N.Y. Public Health Law § 4015: Pilot program for all-inclusive care for children

§ 4015. Pilot program for all-inclusive care for children. 1. The

commissioner is hereby authorized to establish a pilot program for

all-inclusive care for children. Such program, subject to the rules and

regulations of the commissioner, shall consist of comprehensive hospice

and palliative care services for children with life-limiting illnesses

that addresses the medical, psychosocial and spiritual aspects of care

and allows such children to be cared for at home rather than in an

institutional setting. Such services shall be provided by a licensed,

certified hospice working jointly with a certified home health agency,

or a certified home health agency working jointly with a licensed,

certified hospice to assure the provision of services which are an

enhancement of either the certified home health agency or hospice alone,

and shall include hospice services as well as related expressive

therapies such as art, play or music therapy in addition to services of

a child life specialist, and opportunities for respite care.

2. "A child with a life threatening illness" shall mean a child

eligible for medical assistance under article five of the social

services law, who under the age of eighteen is diagnosed with an illness

that places the child at substantial risk of dying before the age of

twenty-one where the child can, with appropriate services be cared for

at an alternative to institutional care.

3. Qualified agencies providing services under this section to a child

shall be reimbursed under medical assistance under article five of the

social services law, at a per diem rate for each day the child is

enrolled in a program. To ensure the alienability of needed services to

these children, reimbursement shall be provided only to those agencies

having satisfied conditions of the department including satisfactory

training in pediatric palliative care.

4. Certified hospice programs shall be allowed to waive the admission

criteria requiring certification of "a terminal illness with prognosis

of six months or less" as well as the requirement for families to forgo

curative treatment for children qualifying for this program receiving

care from an approved site.

5. All home care and other medical assistance under article five of

the social services law otherwise authorized for the child, shall

continue without interruption. The pilot program for all-inclusive care

for children is not intended to supersede any program already in place.

6. The locations of the providers under the pilot program for

all-inclusive care shall be geographically disbursed throughout the

state and approved by the commissioner.

7. The commissioner shall require each provider under the pilot

program for all-inclusive care for children to submit an annual report,

which shall include data analyzing the cost and efficiency of care

provided under such program. On or before December thirty-first, two

thousand eight, the commissioner shall submit a report to the governor,

the temporary president of the senate and the speaker of the assembly

analyzing the cost and efficiency of the pilot program.