NY State Assembly Bill 2009-A8647

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Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 17, 2010	print number 8647c
Jun 17, 2010	amend and recommit to codes
Mar 02, 2010	reported referred to codes
Feb 24, 2010	print number 8647b
Feb 24, 2010	amend and recommit to health
Jan 06, 2010	referred to health
Jun 17, 2009	reported referred to rules
Jun 15, 2009	reported referred to codes
Jun 12, 2009	print number 8647a
Jun 12, 2009	amend and recommit to health
Jun 02, 2009	referred to health

Bill Amendments

Original

C (Active)

co-Sponsors

2009-A8647 - Details

Current Committee:: Assembly Codes
Law Section:: Public Health Law
Laws Affected:: Add §2803-s, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A2473

2009-A8647 - Summary

Establishes the transition authorization panel demonstration program to evaluate an approach to secure decisions relating to the transition of isolated patients from inpatient care to post-acute care; creates three-person panels which will authorize the transition of eligible patients from participating hospital to post-acute care; authorizes transition-related financial arrangements; sets forth provisions relating to the composition, duties, and powers of such panels

2009-A8647 - Sponsor Memo

                                BILL NUMBER:A8647

TITLE  OF  BILL:   An act to amend the public health law, in relation to
establishing a demonstration program to study  transition  authorization
panels  as  an  approach to secure decisions regarding the transition of
incapable patients who do not  have  legally  authorized  decisionmakers
from  inpatient care to post-acute care; and providing for the repeal of
such provisions upon expiration thereof

PURPOSE: To determine whether transition authorization panels will serve
the interests of patients, families, providers and the public by facili-
tating the transition of incapable, non-objecting hospital  patients  to
more appropriate settings.

SUMMARY  OF  PROVISIONS:  Section  1  sets  forth  legislative findings,
including findings that:

* in many instances there are hospital patients who are medically  ready
to  transition  to a different level of care, such as nursing home care,
home care or assisted living, but they lack capacity  to  authorize  the
transition,  and  also  lack  a  family  member  or other person who can
authorize the transition on their behalf.

* as a result, such patients can be  subject  to  inordinate  delays  in
accomplishing a needed transition, and can remain as hospital inpatients
for long periods.

*  delay  is  harmful  to the interests of those patients, as well as to
other persons who may need the scarce inpatient resources, to hospitals,
to payors and to the public in general.

* it would be valuable to study an alternative approach to secure  deci-
sions  relating  to  the  transition of isolated incapable patients from
inpatient care to post-acute care.

* the transition authorization panel demonstration program shows promise
as means to protect the rights and interests of  incapable  patients  in
the transition decision, while allowing such decisions to be made within
a reasonable timeframe.

Section  2  adds  a  new section 2803-s to the Public Health Law, called
"Transition authorization panel demonstration program."

Subsection 1 would state that the transition authorization  panel  (TAP)
program is established at five sites.

Subsection 2 sets forth definitions. Significantly, it defines "eligible
patient" to mean an inpatient at a participating hospital who, according
to the patient's attending physician:

(i)  is  ready to be discharged as an inpatient, but needs to be transi-
tioned to post-acute care;

(ii) lacks capacity to consent to the  discharge  and  to  admission  to
post-acute care;

(iii)  does not have a guardian, health care agent or power of attorney,
or a family member, friend or other representative who  is  willing  and
legally  authorized  to make a transition decision on his or her behalf,
and whose consent would  be  accepted  by  a  proposed  post-acute  care
provider;

(iv) has a discharge plan that identifies an appropriate post-acute care
provider  that is or may be willing to admit the patient if a panel were
to authorize the transition and, if necessary,  make  transition-related
financial arrangements; and

(v)  has  not expressed an objection to any of the foregoing findings or
to being transitioned to the proposed post-acute facility or service or,
if applicable, the proposed transition-related financial arrangements;

This subsection also defines "Participating hospital" to mean any of the
following hospitals: (i) Crouse Hospital, Syracuse NY; (ii) Glens  Falls
Hospital,  Glens  Falls  NY;  (ii)  Memorial  Hospital, Albany NY; (iii)
Samaritan Hospital, Troy,  NY;  (iv)  University  of  Rochester  Medical
Center, Rochester NY.

This  subsection  also  defines  "Post-acute care," "Transition authori-
zation," "Transition authorization panel  agent,"  "Transition  authori-
zation panel," "Transition authorization panel pool" and "Transition-re-
lated financial arrangements."

Subsection 3 sets forth the responsibilities of participating hospitals,
including  the  responsibility to designate a person as administrator of
the program at that site, and to carry out, and bear the costs  of,  the
administrative responsibilities of the program.

Subsection  4 authorizes each participating hospital to create a transi-
tion authorization pool - the collection of persons at each site who can
serve on transition authorization panels.

Subsection 5 provides that requests for transition authorization and for
transition-related financial arrangements may be undertaken  by  transi-
tion  authorization  panels, and describes the selection and composition
of such panels.

Subsection 6 sets forth the procedure for requesting a  panel,  and  for
notice to involved persons.

Subsection 7 sets forth the procedure for review by a transition author-
ization panel.

Subsection 8 specifies what the panel may determine and authorize.

Subsection 9 provides that a participating hospital, the social services
department,  and  any  other  person  may, but shall not be required to,
enter into an agreement with a post-acute provider  for  such  hospital,
department or other person to petition for the appointment of a guardian
under  Mental Hygiene Law Art. 81 for a patient transitioned pursuant to
the order of a panel.

Subsection 10 provides immunity to persons who  act  in  good  faith  as
panel members, and others who act in good faith pursuant to this Act.

Subsection  11  requires  the  administrator  of each panel to submit an
annual report to the commissioner of health, and specifies the  contents
of the report.

Section 3 provides for the Act to take effect immediately.

EXISTING  LAW:  In general, when a hospital inpatient needs to be trans-
ferred to post-acute care, the patient must  consent  to  the  discharge
from  the  hospital,  the admission to the post-acute care provider, and
the financial arrangements with the post-acute  care  provider.  When  a
patient  lacks  capacity,  hospitals  will  often try to turn to a close
family member to make this decision. However:

1. Unless the family member is guardian (e.g., under MHL Article 81)  or
a health care agent, the family member will not have clear legal author-
ity  to authorize the patient's discharge from the hospital or admission
to the post-acute care facility. While some post-acute  care  facilities
will  admit  incapable patients based on a family member consent, others
will not;

2. Unless the family member is a guardian of the property,  or  holds  a
power  of  authority from the patient, or jointly owns property with the
patient, the family member is unlikely to be  able  make  the  financial
arrangements  on  behalf  of the patient that may be necessary to secure
admission to the post-acute care facility.

