S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3754
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 27, 2015
                                      ___________
       Introduced  by  M. of A. GOLDFEDER, GUNTHER -- read once and referred to
         the Committee on Mental Health
       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:
    1    Section  1.  Legislative intent. The legislature hereby finds that the
    2  goals of the state include providing individuals with  mental  illnesses
    3  the tools necessary to: (a) make informed choices and decisions; and (b)
    4  achieve equality of opportunity, full inclusion and integration in soci-
    5  ety, employment, independent living, and economic and social self-suffi-
    6  ciency.  The legislature further finds that such goals are best achieved
    7  by providing individuals with mental illnesses a variety of  residential
    8  options  that  are  both integrated and appropriate to the needs of each
    9  person. Therefore, the legislature finds it appropriate and  prudent  to
   10  continue  overseeing the regulation of adult homes as the state develops
   11  community based settings sufficient to meet the  desires  and  needs  of
   12  individuals with mental illnesses.
   13    S  2.  Definitions.  For the purposes of this act, the following terms
   14  shall have the following meanings:
   15    (a) "Administrative action" means any decision or action  by  a  state
   16  agency, including but not limited to the promulgation, implementation or
   17  enforcement of regulations.
   18    (b)  "Adult  home"  means an adult care facility established and oper-
   19  ated, pursuant to article 7 of the social services law, for the  purpose
   20  of  providing  long-term  residential  care,  room, board, housekeeping,
   21  personal care and supervision to five or more adults who  are  unrelated
   22  to the operator.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06381-01-5
       A. 3754                             2
    1    (c) "Mental health census" means the number or percentage of residents
    2  in a facility who are persons with serious mental illness.
    3    (d)  "Persons  with  serious  mental illness" means persons who are in
    4  psychiatric crisis; or persons who have a designated diagnosis of mental
    5  illness under the most recent edition of the Diagnostic and  Statistical
    6  Manual  of  Mental  Disorders, and whose severity and duration of mental
    7  illness results in substantial functional disability.
    8    (e) "Transitional adult home" means an  adult  home  with  a  licensed
    9  capacity  of  greater  than  80  beds  and  a mental health census of 25
   10  percent  or  more  of  the  resident  population.  Notwithstanding   any
   11  provision  of law or regulation to the contrary, an adult home shall not
   12  be considered a transitional adult home if it is authorized  to  operate
   13  55  percent  or  more  of its total licensed capacity as assisted living
   14  program beds, pursuant to section 461-1 of the social services law.
   15    S 3. Notwithstanding any provision of law, rule or regulation  to  the
   16  contrary,  no  state  agency  shall  undertake any administrative action
   17  designed to limit or reduce the mental health census of  an  adult  home
   18  unless such administrative action:
   19    (a)  ensures that all persons with serious mental illness are provided
   20  with the opportunity to choose to live in the  most  integrated  setting
   21  appropriate  to  their  needs,  as  determined by individual assessments
   22  conducted by managed long term care providers or adult homes;
   23    (b) facilitates informed  decision  making  by  persons  with  serious
   24  mental  illness  by  requiring that current residents are presented with
   25  fair, objective and unbiased information about their housing options;
   26    (c) prohibits the discharge of an adult home resident  into  community
   27  based  settings without department certification that appropriate alter-
   28  native housing options and supportive services  are  available  in  such
   29  resident's preferred geographic location;
   30    (d)  clearly  defines "persons with serious mental illness" as persons
   31  who have a designated diagnosis of mental illness under the most  recent
   32  edition  of  the  Diagnostic and Statistical Manual of Mental Disorders,
   33  and whose severity and duration of mental illness  directly  results  in
   34  substantial functional disability; provided that
   35    (1) "designated diagnosis of mental illness" shall not include a diag-
   36  nosis of Alzheimer's disease, dementia or acquired brain injury; and
   37    (2)  "substantial  functional  disability"  shall  be substantiated by
   38  documentation that an individual has experienced at  least  two  of  the
   39  four  following  functional  limitations  during the past 12 months as a
   40  direct result of such mental illness:
   41    (i) marked and prolonged difficulties in self care (personal  hygiene,
   42  diet,  clothing,  avoiding  injuries,  securing health care or complying
   43  with medical advice).
   44    (ii) marked and prolonged restriction of activities  of  daily  living
   45  (maintaining a residence, using transportation, day to day money manage-
   46  ment, accessing community services).
   47    (iii)  marked  and  prolonged difficulties in maintaining social func-
   48  tioning (establishing and maintaining  social  relationships,  interper-
   49  sonal  interactions  with  primary  partner,  children  or  other family
   50  members, friends,  neighbors,  social  skills,  compliance  with  social
   51  norms, appropriate use of leisure time).
