Fund Long-Term Care Services

Section 1. Short title. This act shall be known and may be cited as the "New York long term care trust act".

§ 2. The public health law is amended by adding a new article 36-B to read as follows:

ARTICLE 36-B

NEW YORK LONG TERM CARE TRUST PROGRAM Section 3670. Definitions.

3671. Program established.

3672. Long term care trust commission.

3673. Long term care trust advisory panel.

3674. Qualified individuals; determination.

3675. Eligible beneficiaries; determination.

3676. Reimbursement for services and supports.

3677. Individual premium contributions.

3678. Appeals and appeal hearings.

3679. Waivers.

§ 3670. Definitions. As used in this article, the following terms shall have the following meanings, unless the context clearly requires otherwise:

1. "Fund" means the long term care trust fund established pursuant to section ninety-nine-ss of the state finance law.

2. "Approved service" means long term care services and supports including, but not limited to:

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD03601-01-5

(a) adult day services, including social adult day services, enriched social adult day services, and adult day health care;

(b) care transition coordination;

(c) adaptive equipment and technology;

(d) environmental modification;

(e) personal emergency response system;

(f) home safety evaluation;

(g) respite services providing temporary substitute care to relieve unpaid relative or non-relative caregivers;

(h) home delivered meals;

(i) transportation;

(j) services or supports for persons with dementia, Alzheimer's diagnosis, or other cognitive impairments;

(k) education and consultation for current or prospective caregivers;

(l) care by a qualified family member;

(m) professional services, including but not limited to services provided by a physician, physician's assistant, registered nurse, licensed practical nurse, or occupational, physical, or speech therapist or any other health care professional licensed under title eight of the education law acting within their scope of practice;

(n) services that assist paid and unpaid relative or non-relative caregivers caring for eligible individuals, including training for informal caregivers and other individuals providing care who are not otherwise employed as long term care workers under section thirty-six hundred fourteen of this chapter;

(o) home care services as defined in section thirty-six hundred two of this chapter;

(p) assisted living services, including enhanced assisted living or special needs assisted living services;

(q) adult care facility services;

(r) nursing home services; and

(s) any other long term care services as defined in paragraph (b) of subdivision one of section three hundred sixty-seven-f of the social services law or otherwise designated as such in law or regulations by the department.

3. "Benefit unit" means the maximum daily benefit the department is authorized to pay a long term care services and supports provider as reimbursement for providing an approved service or services to an eligible beneficiary, which amount shall initially be two hundred dollars, and which shall be adjusted annually by the advisory panel in accordance with the provisions of section thirty-six hundred seventy-three of this article.

4. "Commission" means the long term care trust commission established pursuant to section thirty-six hundred seventy-two of this article.

5. "Advisory panel" or "panel" means the long term care trust advisory panel established pursuant to section thirty-six hundred seventy-three of this article.

6. "Eligible beneficiary" means a qualified individual as defined in subdivision sixteen of this section who:

(a) was not disabled before the age of eighteen;

(b) has been assessed by the department as needing the minimum level of assistance with activities of daily living necessary to receive benefits pursuant to section thirty-six hundred seventy-five of this article;

(c) has not exhausted the lifetime benefit limit as defined in subdivision eleven of this section; and

(d) does not have in effect an exemption granted pursuant to subdivision six of section thirty-six hundred seventy-seven of this article.

7. "Employee" means any person engaged in employment as such term is defined in section five hundred eleven of the labor law.

8. "Employer" shall have the same meaning as defined in section five hundred twelve of the labor law.

9. "Employment" shall have the same meaning as defined in section five hundred eleven of the labor law.

10. "Long term care services and supports provider" or "long term care provider" means an individual or entity authorized to provide long term care services as defined in paragraph (b) of subdivision one of section three hundred sixty-seven-f of the social services law, including but not limited to a nursing facility licensed under article twenty-eight of this chapter; a home care services agency, certified home health agency or long term home health care program, as defined in section thirty-six hundred two of this chapter; an adult day health care program in accordance with regulations of the department; a home care services worker as defined in section thirty-six hundred thirteen of this chapter; a personal care provider licensed or qualified to provide services in this state or in any other state or local agency; a qualified family member as defined in subdivision fifteen of this section, and such other individuals or entities that are authorized by law or regulations of this state or any other state or local agency to provide such services.

11. "Lifetime benefit limit", or "lifetime limit" means the dollar equivalent of three hundred sixty-five benefit units paid by the department on behalf of an eligible beneficiary over the course of such eligible individual's lifetime.

12. "Premium contributions" or "premiums" means the payments an employee or self-employed individual is required to contribute to the program pursuant to section thirty-six hundred seventy-seven of this article.

13. "Private long term care insurance coverage" means a contract for insurance which meets the requirements of section one thousand one hundred seventeen of the insurance law.

