S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         6315
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                    March 20, 2015
                                      ___________
       Introduced  by  M.  of A. ENGLEBRIGHT, GOTTFRIED, ABBATE, CAHILL, CLARK,
         DINOWITZ, GALEF, LUPARDO -- Multi-Sponsored by --  M.  of  A.  LIFTON,
         PERRY, RIVERA -- read once and referred 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:
    1    Section 1. The public health law is amended by adding  a  new  section
    2  2801-i to read as follows:
    3    S  2801-I.  RESPITE DAY DEMONSTRATION PROGRAM. 1. DEFINITIONS. AS USED
    4  IN THIS SECTION:
    5    (A) "RESPITE DAY DEMONSTRATION PROGRAM" MEANS A STRUCTURED, COMPREHEN-
    6  SIVE PROGRAM ESTABLISHED BY THE  COMMISSIONER  UNDER  THIS  SECTION,  IN
    7  CONJUNCTION  WITH  THE  DIRECTOR  OF THE OFFICE FOR THE AGING, PROVIDING
    8  LEVEL I, LEVEL II OR LEVEL III SERVICES TO REGISTRANTS.
    9    (B) "REGISTRANT" MEANS A PERSON:
   10    (I) WHO IS NOT A RESIDENT OF A RESIDENTIAL HEALTH  CARE  FACILITY,  IS
   11  FUNCTIONALLY  IMPAIRED  AND  NOT HOMEBOUND, AND REQUIRES SUPERVISION AND
   12  MONITORING BUT DOES NOT REQUIRE CONTINUOUS TWENTY-FOUR HOUR A DAY  INPA-
   13  TIENT CARE AND SERVICES;
   14    (II) WHOSE ASSESSED SOCIAL AND HEALTH CARE NEEDS CAN SATISFACTORILY BE
   15  MET  IN  WHOLE OR IN PART BY THE DELIVERY OF APPROPRIATE SERVICES IN THE
   16  COMMUNITY SETTING; AND
   17    (III) WHO HAS BEEN ADMITTED TO THE PROGRAM BASED ON AN  INTERDISCIPLI-
   18  NARY COMPREHENSIVE ASSESSMENT.
   19    (C) "FUNCTIONALLY IMPAIRED" MEANS A PERSON WHO NEEDS THE ASSISTANCE OF
   20  ANOTHER  PERSON  IN  AT  LEAST  ONE OF THE FOLLOWING ACTIVITIES OF DAILY
   21  LIVING: TOILETING, MOBILITY, TRANSFERRING OR EATING; OR WHO NEEDS SUPER-
   22  VISION DUE TO COGNITIVE OR PSYCHO-SOCIAL IMPAIRMENT.
   23    (D) "ADULT DAY HEALTH" MEANS THE HEALTH CARE SERVICES  AND  ACTIVITIES
   24  DEFINED  BY  THE COMMISSIONER UNDER REGULATIONS UNDER SUBPARAGRAPH (VII)
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09559-01-5
       A. 6315                             2
    1  OF PARAGRAPH F OF SUBDIVISION SIX-A OF SECTION THREE  HUNDRED  SIXTY-SIX
    2  OF THE SOCIAL SERVICES LAW.
    3    (E) "LEVEL I SERVICES" MEANS THE FOLLOWING SERVICES:
    4    (I) SOCIALIZATION AND PLANNED ACTIVITIES;
    5    (II) SUPERVISION AND MONITORING;
    6    (III) ROUTINE PERSONAL CARE, WHICH INCLUDES:
    7    (A)  ASSISTANCE  FOR THE REGISTRANT WITH ANY OF THE FOLLOWING: TOILET-
    8  ING, MOBILITY, TRANSFER AND EATING;
    9    (B) ROUTINE SKIN CARE;
   10    (C) CHANGING SIMPLE DRESSINGS; AND
   11    (D) USING SUPPLIES AND ADAPTIVE AND ASSISTIVE EQUIPMENT;
   12    (IV) MEDICATION DISTRIBUTION;