3. Many patients do not have family members or close friends. For  those
isolated  patients,  noone has the authority to consent to the patient's
discharge from the hospital or admission to the post acute care setting,
or to make the financial arrangements with the post acute care provider.

If the proposed Family Health Care Decisions Act (S.3164  I  A.7729)  is
passed,  it  will help with problem #1 above, because it will give clear
authority to family members and close friends to make health care  deci-
sions - which would probably encompass the discharge and admission deci-
sion. But it will not help with problems #2 and #3.

Currently,  in many instances when an incapable inpatient is ready to be
discharged, but lacks a health  care  or  financial  decisionmaker,  the
hospital or social services district finds it necessary to bring a guar-
dianship  under MHL Article 81 in order to give someone the authority to

accomplish the transition. A guardianship proceeding can. take weeks  or
months, during which time the patient is unnecessarily hospitalized.

STATEMENT  IN SUPPORT: In many instances there are hospital patients who
are medically ready to transition to a different level of care, such  as
nursing  home care, home care or assisted living, but they lack capacity
to authorize the transition, and also lack  a  family  member  or  other
person  who  can  authorize the transition on their behalf. As a result,
such patients can be subject to inordinate  delays  in  accomplishing  a
needed  transition, and can remain as hospital inpatients for long peri-
ods. This delay is harmful to the interests of those patients,  as  well
as  to  other  persons  who  may need the scarce inpatient resources, to
hospitals, to payors and to the public in general.

While Article 81 of the Mental Hygiene Law provides a procedure for  the
court-appointment of guardians who could be empowered to authorize tran-
sition  for  such  patients, that procedure was designed for longer-term
assistance with an incapacitated person's personal and property affairs,
and includes features that appear to go beyond what is needed for  tran-
sition-related decisions alone. As a result, the guardianship proceeding
can require far more time, effort and expense than is warranted for this
limited, non-contested decision.

This  bill would test an alternative approach to secure decisions relat-
ing to the transition of isolated incapable patients from inpatient care
to post-acute care. The approach would be tested at five sites -  Crouse
Hospital in Syracuse, Glens Falls Hospital, Memorial Hospital in Albany,
Samaritan Hospital in Troy and University of Rochester Medical Center in
Rochester.  Each  participating  hospital  would establish a "transition
panel pool" - a group of  persons  qualified  to  serve  on  "transition
authorization panels."

When  the  hospital  identifies  a person who appears to be an "eligible
patient," it could convene a "transition authorization  panel"  to  make
the  transition  authorization decision and transition related financial
arrangements. An eligible patient is a patient who (i) is  ready  to  be
discharged  as  an inpatient, but needs to be transitioned to post-acute
care; (ii) lacks capacity to consent to the discharge and  to  admission
to post-acute care; (iii) does not have a guardian, health care agent or
power  of  attorney,  or a family member, friend or other representative
who is willing and legally authorized to make a transition  decision  on
his  or  her  behalf,  and whose consent would be accepted by a proposed
post-acute care provider; (iv) has a discharge plan that  identifies  an
appropriate  post-acute care provider that is or may be willing to admit
the patient if a panel were to authorize the transition and,  if  neces-
sary,  make  transition-related  financial arrangements; and (v) has not
expressed an objection to any of the  foregoing  findings  or  to  being
transitioned  to  the  proposed  post-acute  facility  or service or, if
applicable, the proposed transition-related financial arrangements.

The transition authorization panel, or TAP, would be composed  of  three
persons  --  one  person appointed by the hospital, one appointed by the

local social services district, and one jointly appointed. The TAP could
be convened quickly and, while employing basic  procedural  protections,
could  decide  whether  the  patient  is in fact eligible. It could then
authorize  an  appropriate  discharge,  as well as the discharge related
financial arrangements.

In many cases, the patient will still need  a  guardian  for  long  term
personal or property management. But the TAP process will make it possi-
ble  for the guardianship to occur after the patient has been discharged
to an appropriate care setting, rather than while in the hospital,

It is hoped that the TAP process will prove to be  an  ethically  sound,
practical  approach to facilitate the transition of incapable inpatients
from the hospital to appropriate post-acute settings.  If  so,  the  TAP
process  will  benefit  patients,  families,  providers,  and the public
generally.

This is only a demonstration bill; the authority  granted  by  it  would
expire  in  three  years  and  ninety  days. Each of the five sites will
collect data on their experience and annually forward that data  to  the
NYS  Department  of  Health.  The  Department  will compile the data and
forward a report to the Legislature. The Legislature will then be  in  a
position  to  decide  whether  to  continue,  end,  or modify the demon-
stration, or apply the model more broadly.

BUDGET IMPLICATIONS: The bill will have no appreciable budgetary impact.

EFFECTIVE DATE: Immediately, and shall expire and repeal 3 years and  90
days after it shall become law.

2009-A8647 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  8647

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                              June 2, 2009
                               ___________

Introduced  by  M. of A. CANESTRARI, GORDON -- read once and referred to
  the Committee on Health

AN ACT to amend the public health law, in  relation  to  establishing  a
  demonstration  program  to study transition authorization panels as an
  approach to secure decisions regarding  the  transition  of  incapable
  patients  who do not have legally authorized decisionmakers from inpa-
  tient care to post-acute care; and providing for the  repeal  of  such
  provisions upon expiration thereof

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The legislature finds and declares that in  many  instances
there  are  hospital patients who are medically ready to transition to a
different level of care,  such  as  nursing  home  care,  home  care  or
assisted living, but they lack capacity to authorize the transition, and
also  lack a family member or other person who can authorize the transi-
tion on their behalf. As a result, such patients can be subject to inor-
dinate delays in accomplishing a needed transition, and  can  remain  as
hospital  inpatients  for  long  periods.  That  delay is harmful to the
interests of those patients, as well as to other persons  who  may  need
the  scarce  inpatient  resources,  to  hospitals,  to payors and to the
public in general.
  The legislature further finds that while  article  81  of  the  mental
hygiene  law provides a procedure for the court-appointment of guardians
who could be empowered to authorize transition for such  patients,  such
procedure  was designed for longer-term assistance with an incapacitated
person's personal and property affairs, and includes features that often
go beyond what is needed for transition-related decisions  alone.  As  a
result,  the  guardianship  proceeding can require far more time, effort
and expense than is warranted for this limited, non-contested decision.
  Accordingly, the legislature finds that it would be valuable to  study
an  alternative  approach to secure decisions relating to the transition

