services outlined in Levels II or III
based on individual needs, or as their situation changes.

Every Adult Day Service program will provide a minimum of the core
services identified in Level I. Facilities have the option to offer
progressively increasing care as described in Levels II and III.
Although the proposal describes three levels of service, the needs of
the majority of Adult Day Services participants fall into the Level
II category. The model described allows the participant's changing
level of need to be served within one program or within partnerships
built at the community level that will help strengthen the continuum
of care. This will be accomplished through the ongoing care
coordination and assessment as a client's needs change. Reimbursement
will reflect actual services provided.  New York State
certification/licensing will be based upon the services and staffing
provided.

LEGISLATIVE HISTORY:
2005-06:  A.8650A Amended and Recommitted to Ways & Means
2007-08:  A.1655 Referred to Health


FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect immediately.

S647-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                          647
 2011-2012 Regular Sessions
 I N  SENATE
 (PREFILED)
 January 5, 2011
 
 Introduced  by  Sens. GOLDEN, DeFRANCISCO, RANZENHOFER -- 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 creating adult day
 services respite demonstration programs
 

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  section
 2801-h to read as follows:

 

S  2801-H.  RESPITE DAY DEMONSTRATION PROGRAM. 1. DEFINITIONS. AS USED
 IN THIS SECTION:

 (A) "RESPITE DAY DEMONSTRATION PROGRAM" MEANS A STRUCTURED, COMPREHEN
 SIVE PROGRAM ESTABLISHED BY THE  COMMISSIONER  UNDER  THIS  SECTION,  IN
 CONJUNCTION  WITH  THE  DIRECTOR  OF THE OFFICE FOR THE AGING, PROVIDING
 LEVEL I, LEVEL II OR LEVEL III SERVICES TO REGISTRANTS.
 (B) "REGISTRANT" MEANS A PERSON:

 (I) WHO IS NOT A RESIDENT OF A RESIDENTIAL HEALTH  CARE  FACILITY,  IS
 FUNCTIONALLY  IMPAIRED  AND  NOT HOMEBOUND, AND REQUIRES SUPERVISION AND
 MONITORING BUT DOES NOT REQUIRE CONTINUOUS TWENTY-FOUR HOUR A DAY  INPA
 TIENT CARE AND SERVICES;
 (II) WHOSE ASSESSED SOCIAL AND HEALTH CARE NEEDS CAN SATISFACTORILY BE
 MET  IN  WHOLE OR IN PART BY THE DELIVERY OF APPROPRIATE SERVICES IN THE
 COMMUNITY SETTING; AND
 (III) WHO HAS BEEN ADMITTED TO THE PROGRAM BASED ON AN  INTERDISCIPLI
 NARY COMPREHENSIVE ASSESSMENT.
 (C) "FUNCTIONALLY IMPAIRED" MEANS A PERSON WHO NEEDS THE ASSISTANCE OF
 ANOTHER  PERSON  IN  AT  LEAST  ONE OF THE FOLLOWING ACTIVITIES OF DAILY
 LIVING: TOILETING, MOBILITY, TRANSFERRING OR EATING; OR WHO NEEDS SUPER
 VISION DUE TO COGNITIVE OR PSYCHO-SOCIAL IMPAIRMENT.
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD04229-01-1
 
       S. 647                              2
 (D) "ADULT DAY HEALTH" MEANS THE HEALTH CARE SERVICES  AND  ACTIVITIES
 DEFINED  BY  THE COMMISSIONER UNDER REGULATIONS UNDER SUBPARAGRAPH (VII)
 OF PARAGRAPH F OF SUBDIVISION SIX-A OF SECTION THREE  HUNDRED  SIXTY-SIX
 OF THE SOCIAL SERVICES LAW.
 (E) "LEVEL I SERVICES" MEANS THE FOLLOWING SERVICES:

 (I) SOCIALIZATION AND PLANNED ACTIVITIES;
 (II) SUPERVISION AND MONITORING;
 (III) ROUTINE PERSONAL CARE, WHICH INCLUDES:

