N.Y. Public Health Law § 2807-x: Grants for long term care demonstration projects

§ 2807-x. Grants for long term care demonstration projects. 1. The

commissioner shall establish three demonstration projects to develop,

evaluate and implement programs to test new models for the organization

and delivery of long term care services to encourage community based

programs and smaller residential health care models in order to promote

consumer choice, improve the efficiency and appropriateness of the use

of state and federal resources and ensure the recruitment, retention and

training of health care staff to adequately meet the needs of a

community and residential long term care system. Notwithstanding the

provisions of section one hundred twelve of the state finance law or any

other inconsistent provision of the state finance law or any other law,

funds available for distribution pursuant to this section may be

allocated and distributed by the commissioner without a competitive bid

or request for proposal process.

(a) The following factors shall be considered in approving each

demonstration project respectively:

(i) Residential health care demonstration project. (A) the extent to

which there is a reduction in the need for skilled nursing beds for a

facility that is eligible to replace its existing skilled nursing

facility; (B) the potential to design and develop more appropriate

smaller residential health care facilities as an alternative to

replacing an existing skilled nursing facility; (C) the extent to which

the quality, efficiency and continuity of care will be promoted and

provided for by the development of integrated long-term care services in

the community; (D) the extent to which the project will provide training

to health care workers to appropriately staff new community based models

of long term care; (E) demonstrate the involvement and support of

workforce in the program redesign; (F) the development of a new

long-term care reimbursement methodology that encourages care in the

least restrictive setting and adequately reflects the resources needed

to serve consumers in each level of long term care; (G) and the

incorporation of a research component designed to evaluate the project.

(ii) Community based care demonstration project. (A) the extent to

which there is a reduction in the need for skilled nursing facility beds

on a countywide basis; (B) the development of a new system to inform

recently admitted residents of skilled nursing facilities of the

availability of community long-term care options; (C) the extent to

which the discharge planning program from skilled nursing facilities

will inform, assist and maximize freedom of choice to consumers who

choose to move back to the community; (D) the extent to which the

project will develop community based long term care services, including

funding for the recruitment and retention of direct care health care

workers necessary to increase community based services; (E) the extent

to which the project will provide training to health care staff; and (F)

the incorporation of a research component designed to evaluate the

projects.

(iii) Managed long term care project. (A) the extent to which a

current operator of skilled nursing facilities possesses the necessary

authorizations through a related entity to assume risk and receive

capitated payments, pursuant to titles 18 and 19 of the federal social

security act, for the purpose of providing and arranging for the care of

individuals eligible for admission to a skilled nursing facility, (B)

the extent to which such services to individuals eligible for benefits

pursuant to both titles 18 and 19 of the federal social security act

will be provided through the capitated rate, (C) the extent to which the

quality, efficiency and continuity of care will be promoted and provided

for by the development of integrated long-term care services in the

community, (D) the extent to which the project sponsor will directly or

indirectly in association with a joint labor management program, provide

for training of health care workers to appropriately staff community

based models of long-term care; and (E) the incorporation of a research

component designed to evaluate the project, with specific reference to

the determination of cost savings to the state, the quality of and

satisfaction with services provided to consumers and their families and

the satisfaction of direct care workers, with a report of the project's

progress and findings submitted annually to the commissioner.

2. The commissioner is authorized to waive, modify or suspend the

respective provisions of rules and regulations promulgated pursuant to

this chapter if the commissioner determines that such waiver is

necessary or appropriate for the successful implementation of a

demonstration project and when the health, safety, and general welfare

of persons receiving services under such demonstration project will not

be impaired as a result of such waiver, modification or suspension,

provided however, that for the managed long term care project pursuant

to subparagraph (iii) of paragraph (a) of subdivision one of this

section, the method for setting the capitated rate of payment under

title 19 of the federal social security act shall be consistent with the

method used for all managed long term care plans authorized under

subdivision eight of section forty-four hundred three-f of the public

health law.

3. The commissioner is authorized to seek federal waivers pursuant to

titles XVIII and XIX of the federal social security act when such

waivers are necessary to develop cost-effective long term care

demonstration projects.