Creates adult day services respite demonstration programs; authorizes the commissioner of health in conjunction with the director of the state office for the aging to establish the respite day demonstration programs, based upon adult day health care and social adult day services, which extends the period a caregiver can remain active in the care of elderly or disabled individuals; sets forth definitions; further sets forth reporting requirements.
STATE OF NEW YORK
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4142
2011-2012 Regular Sessions
IN ASSEMBLY
February 1, 2011
___________
Introduced by M. of A. ENGLEBRIGHT -- 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-h to read as follows:
3 § 2801-h. 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.
LBD04229-01-1
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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 (i) an adult day health care program or (ii) 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:
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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 fourteen, 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
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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 eleven, 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 § 2. This act shall take effect immediately.