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11971-02-9

A. 8647                             2

of isolated incapable patients from inpatient care to  post-acute  care.
Specifically,  the  transition authorization panel demonstration program
shows promise as means to protect the rights and interests of  incapable
patients in the transition decision, while allowing such decisions to be
made within a reasonable timeframe.
  S  2.  The public health law is amended by adding a new section 2803-s
to read as follows:
  S 2803-S. TRANSITION AUTHORIZATION PANEL DEMONSTRATION  PROGRAM.    1.
THERE  IS  HEREBY  ESTABLISHED  A  TRANSITION AUTHORIZATION PANEL DEMON-
STRATION PROGRAM, CONDUCTED  AT  FIVE  PROGRAM  SITES,  TO  EVALUATE  AN
APPROACH  TO  SECURE  DECISIONS  RELATING  TO THE TRANSITION OF ISOLATED
PATIENTS FROM INPATIENT CARE TO POST-ACUTE CARE.
  2. AS USED IN THIS SECTION:
  (A) "ELIGIBLE PATIENT" MEANS AN INPATIENT AT A PARTICIPATING  HOSPITAL
WHO, ACCORDING TO THE PATIENT'S ATTENDING PHYSICIAN:
  (I) IS READY TO BE DISCHARGED AS AN INPATIENT, BUT NEEDS TO BE TRANSI-
TIONED TO POST-ACUTE CARE;
  (II)  LACKS  CAPACITY  TO CONSENT TO THE DISCHARGE AND TO ADMISSION TO
POST-ACUTE CARE;
  (III) DOES NOT HAVE A GUARDIAN, HEALTH CARE AGENT OR POWER  OF  ATTOR-
NEY,  OR  A FAMILY MEMBER, FRIEND OR OTHER REPRESENTATIVE WHO IS WILLING
AND LEGALLY AUTHORIZED TO MAKE A  TRANSITION  DECISION  ON  HIS  OR  HER
BEHALF,  AND  WHOSE  CONSENT  WOULD BE ACCEPTED BY A PROPOSED POST-ACUTE
CARE PROVIDER;
  (IV) HAS A DISCHARGE PLAN THAT IDENTIFIES  AN  APPROPRIATE  POST-ACUTE
CARE  PROVIDER THAT IS OR MAY BE WILLING TO ADMIT THE PATIENT IF A TRAN-
SITION AUTHORIZATION PANEL WERE TO  AUTHORIZE  THE  TRANSITION  AND,  IF
NECESSARY, MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS; AND
  (V) HAS NOT EXPRESSED AN OBJECTION TO ANY OF THE FOREGOING FINDINGS OR
TO BEING TRANSITIONED TO THE PROPOSED POST-ACUTE FACILITY OR SERVICE OR,
IF APPLICABLE, THE PROPOSED TRANSITION-RELATED FINANCIAL ARRANGEMENTS;
  (B) "PARTICIPATING HOSPITAL" MEANS ANY OF THE FOLLOWING HOSPITALS:
  (I) CROUSE HOSPITAL, SYRACUSE, NY.
  (II) GLENS FALLS HOSPITAL, GLENS FALLS, NY.
  (III) MEMORIAL HOSPITAL, ALBANY, NY.
  (IV) SAMARITAN HOSPITAL, TROY, NY.
  (V) UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY.
  (C)  "POST-ACUTE  CARE" MEANS CARE PROVIDED BY A NURSING HOME, TRANSI-
TIONAL CARE UNIT, HOME HEALTH AGENCY,  ASSISTED  LIVING  PROGRAM,  ADULT
CARE  FACILITY,  AN INPATIENT TREATMENT FACILITY OR RESIDENTIAL FACILITY
LICENSED OR OPERATED BY THE OFFICE OF  ALCOHOLISM  AND  SUBSTANCE  ABUSE
SERVICES,  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OF MENTAL RETARDA-
TION AND DEVELOPMENTAL DISABILITIES, OR AN INPATIENT TREATMENT  FACILITY
OR  RESIDENTIAL  FACILITY LICENSED BY A HEALTH, MENTAL HYGIENE OR SOCIAL
SERVICES AGENCY OF ANOTHER STATE.
  (D) "TRANSITION AUTHORIZATION" MEANS A DECISION, MADE BY A  TRANSITION
AUTHORIZATION  PANEL  PURSUANT TO THIS ARTICLE, TO AUTHORIZE THE TRANSI-
TION OF AN ELIGIBLE PATIENT FROM A PARTICIPATING HOSPITAL TO A  SPECIFIC
POST-ACUTE CARE PROVIDER.
  (E) "TRANSITION AUTHORIZATION PANEL AGENT" MEANS AN INDIVIDUAL AUTHOR-
IZED  BY  THE  TRANSITION  AUTHORIZATION  PANEL  TO CARRY OUT TRANSITION
RELATED FINANCIAL ARRANGEMENTS.
  (F) "TRANSITION  AUTHORIZATION  PANEL"  MEANS  A  THREE-PERSON  PANEL,
CONVENED  PURSUANT  TO  THIS  ARTICLE, TO AUTHORIZE THE TRANSITION OF AN
ELIGIBLE PATIENT FROM A PARTICIPATING  HOSPITAL  TO  A  POST-ACUTE  CARE
PROVIDER, AND TO MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS.