   52    (iv)  frequent  and consistent deficiencies of concentration, persist-
   53  ence or pace resulting in failure to complete tasks in a  timely  manner
   54  (ability  to complete tasks commonly found in work settings or in struc-
   55  tured activities that take place in home or school settings; individuals
   56  may exhibit limitations in these areas when they repeatedly  are  unable
       A. 3754                             3
    1  to  complete  simple  tasks  within  an  established  time  period, make
    2  frequent errors in tasks, or require assistance  in  the  completion  of
    3  tasks);
    4    (e)  provides  adequate  timeframes to transition persons with serious
    5  mental illness into the most integrated  setting  appropriate  to  their
    6  needs, and does not impose penalties or restrictions on adult home oper-
    7  ators making good faith efforts during the transition of such residents;
    8    (f)  comports  with  the  state goal of providing persons with serious
    9  mental illness with care in the most integrated setting  appropriate  to
   10  their  needs by permitting discharges from inpatient psychiatric centers
   11  or facilities, that are subject to the provisions of article 28  of  the
   12  public  health law, with in-patient psychiatric services to adult homes,
   13  where no less-restrictive and appropriate housing alternative is  avail-
   14  able;
   15    (g)  is subsequent to the award of assisted living program beds pursu-
   16  ant to paragraph (j) of subdivision 3 of section  461-1  of  the  social
   17  services law; and
   18    (h) applies only to transitional adult homes.
   19    S 4. Within thirty days of the effective date of this act, the commis-
   20  sioner  of  health  and the commissioner of mental health, shall jointly
   21  convene a workgroup to address the transition of  persons  with  serious
   22  mental  illness  into  the  most integrated setting appropriate to their
   23  needs. The workgroup shall be  co-chaired  by  such  commissioners,  and
   24  shall  include: a representative sample of adult home operators, includ-
   25  ing operators of assisted living program beds; representatives of  asso-
   26  ciations  of  adult home operators; members of adult home resident coun-
   27  cils; advocacy organizations working on behalf of adult home  residents;
   28  individuals with mental illness; providers of alternative housing accom-
   29  modations  and other support services; and institutions that make refer-
   30  rals to adult homes, including hospitals and local governmental units.
   31    (a) The workgroup shall provide recommendations  for  legislative  and
   32  regulatory actions, which shall address the following:
   33    (1)  the  need  to  promote and respect informed choice by individuals
   34  with serious mental illness, through means including the performance  of
   35  independent assessments and the provision of objective information;
   36    (2)  the  appropriate scope of regulations, including the propriety of
   37  definitions of "persons with serious mental illness"  and  "transitional
   38  adult home";
   39    (3)  a  reasonable  time period for compliance with regulations, which
   40  shall take into account the need to discharge inpatients into  less-res-
   41  trictive  settings, and the availability of alternative housing accommo-
   42  dations and other support services. Alternative housing  shall  include,
   43  but  not be limited to, supported housing, supportive housing, community
   44  residences, enriched housing and other housing alternatives that may  be
   45  appropriate for impacted residents;
   46    (4)  an  examination  of possible costs related to transitioning resi-
   47  dents of impacted adult homes, as well as strategies by which such costs
   48  may be mitigated;
   49    (5) the ability of an  impacted  adult  home  to  provide  appropriate
   50  accommodations and services for its residents;
   51    (6)  the  development  of  long-term quality improvement for all adult
   52  home residents; and
   53    (7) the financial impact of regulations  on  adult  homes,  and  other
   54  licensure  options  or  models of care to which transitional adult homes
   55  may transition.
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    1    (b) The workgroup shall submit a report of its findings and  recommen-
    2  dations  to  the  governor,  the  temporary president of the senate, the
    3  speaker of the assembly, and the  chairs  of  the  senate  and  assembly
    4  health committees no later than October 1, 2015.
    5    S  5.  Notwithstanding any provision of law, rule or regulation to the
    6  contrary, no state agency  shall  undertake  any  administrative  action
    7  designed  to  limit  or reduce the mental health census of an adult home
    8  authorized to operate 55 percent or more of its total licensed  capacity
    9  of  beds  as  assisted living program beds, pursuant to section 461-l of
   10  the social services law, until 120 days after submission  of  the  work-
   11  group report pursuant to section four of this act.
   12    S 6. The commissioner of health shall permit a transitional adult home
   13  to  request  to amend a previously submitted or approved compliance plan
   14  by December 1, 2015, to reflect recommendations made by  the  workgroup.
   15  Such  request shall be granted if, in the discretion of such commission-
   16  er, the compliance plan, as amended, would constitute an approvable plan
   17  and the amendment would not cause an  undue  and  substantial  delay  in
   18  progress.
   19    S 7. This act shall take effect immediately.