14. "Program" means the New York long term care trust program established pursuant to section thirty-six hundred seventy-one of this article.

15. "Qualified family member" means a relative of an eligible beneficiary who meets the educational or training requirements established by the department or the department of education for providing long term care services and supports and is authorized by law or regulation to receive payments from the state.

16. (a) "Qualified individual" means an individual who:

(i) is age eighteen or older; and

(ii) has paid premium contributions pursuant to section thirty-six hundred seventy-seven of this article for a period equivalent to either:

(1) a total of ten years during the course of such individual's lifetime;

(2) a total of three years within the six years immediately preceding such individual's application for benefits under section thirty-six hundred seventy-five of this article; or

(3) for an individual who has not met the ten-year requirement under clause one of this subparagraph, who shall have reached the age of fifty-five before January first of the year in which premium collections begin, at least one year. Such individual may receive one-tenth of the maximum number of benefit units available under section thirty-six hundred seventy-five of this article for each year of premium payments. Nothing in this clause shall prohibit such an individual, who meets the conditions of clause two of this subparagraph, from receiving the maximum number of benefit units available under section thirty-six hundred seventy-five of this article.

(b) For the purposes of paragraph (a) of this subdivision, a "year" shall equal no less than five hundred hours of paid work.

17. "Wages" means all remuneration paid by an employer to an employee with respect to employment during any calendar year. "Wages" does not include benefits paid for by the employer such as health insurance or disability insurance.

§ 3671. Program established. 1. There is hereby established the "New York long term care trust program" to provide long term care services and supports benefits for eligible beneficiaries regardless of income or resources in accordance with the provisions of this article. The department shall implement and administer such program in coordination with the office of temporary and disability assistance, the office of mental health, the state office for the aging, the department of taxation and finance and the department of labor as set forth in this section.

2. The department shall:

(a) Receive applications for benefits and perform initial and continuing eligibility determinations for long term care services and supports benefits in accordance with section thirty-six hundred seventy-five of this article;

(b) Monitor the use of benefit units by each eligible beneficiary to verify that such individual's lifetime benefit limit has not been exhausted;

(c) Establish and maintain standards for all long term care services and supports provided pursuant to this article;

(d) Establish requirements for a uniform system of audits and reports to review the quality and availability of long term care services and supports furnished pursuant to this article to ensure that the program is administered in the best interests of program beneficiaries;

(e) Establish schedules of rates, payments, reimbursements and other charges and standards and procedures relating to payments of benefits to registered long term care services and supports providers pursuant to section thirty-six hundred seventy-six of this article; including procedures for auditing payments and recoupment of improper payments;

(f) Establish plans for the coordination of long term care services and supports benefits under this article for eligible beneficiaries who are funded through Medicaid or receiving other long term care services and supports, including through Medicare, private long term care insurance coverage, or other programs;

(g) Establish standards and procedures relating to contractual arrangements between long term care providers and the department;

(h) Develop and maintain a registry of long term care services and supports providers that meet the minimum qualifications established by the commission pursuant to section thirty-six hundred seventy-two of this article, in accordance with subdivision three of section thirty-six hundred seventy-six of this article; and

(i) Provide consultative services to long term care providers in order to assist them: to qualify for payments under the provisions of this article; in providing information needed to determine such payments; and in establishing and maintaining such fiscal records as may be necessary for the proper and efficient administration of long term care services and supports.

3. Prior to or on the first of January next succeeding two years after the effective date of this article, the department shall, in consultation with the department of labor, the department of taxation and finance, the state office for the aging, the office of temporary and disability assistance, and any other department or agency it deems relevant, develop and maintain such programs and processes as shall be necessary to determine and keep records regarding the applicability of premium contribution requirements of section thirty-six hundred seventy-seven of this article to employees and self-employed individuals. The department shall thereafter monitor individual premium contributions and make eligibility determinations pursuant to sections thirty-six hundred seventy-four and thirty-six hundred seventy-five of this article.

§ 3672. Long term care trust commission. 1. The long term care trust commission is hereby established to make recommendations to all relevant departments and agencies to ensure the adequacy of benefits provided under the program and to maintain the solvency and sustainability of the fund.

2. The commission shall consist of a total of fifteen voting members and ten nonvoting members as follows:

(a) six voting members representing the legislature, to be appointed as follows:

(i) two members appointed by the speaker of the assembly;

(ii) two members appointed by the temporary president of the senate;

(iii) one member appointed by the minority leader of the assembly;

(iv) one member appointed by the minority leader of the senate; and

(b) nine members to be appointed by the governor, all of whom shall be voting members, which shall include:

(i) the commissioner, or such commissioner's designee;

(ii) the director of the state office for the aging, or such director's designee;