A. 8647                             3

  (G)  "TRANSITION  AUTHORIZATION  PANEL  POOL"  MEANS  THE FULL POOL OF
PERSONS QUALIFIED AND DESIGNATED TO SERVE  ON  TRANSITION  AUTHORIZATION
PANELS AT A PROGRAM SITE.
  (H) "TRANSITION-RELATED FINANCIAL ARRANGEMENTS" MEANS ACTS NECESSARY:
  (I) TO EXPEND THE ELIGIBLE PATIENT'S FUNDS FOR POST-ACUTE CARE FOR ONE
HUNDRED  TWENTY DAYS OR UNTIL THE COURT APPOINTMENT OF A GUARDIAN OF THE
PERSON PURSUANT TO ARTICLE EIGHTY-ONE OF THE MENTAL HYGIENE LAW,  WHICH-
EVER OCCURS FIRST.
  (II) TO APPLY FOR THE ELIGIBLE PATIENT'S ENROLLMENT IN MEDICAID.
  (III)  TO ACCESS FINANCIAL INFORMATION ABOUT THE ELIGIBLE PATIENT FROM
FINANCIAL INSTITUTIONS TO THE EXTENT  NECESSARY  FOR  THE  PURPOSES  SET
FORTH IN SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH.
  3. EACH PARTICIPATING HOSPITAL SHALL:
  (A) DESIGNATE A PERSON AS ADMINISTRATOR OF THE PROGRAM WITH RESPECT TO
THAT PROGRAM SITE; AND
  (B)  CARRY OUT, AND BEAR THE COSTS OF, THE ADMINISTRATIVE RESPONSIBIL-
ITIES OF THE PROGRAM AS SET FORTH IN THIS SECTION, WITH RESPECT TO  THAT
PROGRAM SITE.
  4.  (A) A PARTICIPATING HOSPITAL MAY CREATE A TRANSITION AUTHORIZATION
PANEL POOL AT A PROGRAM SITE, WHICH SHALL HAVE THREE CLASSES OF MEMBERS:
  (I) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY  THE
HOSPITAL;
  (II) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY THE
LOCAL SOCIAL SERVICES COMMISSIONER; AND
  (III)  ONE  CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS JOINTLY DESIG-
NATED BY THE HOSPITAL AND LOCAL SOCIAL SERVICES  COMMISSIONER,  WHO  ARE
NOT EMPLOYED BY EITHER.
  (B)  FOR  THE  PURPOSES  OF  THIS PARAGRAPH, "QUALIFIED PERSONS" MEANS
ADULT PERSONS WITH RECOGNIZED EXPERTISE OR DEMONSTRATED INTEREST IN  THE
CARE AND TREATMENT OF HOSPITAL AND POST-ACUTE CARE PATIENTS, AND WHO CAN
BE  EXPECTED  TO  APPLY  THE STANDARDS OF THIS ARTICLE IN GOOD FAITH AND
WITH SIGNIFICANT SENSITIVITY TO THE INTERESTS OF THE ELIGIBLE PATIENT.
  (C) THE PARTICIPATING HOSPITAL AND THE LOCAL SOCIAL  SERVICES  COMMIS-
SIONER  SHALL  JOINTLY  APPOINT  ONE  MEMBER  AS CHAIR OF THE TRANSITION
AUTHORIZATION PANEL POOL.
  5. (A) THE REVIEW OF REQUESTS FOR  TRANSITION  AUTHORIZATION  AND  FOR
TRANSITION-RELATED  FINANCIAL ARRANGEMENTS SHALL BE UNDERTAKEN BY PANELS
OF THREE MEMBERS DRAWN FROM THE TRANSITION AUTHORIZATION PANEL POOL, ONE
FROM EACH CLASS. THE MEMBER FROM THE JOINTLY APPOINTED CLASS SHALL SERVE
AS PANEL CHAIR.
  (B) NO PERSON WHO IS A HEALTH CARE PROFESSIONAL ACTIVELY  INVOLVED  IN
THE  TREATMENT  OF  THE  PATIENT  WHOSE CASE IS UNDER CONSIDERATION BY A
PANEL MAY SERVE ON THE PANEL WITH  RESPECT  TO  SUCH  PATIENT,  ALTHOUGH
OTHER HOSPITAL PERSONNEL MAY SERVE ON THE PANEL IF OTHERWISE QUALIFIED.
  6.  (A) THE CHIEF EXECUTIVE OFFICER OF A PARTICIPATING HOSPITAL OR HIS
OR HER DESIGNEE MAY CAUSE A PANEL TO BE CONVENED BY SUBMITTING A WRITTEN
REQUEST TO THE ADMINISTRATOR. THE REQUEST MUST:
  (I) INDICATE THAT IT IS A REQUEST FOR THE PANEL TO AUTHORIZE THE TRAN-
SITION OF THE PATIENT TO POST-ACUTE CARE AND,  IF  APPLICABLE,  TO  MAKE
TRANSITION-RELATED FINANCIAL ARRAIGNMENTS;
  (II) SET FORTH THE REASONS FOR BELIEVING THAT THE PATIENT IS AN ELIGI-
BLE PATIENT; AND
  (III)  SET  FORTH THE PROPOSED POST-ACUTE CARE PROVIDER (OR PROVIDERS,
IF APPLICATIONS HAVE OR WILL BE MADE TO MORE THAN ONE);
  (B) UPON RECEIPT OF THE REQUEST, THE ADMINISTRATOR SHALL:

A. 8647                             4

  (I) SET A TIME, DATE AND PLACE FOR THE TRANSITION AUTHORIZATION  PANEL
TO  REVIEW  THE  REQUEST.  SUCH REVIEW MAY BE SCHEDULED FOR ANY TIME AND
DATE AT LEAST THREE DAYS  AFTER  THE  REQUEST  AND  NOTICE  IS  SENT  AS
PROVIDED  BELOW;  HOWEVER,  THE REVIEW MAY BE HELD EARLIER OR LATER THAN
THE  DATA  SET  FORTH  IN  THE NOTICE IF ALL PERSONS WHO ARE ENTITLED TO
NOTICE, AS SET FORTH BELOW, AGREE, IN WRITING OR VERBALLY (AS DOCUMENTED
BY THE ADMINISTRATOR), TO THE TIME, PLACE AND DATE OF THE REVIEW.
  (II) SEND A COPY OF THE REQUEST AND NOTICE,  BY  HAND,  MAIL,  FAX  OR
E-MAIL, TO THE FOLLOWING PERSONS:
  (A) THREE MEMBERS OF THE TRANSITION AUTHORIZATION PANEL POOL, ONE FROM
EACH  CLASS,  SELECTED  BY  THE  POOL CHAIR, WHO ARE WILLING AND ABLE TO
SERVE AS A PANEL FOR THE PURPOSE OF THIS REVIEW;
  (B) THE PATIENT, IF THERE IS ANY INDICATION OF THE  PATIENT'S  ABILITY
TO COMPREHEND SUCH NOTICE;
  (C)  TO  A  FAMILY  MEMBER  OR FRIEND OF THE PATIENT WHO IS REASONABLY
AVAILABLE, AND WHO HAS BEEN INVOLVED IN THE PATIENT'S CARE  OR  WHO  HAS
DEMONSTRATED  CONCERN  ABOUT THE PATIENT'S WELFARE, IF THERE IS ANY SUCH
PERSON;
  (D) IF THE PATIENT WAS ADMITTED FROM A FACILITY OR RESIDENCE  LICENSED
BY  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OR MENTAL RETARDATION AND
DEVELOPMENTAL DISABILITIES, TO  THE FACILITY DIRECTOR AND TO THE  MENTAL
HYGIENE LEGAL SERVICES OFFICE FOR THAT JUDICIAL DEPARTMENT; AND
  (E) TO THE PATIENT'S ATTENDING PHYSICIAN.
  (III)  PROVIDE  NOTICE  TO  THE  PATIENT  AND  TO MENTAL HYGIENE LEGAL
SERVICES WHICH SHALL INFORM THE PATIENT THAT HE OR SHE WILL BE  AFFORDED
AN  OPPORTUNITY  TO  ADDRESS  THE  PANEL,  MAY  BE PRESENT FOR ANY OTHER
ADDRESSES MADE TO THE PANEL, AND MAY BE PRESENT FOR OTHER PARTS  OF  THE
PANEL  REVIEW  AS  THE  CHAIR MAY PERMIT, BUT THAT HE OR SHE WILL NOT BE
PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  (IV) PROVIDE NOTICE TO A PERSON DESCRIBED IN CLAUSES (B)  THROUGH  (E)
OF  THIS  SUBPARAGRAPH WHICH SHALL INFORM THE PERSON THAT HE OR SHE WILL
BE AFFORDED AN OPPORTUNITY TO ADDRESS THE PANEL, AND MAY BE PRESENT  FOR
SUCH  OTHER  PARTS OF THE PANEL REVIEW AS THE CHAIR MAY PERMIT, THAT THE
PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A  PATIENT)
MAY  BE  PRESENT  WHEN ANY OTHER PERSON ADDRESSES THE PANEL, AND THAT NO
PERSON DESCRIBED IN CLAUSES (B) THROUGH (E) OF THIS  SUBPARAGRAPH  SHALL
BE PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  7. (A) PRIOR TO OR DURING THE REVIEW, THE PANEL CHAIR MAY REQUEST AND,
NOTWITHSTANDING  ANY  OTHER  LAW  TO  THE CONTRARY, SHALL BE ENTITLED TO
RECEIVE FROM ANY HEALTH CARE PROVIDER AND  DISCLOSE  TO  THE  PANEL  ANY
INFORMATION  WHICH  IS RELEVANT TO THE PANEL'S REVIEW. INFORMATION WHICH
IS CONFIDENTIAL, AS PROVIDED FOR BY LAW, SHALL BE KEPT  CONFIDENTIAL  BY
THE  PANEL AND ANY LIMITATIONS ON THE FURTHER RELEASE THEREOF IMPOSED BY
LAW UPON THE PARTY FURNISHING THE INFORMATION SHALL APPLY TO THE PANEL.
  (B) THE PANEL SHALL MEET IN PERSON TO CONDUCT ITS REVIEW.
  (C) THE PANEL CHAIR MAY REQUEST THE ATTENDANCE AT THE  REVIEW  OF  ANY
PERSON WHO MIGHT ASSIST THE PANEL IN ITS REVIEW.
  (D) THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A
PATIENT) MAY BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE PANEL.
  (E)  WHERE  PRACTICABLE,  THE PANEL MEMBERS SHALL PERSONALLY INTERVIEW
AND OBSERVE THE PATIENT PRIOR TO MAKING THEIR DECISION.
  (F) NO PERSON DESCRIBED IN CLAUSES (B)  THROUGH  (E)  OF  SUBPARAGRAPH
(II)  OF  PARAGRAPH  (B)  OF  SUBDIVISION  SIX  OF THIS SECTION SHALL BE
PERMITTED TO BE PRESENT DURING THE PANEL DELIBERATION.
  (G) THE PANEL CHAIR MAY ADJOURN AND RECONVENE THE PANEL AS NECESSARY.

