N.Y. Public Health Law § 4623: Long term care insurance and continuing care retirement contracts or continuing care at home contracts

§ 4623. Long term care insurance and continuing care retirement

contracts or continuing care at home contracts. 1. The commissioner may

approve an application for a certificate of authority and may issue a

certificate of authority for the establishment and operation of a

continuing care retirement community under an arrangement which

otherwise complies with the requirements of this article except that the

costs of nursing facility or home health care services are paid for in

whole or in part by (a) long term care insurance obtained and paid for

by the resident or by medical assistance payments in accordance with the

partnership for long term care program pursuant to section three hundred

sixty-seven-f of the social services law and section three thousand two

hundred twenty-nine of the insurance law or (b) other group or

individual long term care insurance approved by the superintendent in

connection with the application. The commissioner, in consultation with

the superintendent, shall provide for adequate disclosure to residents

of their options, rights and obligations under such an arrangement, and

shall establish standards for the remittance and collection of premiums

and monthly care fees.

2. With regard to nursing facility or home health care services which

are part of the continuing care retirement contract or continuing care

at home contract, any elimination or waiting periods and any

deductibles, copayments, or other amounts not paid for by such long term

care insurance or medical assistance payments shall be the

responsibility of the continuing care retirement community. The resident

shall not be liable to pay any such amounts.

3. The continuing care retirement community operator shall not require

that long term care insurance be purchased from a specified insurer or

group of insurers and the operator shall not, without the approval of

the council and the approval of the superintendent, specify a minimum

acceptable benefit level different from that established under the

partnership for long term care program.

4. Entrance fees and monthly care fees shall reflect that the cost of

a resident's nursing facility and home health care services are or will

be paid for in whole or in part in accordance with (a) the partnership

for long term care program or (b) other group or individual long term

care insurance approved by the superintendent and the council in

connection with the application.

5. a. If a resident fails to maintain minimum long term care insurance

coverage in accordance with this section, the continuing care retirement

community operator shall purchase, if possible, such coverage on behalf

of and at the expense of the resident and may require an appropriate

adjustment in payments by the resident to the operator.

b. If the continuing care retirement community operator cannot

purchase long term care insurance coverage under paragraph a of this

subdivision, the operator may require an adjustment in the resident's

monthly fees, subject to the approval of the superintendent, to fund the

additional risk to the facility.

c. If the resident fails to maintain long term care insurance coverage

in accordance with this section and the community operator has not

purchased such coverage, the operator shall be responsible for any

expenses which would have been covered under the long term care

insurance policy which the resident failed to maintain. The operator may

add the amount of such expenses to the resident's monthly fees.