 (A)  ASSISTANCE  FOR THE REGISTRANT WITH ANY OF THE FOLLOWING: TOILET
 ING, MOBILITY, TRANSFER AND EATING;
 (B) ROUTINE SKIN CARE;
 (C) CHANGING SIMPLE DRESSINGS; AND
 (D) USING SUPPLIES AND ADAPTIVE AND ASSISTIVE EQUIPMENT;
 (IV) MEDICATION DISTRIBUTION;
 (V) CASE MANAGEMENT; AND
 (VI) MEALS CONSISTENT WITH STANDARDS SET FOR THE NUTRITION PROGRAM FOR
 THE ELDERLY ESTABLISHED BY THE STATE OFFICE FOR THE AGING.
 (F) "LEVEL II SERVICES" MEANS ALL LEVEL I SERVICES, PLUS THE FOLLOWING
 SERVICES:

 (I) MAJOR PERSONAL CARE SERVICES, WHICH INCLUDES:

 (A) ASSISTANCE FOR THE REGISTRANT WITH SHOWERING AND BATHING; AND
 (B) SOME OR TOTAL ASSISTANCE WITH DRESSING AND GROOMING;
 (II) HEALTH EDUCATION;
 (III) NURSING MONITORING AND SUPERVISION OF BASIC TREATMENTS;
 (IV) COUNSELING; AND
 (V) RESTORATIVE THERAPIES NOT LASTING LONGER THAN SIX MONTHS.
 (G) "LEVEL III SERVICES" MEANS AND INCLUDES ALL LEVEL I AND  LEVEL  II
 SERVICES, PLUS THE FOLLOWING SERVICES:

 (I) PSYCHIATRIC EVALUATIONS AND DIAGNOSIS;
 (II) SKILLED NURSING SERVICES;
 (III) MEDICATION MANAGEMENT;
 (IV)  MAINTENANCE AND RESTORATIVE THERAPIES GREATER THAN SIX MONTHS IN
 DURATION; AND
 (V) ADDITIONAL MEDICAL SERVICES AS REQUIRED BY REGULATION.
 (H) "BASE RATE" MEANS THE RATE PAID  FOR  APPROVED  ADULT  DAY  HEALTH
 SERVICES  UNDER  SECTION  THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES
 LAW.
 (I) "OPERATOR" MEANS (I) AN ADULT DAY HEALTH CARE PROGRAM  OR  (II)  A
 SOCIAL  ADULT  DAY  SERVICES  PROGRAM, AS DEFINED IN SECTION TWO HUNDRED
 FIFTEEN OF THE ELDER LAW.
 2. RESPITE DAY DEMONSTRATION PROGRAM. THE COMMISSIONER, IN CONJUNCTION
 WITH THE DIRECTOR OF THE OFFICE FOR THE AGING, MAY ESTABLISH RESPITE DAY
 DEMONSTRATION PROGRAMS BASED UPON ADULT DAY HEALTH CARE AND SOCIAL ADULT
 DAY SERVICES, AS DEFINED IN SECTION TWO HUNDRED  FIFTEEN  OF  THE  ELDER
 LAW,  TO  EXTEND THE PERIOD A CAREGIVER CAN REMAIN ACTIVE IN THE CARE OF
 ELDERLY OR DISABLED INDIVIDUALS,  AVOIDING  THE  NEED  FOR  MORE  COSTLY
 INSTITUTIONAL PLACEMENT.
 3.  ESTABLISHMENT.    THERE  SHALL BE A MINIMUM OF TEN PROGRAMS ESTAB
 LISHED IN SIX LOCATIONS, WITH AT LEAST ONE SITE  TO  BE  LOCATED  WITHIN
 EACH  OF  THE  FOLLOWING SIX REGIONS: NEW YORK CITY, LONG ISLAND, HUDSON
 VALLEY, NORTH COUNTRY, CENTRAL  AND  WESTERN.  EACH  LOCATION'S  PROGRAM
 SHALL  CONSIST OF UP TO FIFTEEN REGISTRANTS. OPERATORS SHALL BE SELECTED
 BASED ON A REQUEST FOR PROPOSAL PROCESS WITH PREFERENCE GIVEN  TO  THOSE
 APPLICANTS  WHO ARE ABLE TO DEMONSTRATE THEIR CAPACITY TO BUILD PARTNER
 SHIPS AND ENTER INTO COOPERATIVE ARRANGEMENTS. THIS SECTION SHALL NOT BE
 