   13    (V) CASE MANAGEMENT; AND
   14    (VI) MEALS CONSISTENT WITH STANDARDS SET FOR THE NUTRITION PROGRAM FOR
   15  THE ELDERLY ESTABLISHED BY THE STATE OFFICE FOR THE AGING.
   16    (F) "LEVEL II SERVICES" MEANS ALL LEVEL I SERVICES, PLUS THE FOLLOWING
   17  SERVICES:
   18    (I) MAJOR PERSONAL CARE SERVICES, WHICH INCLUDES:
   19    (A) ASSISTANCE FOR THE REGISTRANT WITH SHOWERING AND BATHING; AND
   20    (B) SOME OR TOTAL ASSISTANCE WITH DRESSING AND GROOMING;
   21    (II) HEALTH EDUCATION;
   22    (III) NURSING MONITORING AND SUPERVISION OF BASIC TREATMENTS;
   23    (IV) COUNSELING; AND
   24    (V) RESTORATIVE THERAPIES NOT LASTING LONGER THAN SIX MONTHS.
   25    (G) "LEVEL III SERVICES" MEANS AND INCLUDES ALL LEVEL I AND  LEVEL  II
   26  SERVICES, PLUS THE FOLLOWING SERVICES:
   27    (I) PSYCHIATRIC EVALUATIONS AND DIAGNOSIS;
   28    (II) SKILLED NURSING SERVICES;
   29    (III) MEDICATION MANAGEMENT;
   30    (IV)  MAINTENANCE AND RESTORATIVE THERAPIES GREATER THAN SIX MONTHS IN
   31  DURATION; AND
   32    (V) ADDITIONAL MEDICAL SERVICES AS REQUIRED BY REGULATION.
