N.Y. Social Services Law § 367-s: Long term care demonstration program

* § 367-s. Long term care demonstration program. 1. Notwithstanding

any inconsistent provision of law, the commissioner of health is

authorized to establish a long term care demonstration program for

persons eligible to receive services under this title, to operate in up

to four social services districts, for the purposes of creating

incentives for providers to care for individuals with more complex

medical needs, supporting relatives and other caregivers to assist

patients needing care at home and reducing the need for

institutionalization.

2. The provisions of this section shall not take effect unless all

necessary approvals under federal law and regulation have been obtained

to receive federal financial participation in the costs of the health

care services provided pursuant to this section.

3. (a) The demonstration program established pursuant to this section

may include a program to improve the availability of care for persons

with clinically complex care needs who are being discharged from

hospitals or residential health care facilities. In this regard, and in

accordance with paragraph (d) of this subdivision, the commissioner

shall adjust the rates of payment to selected home health agencies

certified under article thirty-six of the public health law that provide

services to such persons.

(b) Eligible certified home health agencies shall:

(i) demonstrate they have the experience and resources to provide

services to individuals who are discharged from hospitals or residential

health care facilities with clinically complex care needs, as determined

in accordance with criteria established by the commissioner.

(ii) demonstrate that they are capable of meeting such other

conditions as may be established by the commissioner.

(c) In selecting eligible certified home health agencies, the

commissioner shall consider the likelihood that the agency will provide

improved availability of care and may consider such other matters as the

commissioner deems appropriate.

(d) The adjusted Medicaid rate pursuant to this subdivision shall be

available for eligible certified home health agencies for services

provided to individuals, eligible for medical assistance pursuant to

this title, who are discharged from a hospital or residential health

care facility and have clinically complex care needs, as determined in

accordance with criteria established by the commissioner. Such rate

shall be payable for services provided up to the first sixty days after

discharge from a hospital or residential health care facility.

4. One or more demonstration sites established pursuant to this

section may include the provision of respite care through innovative

models. Subject to the approval of the director of the division of the

budget, the commissioner is authorized to establish payment rates or

fees for services provided pursuant to this subdivision.

5. One or more of the demonstration sites established pursuant to this

section may include a program with authority to make payments for

personal care services that are provided by a consumer's family members.

* NB There are 2 § 367-s's