       S. 647                              3
 CONSTRUED TO PERMIT AN OPERATOR TO PROVIDE SERVICES FOR WHICH THE OPERA
 TOR IS NOT OTHERWISE LICENSED OR CERTIFIED TO PROVIDE.
 4. REGISTRANT CARE PLAN. THE OPERATOR SHALL ENSURE:

 (A)  THAT  A  CARE  PLAN  BASED  ON  A COMPREHENSIVE INTERDISCIPLINARY
 ASSESSMENT AND, WHEN APPLICABLE, A TRANSFER OR DISCHARGE PLAN IS  DEVEL
 OPED  FOR EACH REGISTRANT WITHIN FIVE VISITS, NOT TO EXCEED THIRTY DAYS,
 FROM REGISTRATION;
 (B) EACH REGISTRANT'S CARE PLAN SHALL INCLUDE:

 (I) DESIGNATION OF A PROFESSIONAL PERSON TO BE RESPONSIBLE FOR COORDI
 NATING THE CARE PLAN;
 (II) THE REGISTRANT'S PERTINENT DIAGNOSES,  INCLUDING  MENTAL  STATUS,
 TYPES  OF EQUIPMENT AND SERVICES REQUIRED, CASE MANAGEMENT, FREQUENCY OF
 PLANNED VISITS, PROGNOSIS, REHABILITATION POTENTIAL, FUNCTIONAL  LIMITA
 TIONS,  PLANNED  ACTIVITIES,  NUTRITIONAL  REQUIREMENTS, MEDICATIONS AND
 TREATMENTS, NECESSARY MEASURES TO PROTECT AGAINST  INJURY,  INSTRUCTIONS
 FOR  DISCHARGE  OR  REFERRAL  IF APPLICABLE, ORDERS FOR THERAPY SERVICES
 INCLUDING THE SPECIFIC PROCEDURES AND MODALITIES  TO  BE  USED  AND  THE
 AMOUNT, FREQUENCY AND DURATION OF SUCH SERVICES, AND ANY OTHER APPROPRI
 ATE ITEM;
 (III)  THE  MEDICAL  AND NURSING GOALS AND LIMITATIONS ANTICIPATED FOR
 THE REGISTRANT AND, AS APPROPRIATE, THE NUTRITIONAL, SOCIAL, REHABILITA
 TIVE AND LEISURE TIME GOALS AND LIMITATIONS;
 (IV) THE REGISTRANT'S POTENTIAL FOR REMAINING IN THE COMMUNITY; AND
 (V) A DESCRIPTION OF ALL SERVICES TO BE PROVIDED TO THE REGISTRANT  BY
 THE PROGRAM, INFORMAL SUPPORTS AND OTHER COMMUNITY RESOURCES PURSUANT TO
 THE CARE PLAN, AND HOW SUCH SERVICES WILL BE COORDINATED;
 (C)  DEVELOPMENT AND MODIFICATION OF THE CARE PLAN IS COORDINATED WITH
 OTHER HEALTH CARE PROVIDERS OUTSIDE THE PROGRAM WHO ARE INVOLVED IN  THE
 REGISTRANT'S CARE; AND
 (D)  THE  RESPONSIBLE  PERSONS,  WITH THE APPROPRIATE PARTICIPATION OF
 CONSULTANTS IN THE  MEDICAL,  SOCIAL,  PARAMEDICAL  AND  RELATED  FIELDS
 INVOLVED IN THE REGISTRANT'S CARE:

 (I)  RECORD  IN THE CLINICAL RECORD CHANGES IN THE REGISTRANT'S STATUS
 WHICH REQUIRE ALTERATIONS IN THE REGISTRANT CARE PLAN;
 (II) MODIFY THE CARE PLAN ACCORDINGLY;
 (III) REVIEW THE CARE PLAN AT LEAST ONCE EVERY SIX MONTHS AND WHENEVER
 THE REGISTRANT'S CONDITION WARRANTS AND DOCUMENT EACH SUCH REVIEW IN THE
 CLINICAL RECORD; AND
 (IV) PROMPTLY ALERT THE REGISTRANT'S AUTHORIZED  HEALTH  CARE  PRACTI
 TIONER  OF  ANY  SIGNIFICANT CHANGES IN THE REGISTRANT'S CONDITION WHICH
 INDICATE A NEED TO REVISE THE CARE PLAN.
 5. REIMBURSEMENT. FOR THE  PURPOSES  OF  THIS  SECTION,  REIMBURSEMENT
 RATES  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW FOR
 PROGRAMS SHALL BE AS FOLLOWS:

 (A) LEVEL I SERVICES WILL BE REIMBURSED AT FORTY PERCENT OF  THE  BASE
 RATE;
 (B)  LEVEL  II  SERVICES WILL BE REIMBURSED AT SEVENTY-FIVE PERCENT OF
 THE BASE RATE; AND
 (C) LEVEL III SERVICES WILL BE REIMBURSED AT ONE  HUNDRED  PERCENT  OF
 THE BASE RATE.
 6.  EVALUATION  AND  REPORT. NO LATER THAN JANUARY FIRST, TWO THOUSAND
 FOURTEEN, THE COMMISSIONER SHALL PROVIDE  THE  GOVERNOR,  THE  TEMPORARY
 PRESIDENT  OF  THE SENATE AND THE SPEAKER OF THE ASSEMBLY WITH A WRITTEN
 EVALUATION OF THE PROGRAM, BASED ON AN ASSESSMENT TOOL DEVELOPED BY  THE
 DEPARTMENT.  SUCH  EVALUATION SHALL ADDRESS THE OVERALL EFFECTIVENESS OF
 THE PROGRAM IN IMPROVING OUTCOMES FOR INDIVIDUAL PATIENTS AND GROUPS  OF
 
       S. 647                              4
 PATIENTS,  REDUCING  COSTS,  ENCOURAGING PLACEMENTS IN APPROPRIATE ADULT
 DAY HEALTH SERVICES SETTINGS, AND ENHANCING  THE  AVAILABILITY  OF  LESS
 RESTRICTIVE AND LESS INSTITUTIONAL SERVICES; SHALL EVALUATE THE NEED FOR
 LEVEL  I, II AND III SERVICES AND THE IMPACT ON THE AVAILABILITY OF EACH
 OF THE SERVICES ON COST AND INSTITUTIONAL PLACEMENT; AND  SHALL  CONTAIN
 RECOMMENDATIONS  RELATIVE  TO  EXTENDING  AND  EXPANDING THE PROGRAM. IN
 EVALUATING INDIVIDUAL OUTCOMES, THE COMMISSIONER SHALL CONSULT WITH  THE
 CENTER FOR FUNCTIONAL ASSESSMENT RESEARCH AT THE STATE UNIVERSITY OF NEW
 YORK AT BUFFALO.
 7.  WAIVERS  AND FEDERAL APPROVALS. (A) THE PROVISIONS OF THIS SECTION
 SHALL NOT APPLY UNLESS ALL NECESSARY APPROVALS  UNDER  FEDERAL  LAW  AND
 REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
 IN THE COSTS OF SERVICES PROVIDED UNDER THIS SECTION.
 (B)  THE  COMMISSIONER IS AUTHORIZED TO SUBMIT AMENDMENTS TO THE STATE
 PLAN FOR MEDICAL ASSISTANCE AND SUBMIT  ONE  OR  MORE  APPLICATIONS  FOR
 WAIVERS  OF  THE  FEDERAL  SOCIAL  SECURITY  ACT,  TO OBTAIN THE FEDERAL
 APPROVALS NECESSARY TO IMPLEMENT THIS SECTION.  THE  COMMISSIONER  SHALL
 SUBMIT  SUCH AMENDMENTS OR APPLICATIONS FOR WAIVERS BY SEPTEMBER THIRTI
 ETH, TWO THOUSAND ELEVEN, AND SHALL  USE  BEST  EFFORTS  TO  OBTAIN  THE
 APPROVALS REQUIRED BY THIS SUBDIVISION IN A TIMELY MANNER SO AS TO ALLOW
 EARLY IMPLEMENTATION OF THIS SECTION.
 

S 2. This act shall take effect immediately.

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