N.Y. Public Health Law § 2808-e: Residential health care for children with medical fragility in transition to young adults and young adults with medical fragility demonst...

* § 2808-e. Residential health care for children with medical

fragility in transition to young adults and young adults with medical

fragility demonstration program. 1. Notwithstanding any law, rule, or

regulation to the contrary, the commissioner shall, within amounts

appropriated and subject to the availability of federal financial

participation, establish a demonstration program for two eligible

pediatric residential health care facilities, as defined in paragraph

(d) of subdivision two of this section, to construct a new facility or

repurpose part of an existing facility to operate as a young adult

residential health care facility for the purpose of improving the

quality of care for young adults with medical fragility.

2. For purposes of this section:

(a) "children with medical fragility" shall mean children up to

twenty-one years of age who have a chronic debilitating condition or

conditions, are at risk of hospitalization, are technology-dependent for

life or health sustaining functions, require complex medication regimens

or medical interventions to maintain or to improve their health status,

and/or are in need of ongoing assessment or intervention to prevent

serious deterioration of their health status or medical complications

that place their life, health or development at risk.

(b) "young adults with medical fragility" shall mean individuals who

meet the definition of children with medical fragility, but for the fact

such individuals are aged between eighteen and thirty-five years old.

(c) "pediatric residential health care facility" shall mean a

residential health care facility or discrete unit of a residential

health care facility providing services to children under the age of

twenty-one.

(d) "eligible pediatric residential health care facilities" shall mean

pediatric health care facilities that meet the following eligibility

criteria for the demonstration program set forth in subdivision one of

this section: (i) has over one hundred and sixty licensed pediatric

beds; or (ii) is currently licensed for pediatric beds pursuant to this

article, is co-operated by a system of hospitals licensed pursuant to

this article, and such hospitals qualify for funds pursuant to a vital

access provider assurance program or a value based payment incentive

program, as administered by the department in accordance with all

requirements set forth in the state's federal 1115 Medicaid waiver

standard terms and conditions.

3. Notwithstanding any law, rule, or regulation to the contrary, any

child with medical fragility who has resided for at least thirty

consecutive days in an eligible pediatric residential health care

facility and who has reached the age of twenty-one while a resident, may

continue residing at such eligible pediatric residential health care

facility and receiving such services from the facility, provided that

such young adult with medical fragility remains eligible for nursing

home care, and provided further that the eligible pediatric residential

health care facility has prepared, applied for, and submitted to the

commissioner, a proposal for a new residential health care facility for

the provision of extensive nursing, medical, psychological and

counseling support services to young adults with medical fragility in

accordance with subdivision four of this section. A young adult with

medical fragility may remain in such eligible pediatric residential

health care facility until such time that the young adult with medical

fragility attains the age of thirty-five years or the young adult

residential health care facility is constructed and becomes operational,

whichever is sooner.

4. Upon receipt of a certificate of need application from an eligible

pediatric residential health care facility selected by the commissioner

for the demonstration program authorized under this section, the

commissioner is authorized to approve, with the written approval of the

public health and health planning council pursuant to section

twenty-eight hundred two of this article, the construction of a new

residential health care facility to be constructed and operated on a

parcel of land within the same county as that of eligible pediatric

residential health care facility that is proposing such new facility and

over which it will have site control, or the repurposing of a portion of

a residential health care facility that is currently serving geriatric

residents or those with similar needs for the provision of nursing,

medical, psychological and counseling support services appropriate to

the needs of nursing home-eligible young adults with medical fragility,

referred to herein below as a young adult facility, provided that the

established operator of such eligible pediatric residential health care

facility proposing the young adult facility is in good standing and

possesses at least thirty years' prior experience operating as a

pediatric residential health care facility in the state or more than

thirty years' experience serving medically fragile pediatric patients,

and provided further that such facility qualifies for the demonstration

program set forth in subdivision one of this section.

5. A young adult facility established pursuant to subdivision four of

this section may admit, from the community-at-large or upon referral

from an unrelated facility, young adults with medical fragility who

prior to reaching age twenty-one were children with medical fragility,

and who are eligible for nursing home care and in need of extensive

nursing, medical, psychological and counseling support services,

provided that the young adult facility, to promote continuity of care,

undertakes to provide priority admission to young adults with medical

fragility transitioning from the pediatric residential health care

facility or unit operated by the entity that proposed the young adult

facility and ensure sufficient capacity to admit such young adults as

they approach or attain twenty-one years of age.

6. (a) For inpatient services provided to any young adults with

medical fragility eligible for medical assistance pursuant to title

eleven of article five of the social services law residing at any

eligible pediatric residential health care facility as authorized in

subdivision three of this section, the commissioner shall establish the

operating component of rates of reimbursement appropriate for young

adults with medical fragility residing at a pediatric residential health

care facility, to apply to such young adults twenty-one years of age or

older. Such methodology shall take into account the methodology used to

establish the operating component of the rates pursuant to section

twenty eight hundred eight of this article for pediatric residential

health care facilities with an increase or decrease adjustment as

appropriate to account for any discrete expenses associated with caring

for young adults with medical fragility, including addressing their

distinct needs as young adults for psychological and counseling support

services.

(b) For inpatient services provided to any young adults with medical

fragility eligible for medical assistance pursuant to title eleven of

article five of the social services law at any young adult facility as

authorized in subdivision four of this section, the commissioner shall

establish the operating component of rates of reimbursement appropriate

for young adults with medical fragility. Such methodology shall take

into account the methodology used to establish the operating component

of the rates pursuant to section twenty eight hundred eight of this

article for pediatric residential health care facilities with an

increase or decrease adjustment as appropriate to account for any

discrete expenses associated with caring for young adults with medical

fragility, including addressing their distinct needs as young adults for

psychological and counseling support services.

7. The commissioner shall have authority to waive any rule or

regulation to effectuate the demonstration program authorized pursuant

to subdivision one of this section.

* NB Repealed August 17, 2027

* NB There are 2 § 2808-e's