   33    (H) "BASE RATE" MEANS THE RATE PAID  FOR  APPROVED  ADULT  DAY  HEALTH
   34  SERVICES  UNDER  SECTION  THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES
   35  LAW.
   36    (I) "OPERATOR" MEANS (A) AN ADULT DAY HEALTH CARE  PROGRAM  OR  (B)  A
   37  SOCIAL  ADULT  DAY  SERVICES  PROGRAM, AS DEFINED IN SECTION TWO HUNDRED
   38  FIFTEEN OF THE ELDER LAW.
   39    2. RESPITE DAY DEMONSTRATION PROGRAM. THE COMMISSIONER, IN CONJUNCTION
   40  WITH THE DIRECTOR OF THE OFFICE FOR THE AGING, MAY ESTABLISH RESPITE DAY
   41  DEMONSTRATION PROGRAMS BASED UPON ADULT DAY HEALTH CARE AND SOCIAL ADULT
   42  DAY SERVICES, AS DEFINED IN SECTION TWO HUNDRED  FIFTEEN  OF  THE  ELDER
   43  LAW,  TO  EXTEND THE PERIOD A CAREGIVER CAN REMAIN ACTIVE IN THE CARE OF
   44  ELDERLY OR DISABLED INDIVIDUALS,  AVOIDING  THE  NEED  FOR  MORE  COSTLY
   45  INSTITUTIONAL PLACEMENT.
   46    3.  ESTABLISHMENT.    THERE  SHALL BE A MINIMUM OF TEN PROGRAMS ESTAB-
   47  LISHED IN SIX LOCATIONS, WITH AT LEAST ONE SITE  TO  BE  LOCATED  WITHIN
   48  EACH  OF  THE  FOLLOWING SIX REGIONS: NEW YORK CITY, LONG ISLAND, HUDSON
   49  VALLEY, NORTH COUNTRY, CENTRAL  AND  WESTERN.  EACH  LOCATION'S  PROGRAM
   50  SHALL  CONSIST OF UP TO FIFTEEN REGISTRANTS. OPERATORS SHALL BE SELECTED
   51  BASED ON A REQUEST FOR PROPOSAL PROCESS WITH PREFERENCE GIVEN  TO  THOSE
   52  APPLICANTS  WHO ARE ABLE TO DEMONSTRATE THEIR CAPACITY TO BUILD PARTNER-
   53  SHIPS AND ENTER INTO COOPERATIVE ARRANGEMENTS. THIS SECTION SHALL NOT BE
   54  CONSTRUED TO PERMIT AN OPERATOR TO PROVIDE SERVICES FOR WHICH THE OPERA-
   55  TOR IS NOT OTHERWISE LICENSED OR CERTIFIED TO PROVIDE.
   56    4. REGISTRANT CARE PLAN. THE OPERATOR SHALL ENSURE:
       A. 6315                             3
    1    (A) THAT A  CARE  PLAN  BASED  ON  A  COMPREHENSIVE  INTERDISCIPLINARY
    2  ASSESSMENT  AND, WHEN APPLICABLE, A TRANSFER OR DISCHARGE PLAN IS DEVEL-
    3  OPED FOR EACH REGISTRANT WITHIN FIVE VISITS, NOT TO EXCEED THIRTY  DAYS,
    4  FROM REGISTRATION;
    5    (B) EACH REGISTRANT'S CARE PLAN SHALL INCLUDE:
    6    (I) DESIGNATION OF A PROFESSIONAL PERSON TO BE RESPONSIBLE FOR COORDI-
    7  NATING THE CARE PLAN;
    8    (II)  THE  REGISTRANT'S  PERTINENT DIAGNOSES, INCLUDING MENTAL STATUS,
    9  TYPES OF EQUIPMENT AND SERVICES REQUIRED, CASE MANAGEMENT, FREQUENCY  OF
   10  PLANNED  VISITS, PROGNOSIS, REHABILITATION POTENTIAL, FUNCTIONAL LIMITA-
   11  TIONS, PLANNED ACTIVITIES,  NUTRITIONAL  REQUIREMENTS,  MEDICATIONS  AND
   12  TREATMENTS,  NECESSARY  MEASURES TO PROTECT AGAINST INJURY, INSTRUCTIONS
   13  FOR DISCHARGE OR REFERRAL IF APPLICABLE,  ORDERS  FOR  THERAPY  SERVICES
   14  INCLUDING  THE  SPECIFIC  PROCEDURES  AND  MODALITIES TO BE USED AND THE
   15  AMOUNT, FREQUENCY AND DURATION OF SUCH SERVICES, AND ANY OTHER APPROPRI-
   16  ATE ITEM;
   17    (III) THE MEDICAL AND NURSING GOALS AND  LIMITATIONS  ANTICIPATED  FOR
   18  THE REGISTRANT AND, AS APPROPRIATE, THE NUTRITIONAL, SOCIAL, REHABILITA-
   19  TIVE AND LEISURE TIME GOALS AND LIMITATIONS;
   20    (IV) THE REGISTRANT'S POTENTIAL FOR REMAINING IN THE COMMUNITY; AND
   21    (V)  A DESCRIPTION OF ALL SERVICES TO BE PROVIDED TO THE REGISTRANT BY
   22  THE PROGRAM, INFORMAL SUPPORTS AND OTHER COMMUNITY RESOURCES PURSUANT TO
   23  THE CARE PLAN, AND HOW SUCH SERVICES WILL BE COORDINATED;
   24    (C) DEVELOPMENT AND MODIFICATION OF THE CARE PLAN IS COORDINATED  WITH
   25  OTHER  HEALTH CARE PROVIDERS OUTSIDE THE PROGRAM WHO ARE INVOLVED IN THE
   26  REGISTRANT'S CARE; AND
   27    (D) THE RESPONSIBLE PERSONS, WITH  THE  APPROPRIATE  PARTICIPATION  OF
   28  CONSULTANTS  IN  THE  MEDICAL,  SOCIAL,  PARAMEDICAL  AND RELATED FIELDS
   29  INVOLVED IN THE REGISTRANT'S CARE:
   30    (I) RECORD IN THE CLINICAL RECORD CHANGES IN THE  REGISTRANT'S  STATUS
   31  WHICH REQUIRE ALTERATIONS IN THE REGISTRANT CARE PLAN;
   32    (II) MODIFY THE CARE PLAN ACCORDINGLY;