A. 8647                             5

  (H) THE ADMINISTRATOR SHALL TAKE AND MAINTAIN  MINUTES  OF  ANY  PANEL
MEETING, BUT NO RECORDING OR TRANSCRIPTION SHALL BE REQUIRED.
  8.  (A)  THE PANEL SHALL MAKE A DETERMINATION, BY MAJORITY VOTE, AS TO
WHETHER THE PATIENT IS AN ELIGIBLE PATIENT,  WHETHER  TO  AUTHORIZE  THE
PROPOSED  TRANSITION, AND WHETHER TO AUTHORIZE TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS. THE DETERMINATION SHALL BE SET FORTH IN  WRITING  AND
SHALL BE SIGNED BY THE CHAIR ON BEHALF OF THE PANEL.
  (B)  IF  THE  PANEL  DETERMINES  TO  AUTHORIZE THE PROPOSED TRANSITION
AND/OR  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS,  THE  AUTHORIZATION
SHALL  BE  SET  FORTH  IN AN ORDER, SIGNED BY THE CHAIR ON BEHALF OF THE
PANEL. THE ORDER SHALL DESCRIBE THE SCOPE OF SUCH AUTHORIZATION AND,  IF
IT  AUTHORIZES  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS, DESIGNATE A
TRANSITION AUTHORIZATION PANEL AGENT.
  (C) THE DETERMINATION, AND THE ORDER IF THERE IS ONE,  SHALL  BE  MADE
PART OF THE PATIENT'S MEDICAL RECORD.
  (D) NOTWITHSTANDING ANY LAW TO THE CONTRARY, THE ADMINISTRATOR AND THE
AGENT  SHALL  DISCLOSE  THE  ORDER  TO SUCH PERSONS AS NECESSARY FOR THE
PURPOSE OF CARRYING OUT ITS TERMS.
  (E) THE ORDER MAY BE RELIED UPON BY  THE  PARTICIPATING  HOSPITAL,  BY
POST-ACUTE  CARE  PROVIDERS,  BY  FINANCIAL  INSTITUTIONS,  AND BY OTHER
THIRD-PARTIES AS LEGAL AUTHORITY FOR THEM TO PERFORM OR COOPERATE IN THE
PERFORMANCE OF THE AUTHORIZED ACTS, INCLUDING LEGAL AUTHORITY:
  (I) FOR THE PARTICIPATING HOSPITAL TO DISCHARGE THE PATIENT;
  (II) FOR THE POST-ACUTE CARE PROVIDER TO ADMIT THE PATIENT;
  (III) FOR THE TRANSITION AUTHORIZATION PANEL  AGENT  TO  MAKE  TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS; AND
  (IV) FOR MEDICAID, FINANCIAL INSTITUTIONS AND OTHER PARTIES TO PROVIDE
FINANCIAL AND OTHER PERSONAL INFORMATION ABOUT THE PATIENT TO THE ADMIN-
ISTRATOR  OR AGENT, AND TO OTHERWISE COOPERATE IN THE TRANSITION-RELATED
FINANCIAL ARRANGEMENTS.
  9. A PARTICIPATING HOSPITAL, THE LOCAL SOCIAL SERVICES DEPARTMENT, AND
ANY OTHER PERSON MAY, BUT SHALL NOT BE REQUIRED TO, ENTER INTO AN AGREE-
MENT WITH A POST-ACUTE CARE PROVIDER FOR SUCH HOSPITAL,  DEPARTMENT,  OR
OTHER PERSON TO PETITION FOR THE APPOINTMENT OF A GUARDIAN UNDER ARTICLE
EIGHTY-ONE OF THE MENTAL HYGIENE LAW FOR A PATIENT TRANSITIONED PURSUANT
TO THE ORDER OF A TRANSITION AUTHORIZATION PANEL, EITHER BEFORE OR AFTER
THE  TRANSITION,  AS  A WAY TO PROVIDE FOR BROADER AND LONGER TERM DECI-
SIONMAKING AUTHORITY WITH RESPECT TO THE TRANSITIONED PATIENT. THE CHIEF
EXECUTIVE OFFICER OF A PARTICIPATING HOSPITAL, OR HIS OR  HER  DESIGNEE,
THAT  ENTERS  INTO SUCH AGREEMENT PRIOR TO THE PATIENT'S DISCHARGE SHALL
BE DEEMED TO HAVE THE AUTHORITY TO COMMENCE A PETITION  UNDER  PARAGRAPH
SEVEN OF SUBDIVISION (A) OF SECTION 81.06 OF THE MENTAL HYGIENE LAW.
  10. NO PERSON SHALL BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR SANC-
TION  BY A GOVERNMENTAL AGENCY (A) FOR ACTIONS IN GOOD FAITH PURSUANT TO
THIS ARTICLE AS A MEMBER OR AGENT OF A TRANSITION  AUTHORIZATION  PANEL,
OR  AS  ADMINISTRATOR  OF  A  TRANSITION  AUTHORIZATION PROGRAM; (B) FOR
DISCHARGING, TRANSFERRING OR ADMITTING A PATIENT FROM OR TO  A  FACILITY
PURSUANT  TO  AN  ORDER  OF A TRANSITION AUTHORIZATION PANEL; OR (C) FOR
DISCLOSING FINANCIAL INFORMATION ABOUT A PATIENT OR  DISBURSING  PATIENT
FUNDS PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL.
  11.  (A) THE ADMINISTRATOR OF EACH PANEL SHALL SUBMIT AN ANNUAL REPORT
TO THE COMMISSIONER OF HEALTH, DUE WITHIN THIRTY DAYS OF  EACH  ANNIVER-
SARY OF THE EFFECTIVE DATE OF THIS SECTION.  THE REPORT SHALL SET FORTH:
  (I)  WITH  RESPECT  TO  EACH  CASE  CONSIDERED BY A PANEL, THE TYPE OF
POST-ACUTE CARE REQUESTED;   THE LENGTH OF TIME FROM  THE  DATE  OF  THE
REQUEST  UNTIL (A) THE PANEL CONVENED, (B) THE PANEL ISSUED ITS DETERMI-

A. 8647                             6

NATION, AND (C) THE PATIENT WAS DISCHARGED FROM THE PARTICIPATING HOSPI-
TAL (IF THE DETERMINATION APPROVED THE TRANSITION);  THE  CATEGORIES  OF
PERSONS  WHO ADDRESSED THE PANEL; THE NUMBER OF UNANIMOUS AND NON-UNANI-
MOUS PANEL VOTES; WHETHER THE ORDER CALLED FOR TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS AND IF SO WHETHER THOSE ARRANGEMENTS WERE SUCCESSFULLY
MADE;  AND  ANY DATA OR OTHER INFORMATION AVAILABLE TO THE ADMINISTRATOR
REGARDING THE IMPACT OF THE  DEMONSTRATION  ON  THE  HOSPITAL'S  AVERAGE
INPATIENT LENGTH OF STAY.
  (II) THE PARTICIPATING HOSPITAL AND LOCAL SOCIAL SERVICES DEPARTMENT'S
RECOMMENDATIONS  FOR  AMENDMENTS  TO  THIS  SECTION, AND RECOMMENDATIONS
REGARDING THE MERIT OF EXTENDING THIS DEMONSTRATION PROGRAM OR  ADOPTING
A PERMANENT AND STATEWIDE TRANSITION AUTHORIZATION PROGRAM.
  (B) THE COMMISSIONER SHALL COMPILE THE REPORTS SUBMITTED TO HIM OR HER
AS  REQUIRED  ABOVE,  AND  PROMPTLY SUBMIT SUCH REPORTS TO THE TEMPORARY
PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
ER OF THE SENATE AND THE MINORITY LEADER OF THE  ASSEMBLY.  THE  COMMIS-
SIONER MAY ADD HIS OR HER OWN RECOMMENDATIONS TO THAT COMPILATION.
  S  3.  This act shall take effect immediately, and shall expire and be
deemed repealed three years and ninety days after it shall have become a
law.

co-Sponsors

2009-A8647A - Details

Current Committee:: Assembly Codes
Law Section:: Public Health Law
Laws Affected:: Add §2803-s, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A2473

2009-A8647A - Summary

2009-A8647A - Sponsor Memo

                                BILL NUMBER:A8647A

TITLE OF BILL:  An act to amend the public health law, in relation to
establishing a demonstration program to study transition authorization
panels as an approach to secure decisions regarding the transition of
incapable patients who do not have legally authorized decisionmakers
from inpatient care to post-acute care; and providing for the repeal of
such provisions upon expiration thereof

PURPOSE: To determine whether transition authorization panels will serve
the interests of patients, families, providers and the public by facili-
tating the transition of incapable, non-objecting hospital patients to
more appropriate settings.

