N.Y. Public Health Law § 4012-a: Hospice supplemental financial assistance program for persons with special needs

§ 4012-a. Hospice supplemental financial assistance program for

persons with special needs. 1. Notwithstanding any provision of law or

regulation to the contrary, an additional amount may be added to a

hospice's rate pursuant to the medical assistance program, subject to

approval by the state director of the budget, for purposes of enabling

such hospice to provide care and services to persons with special needs,

after a determination that such care cannot be appropriately provided at

the rates of payment established pursuant to federal criteria.

2. "Persons with special needs" as used herein shall include persons

with acquired immune deficiency syndrome and other illnesses or

conditions, which require a more costly or intensive level of care than

typically provided, and persons receiving care in a hospice residence.

Such other illnesses or conditions shall be specified in regulation by

the state hospital review and planning council.

3. In order for a hospice to obtain additional medicaid payment as

provided for in this section, the hospice shall submit cost information

as required by the commissioner, in consultation with the commissioner

of social services, which justifies additional medicaid expenditures,

including a demonstration that adequate care to persons with special

needs cannot be provided within the rates of payment established

pursuant to federal criteria. In addition to demonstrating that the

hospice is certified and in good standing with all applicable

regulations and requirements, the hospice shall also demonstrate that it

shall:

(a) utilize such additional payment to provide services to persons

with special needs;

(b) shall undertake reasonable efforts to maintain financial support

from public and community contributed funding sources;

(c) shall make every reasonable effort to collect payments for

services from third party insurance payers, governmental payers and

self-paying patients; and

(d) shall establish a reasonable relationship between costs and

charges, or establish charges at approximate costs.

4. The commissioner, in consultation with the commissioner of social

services, is authorized to submit for approval and adoption by the state

hospital review and planning council such regulations as necessary to

effectuate the provisions of this section.

5. The commissioner shall establish a rate for persons receiving care

in a hospice residence, and may by regulation specify additional

standards necessary to ensure that the provisions of this section

promote medical assistance recipients access to hospice residence care

including; (a) that such recipients are otherwise unable to

appropriately receive hospice care in their own home; and (b) the

provision of supplemental financial assistance will promote the

efficient delivery of appropriate, quality, cost-effective services.