   33    (III) REVIEW THE CARE PLAN AT LEAST ONCE EVERY SIX MONTHS AND WHENEVER
   34  THE REGISTRANT'S CONDITION WARRANTS AND DOCUMENT EACH SUCH REVIEW IN THE
   35  CLINICAL RECORD; AND
   36    (IV)  PROMPTLY  ALERT  THE REGISTRANT'S AUTHORIZED HEALTH CARE PRACTI-
   37  TIONER OF ANY SIGNIFICANT CHANGES IN THE  REGISTRANT'S  CONDITION  WHICH
   38  INDICATE A NEED TO REVISE THE CARE PLAN.
   39    5.  REIMBURSEMENT.  FOR  THE  PURPOSES  OF THIS SECTION, REIMBURSEMENT
   40  RATES UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW  FOR
   41  PROGRAMS SHALL BE AS FOLLOWS:
   42    (A)  LEVEL  I SERVICES WILL BE REIMBURSED AT FORTY PERCENT OF THE BASE
   43  RATE;
   44    (B) LEVEL II SERVICES WILL BE REIMBURSED AT  SEVENTY-FIVE  PERCENT  OF
   45  THE BASE RATE; AND
   46    (C)  LEVEL  III  SERVICES WILL BE REIMBURSED AT ONE HUNDRED PERCENT OF
   47  THE BASE RATE.
   48    6. EVALUATION AND REPORT. NO LATER THAN JANUARY  FIRST,  TWO  THOUSAND
   49  EIGHTEEN,  THE  COMMISSIONER  SHALL  PROVIDE THE GOVERNOR, THE TEMPORARY
   50  PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY WITH  A  WRITTEN
   51  EVALUATION  OF THE PROGRAM, BASED ON AN ASSESSMENT TOOL DEVELOPED BY THE
   52  DEPARTMENT. SUCH EVALUATION SHALL ADDRESS THE OVERALL  EFFECTIVENESS  OF
   53  THE  PROGRAM IN IMPROVING OUTCOMES FOR INDIVIDUAL PATIENTS AND GROUPS OF
   54  PATIENTS, REDUCING COSTS, ENCOURAGING PLACEMENTS  IN  APPROPRIATE  ADULT
   55  DAY  HEALTH  SERVICES  SETTINGS,  AND ENHANCING THE AVAILABILITY OF LESS
   56  RESTRICTIVE AND LESS INSTITUTIONAL SERVICES; SHALL EVALUATE THE NEED FOR
       A. 6315                             4
    1  LEVEL I, II AND III SERVICES AND THE IMPACT ON THE AVAILABILITY OF  EACH
    2  OF  THE  SERVICES ON COST AND INSTITUTIONAL PLACEMENT; AND SHALL CONTAIN
    3  RECOMMENDATIONS RELATIVE TO EXTENDING  AND  EXPANDING  THE  PROGRAM.  IN
    4  EVALUATING  INDIVIDUAL OUTCOMES, THE COMMISSIONER SHALL CONSULT WITH THE
    5  CENTER FOR FUNCTIONAL ASSESSMENT RESEARCH AT THE STATE UNIVERSITY OF NEW
    6  YORK AT BUFFALO.
    7    7. WAIVERS AND FEDERAL APPROVALS. (A) THE PROVISIONS OF  THIS  SECTION
    8  SHALL  NOT  APPLY  UNLESS  ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND
    9  REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
   10  IN THE COSTS OF SERVICES PROVIDED UNDER THIS SECTION.
   11    (B) THE COMMISSIONER IS AUTHORIZED TO SUBMIT AMENDMENTS TO  THE  STATE
   12  PLAN  FOR  MEDICAL  ASSISTANCE  AND  SUBMIT ONE OR MORE APPLICATIONS FOR
   13  WAIVERS OF THE FEDERAL  SOCIAL  SECURITY  ACT,  TO  OBTAIN  THE  FEDERAL
   14  APPROVALS  NECESSARY  TO  IMPLEMENT THIS SECTION. THE COMMISSIONER SHALL
   15  SUBMIT SUCH AMENDMENTS OR APPLICATIONS FOR WAIVERS BY SEPTEMBER  THIRTI-
   16  ETH,  TWO  THOUSAND  FIFTEEN,  AND  SHALL USE BEST EFFORTS TO OBTAIN THE
   17  APPROVALS REQUIRED BY THIS SUBDIVISION IN A TIMELY MANNER SO AS TO ALLOW
   18  EARLY IMPLEMENTATION OF THIS SECTION.
   19    S 2. This act shall take effect immediately.