SUMMARY OF PROVISIONS:  Section 1 sets forth legislative findings,
including findings that:

* in many instances there are hospital patients who are medically ready
to transition to a different level of care, such as nursing home care,
home care or assisted living, but they lack capacity to authorize the
transition, and also lack a family member or other person who can
authorize the transition on their behalf.

* as a result, such patients can be subject to inordinate delays in
accomplishing a needed transition, and can remain as hospital inpatients
for long periods.

* delay is harmful to the interests of those patients, as well as to
other persons who may need the scarce inpatient resources, to hospitals,
to payors and to the public in general.

* it would be valuable to study an alternative approach to secure deci-
sions relating to the transition of isolated incapable patients from
inpatient care to post-acute care.

* the transition authorization panel demonstration program shows promise
as means to protect the rights and interests of incapable patients in
the transition decision, while allowing such decisions to be made within
a reasonable timeframe.

Section 2 adds a new section 2803-s to the Public Health Law, called
"Transition authorization panel demonstration program."

Subsection 1 would state that the transition authorization panel (TAP)
program is established at five sites.

Subsection 2 sets forth definitions. Significantly, it defines "eligible
patient" to mean an inpatient at a participating hospital who, according
to the patient's attending physician:

(i) is ready to be discharged as an inpatient, but needs to be transi-
tioned to post-acute care;

(ii) lacks capacity to consent to the discharge and to admission to
post-acute care;

(iii) does not have a guardian, health care agent or power of attorney,
or a family member, friend or other representative who is willing and
legally authorized to make a transition decision on his or her behalf,
and whose consent would be accepted by a proposed post-acute care
provider;

(iv) has a discharge plan that identifies an appropriate post-acute care
provider that is or may be willing to admit the patient if a panel were
to authorize the transition and, if necessary, make transition-related
financial arrangements; and

(v) has not expressed an objection to any of the foregoing findings or
to being transitioned to the proposed post-acute facility or service or,
if applicable, the proposed transition-related financial arrangements;

This subsection also defines "Participating hospital" to mean any of the
following hospitals: (i) Crouse Hospital, Syracuse NY; (ii) Glens Falls
Hospital, Glens Falls NY; (ii) Memorial Hospital, Albany NY; (iii)
Samaritan Hospital, Troy, NY; (iv) University of Rochester Medical
Center, Rochester NY, and Wycoff Heights Medical Center, Brooklyn, NY.

This subsection also defines "Post-acute care," "Transition authori-
zation," "Transition authorization panel agent," "Transition authori-
zation panel," "Transition authorization panel pool" and "Transition-re-
lated financial arrangements."

Subsection 3 sets forth the responsibilities of participating hospitals,
including the responsibility to designate a person as administrator of
the program at that site, and to carry out, and bear the costs of, the
administrative responsibilities of the program.

Subsection 4 authorizes each participating hospital to create a transi-
tion authorization pool - the collection of persons at each site who can
serve on transition authorization panels.

Subsection 5 provides that requests for transition authorization and for
transition-related financial arrangements may be undertaken by transi-
tion authorization panels, and describes the selection and composition
of such panels.

Subsection 6 sets forth the procedure for requesting a panel, and for
notice to involved persons.

Subsection 7 sets forth the procedure for review by a transition author-
ization panel.

Subsection 8 specifies what the panel may determine and authorize.

Subsection 9 provides that a participating hospital, the social services
department, and any other person may, but shall not be required to,
enter into an agreement with a post-acute provider for such hospital,
department or other person to petition for the appointment of a guardian
under Mental Hygiene Law Art. 81 for a patient transitioned pursuant to
the order of a panel.

Subsection 10 provides immunity to persons who act in good faith as
panel members, and others who act in good faith pursuant to this Act.

Subsection 11 requires the administrator of each panel to submit an
annual report to the commissioner of health, and specifies the contents
of the report.

Section 3 provides for the Act to take effect immediately.

EXISTING LAW:  In general, when a hospital inpatient needs to be trans-
ferred to post-acute care, the patient must consent to the discharge
from the hospital, the admission to the post-acute care provider, and
the financial arrangements with the post-acute care provider. When a
patient lacks capacity, hospitals will often try to turn to a close
family member to make this decision. However:

1. Unless the family member is guardian (e.g., under MHL Article 81) or
a health care agent, the family member will not have clear legal author-
ity to authorize the patient's discharge from the hospital or admission
to the post-acute care facility. While some post-acute care facilities
will admit incapable patients based on a family member consent, others
will not;

2. Unless the family member is a guardian of the property, or holds a
power of authority of authority from the patient, or jointly owns prop-
erty with the patient, the family member is unlikely to be able make the
financial arrangements on behalf of the patient that may be necessary to
secure admission to the post-acute care facility.

3. Many patients do not have family members or close friends. For those
isolated patients, no-one has the authority to consent to the patient's
discharge from the hospital or admission to the post acute care setting,
or to make the financial arrangements with the post acute care provider.

If the proposed Family Health Care Decisions Act (S.3164 / A.7729) is
passed, it will help with problem #1 above, because it will give clear
authority to family members and close friends to make health care deci-
sions - which would probably encompass the discharge and admission deci-
sion. But it will not help with problems #2 and #3.

Currently, in many instances when an incapable inpatient is ready to be
discharged, but lacks a health care or financial decision-maker, the
hospital or social services district find it necessary to bring a guar-
dianship under MHL Article 81 in order to give someone the authority to

accomplish the transition. A guardianship proceeding can take weeks or
months, during which time the patient is unnecessarily hospitalized.

STATEMENT IN SUPPORT:  In many instances there are hospital patients who
are medically ready to transition to a different level of care, such as
nursing home care, home care or assisted living, but they lack capacity
to authorize the transition, and also lack a family member or other
person who can authorize the transition on their behalf. As a result,
such patients can be subject to inordinate delays in accomplishing a
needed transition, and can remain as hospital inpatients for long peri-
ods. That delay is harmful to the interests of those patients, as well
as to other persons who may need the scarce inpatient resources, to
hospitals, to payors and to the public in general.

While Article 81 of the Mental Hygiene Law provides a procedure for the
court-appointment of guardians who could be empowered to author-
ize.transition for such patients, that procedure was designed for
longer-term assistance with an incapacitated person's personal and prop-
erty affairs, and includes features that appear to go beyond what is
needed for transition-related decisions alone. As a result, the guardi-
anship proceeding can require far more time, effort and expense than is
warranted for this limited, non-contested decision.

This bill would test an alternative approach to secure decisions relat-
ing to the transition of isolated incapable patients from inpatient care
to post-acute care. The approach would be tested at six sites - Crouse
Hospital in Syracuse, Glens Falls Hospital, Memorial Hospital in Albany,
Samaritan Hospital in Troy, the University of Rochester Medical Center
in Rochester and Wycoff Heights Medical Center in Brooklyn.

Each participating hospital would establish a "transition panel pool" -
a group of persons qualified to serve on "transition authorization
panels.

When the hospital identifies a person who appears to be an "eligible
patient," it could convene a "transition authorization panel" to make
the transition authorization decision and transition related financial
arrangements.

An eligible patient is a patient who (i) is ready to be discharged as an
inpatient, but needs to be transitioned to post-acute care; (ii) lacks
capacity to consent to the discharge and to admission to post-acute
care; (iii) does not have a guardian, health care agent or power of
attorney, or a family member, friend or other representative who is
willing and legally authorized to make a transition decision on his or
her behalf, and whose consent would be accepted by a proposed post-acute
care provider; (iv) has a discharge plan that identifies an appropriate
post-acute care provider that is or may be willing to admit the patient
if a panel were to authorize the transition and, if necessary, make
transition-related financial arrangements; and (v) has not expressed an
objection to any of the foregoing findings or to being transitioned to

the proposed post-acute facility or service or, if applicable, the
proposed transition-related financial arrangements;

The transition authorization panel, or TAP, would be composed of three
persons -- one person appointed by the hospital, one appointed by the
local social services district, and one jointly appointed. The TAP could
be convened quickly and, while employing basic procedural protections,
could decide whether the patient is in fact eligible. It could then
authorize an appropriate discharge, as well as the discharge related
financial arrangements.

In many cases, the patient will still need a guardian for long term
personal or property management. But the TAP process will make it possi-
ble for the guardianship to occur after the patient has been discharged
to an appropriate care setting, rather than while in the hospital.

It is hoped that the TAP process will prove to be an ethically sound,
practical approach to facilitate the transition of incapable inpatients
from the hospital to appropriate post-acute settings. If so, the TAP
process will benefit patients, families, providers, and the public
generally.  This is only a demonstration bill; the authority granted by
it would expire in three years and ninety days. Each of the five sites
will collect data on their experience and annually forward that data to
the NYS Department of Health. The Department will compile the data and
forward a report to the Legislature. The Legislature will then be in a
position to decide whether to continue, end, or modify the demon-
stration, or apply the model more broadly.

BUDGET IMPLICATIONS: The bill will have no appreciable budgetary impact.

EFFECTIVE DATE: First day of June next succeeding the year in which it
shall have become a law.

2009-A8647A - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 8647--A

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                              June 2, 2009
                               ___________

Introduced  by  M. of A. CANESTRARI, GORDON -- read once and referred to
  the Committee on Health -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the public health law, in  relation  to  establishing  a
  demonstration  program  to study transition authorization panels as an
  approach to secure decisions regarding  the  transition  of  incapable
  patients  who do not have legally authorized decisionmakers from inpa-
  tient care to post-acute care; and providing for the  repeal  of  such
  provisions upon expiration thereof

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The legislature finds and declares that in  many  instances
there  are  hospital patients who are medically ready to transition to a
different level of care,  such  as  nursing  home  care,  home  care  or
assisted living, but they lack capacity to authorize the transition, and
also  lack a family member or other person who can authorize the transi-
tion on their behalf. As a result, such patients can be subject to inor-
dinate delays in accomplishing a needed transition, and  can  remain  as
hospital  inpatients  for  long  periods.  That  delay is harmful to the
interests of those patients, as well as to other persons  who  may  need
the  scarce  inpatient  resources,  to  hospitals,  to payors and to the
public in general.
  The legislature further finds that while  article  81  of  the  mental
hygiene  law provides a procedure for the court-appointment of guardians
who could be empowered to authorize transition for such  patients,  such
procedure  was designed for longer-term assistance with an incapacitated
person's personal and property affairs, and includes features that often
go beyond what is needed for transition-related decisions  alone.  As  a
result,  the  guardianship  proceeding can require far more time, effort
and expense than is warranted for this limited, non-contested decision.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11971-03-9

A. 8647--A                          2

  Accordingly, the legislature finds that it would be valuable to  study
an  alternative  approach to secure decisions relating to the transition
of isolated incapable patients from inpatient care to  post-acute  care.
Specifically,  the  transition authorization panel demonstration program
shows  promise as means to protect the rights and interests of incapable
patients in the transition decision, while allowing such decisions to be
made within a reasonable timeframe.
  S 2. The public health law is amended by adding a new  section  2803-s
to read as follows:
  S  2803-S.  TRANSITION  AUTHORIZATION PANEL DEMONSTRATION PROGRAM.  1.
THERE IS HEREBY ESTABLISHED  A  TRANSITION  AUTHORIZATION  PANEL  DEMON-
STRATION  PROGRAM,  CONDUCTED  AT  FIVE  PROGRAM  SITES,  TO EVALUATE AN
APPROACH TO SECURE DECISIONS RELATING  TO  THE  TRANSITION  OF  ISOLATED
PATIENTS FROM INPATIENT CARE TO POST-ACUTE CARE.
  2. AS USED IN THIS SECTION:
  (A)  "ELIGIBLE PATIENT" MEANS AN INPATIENT AT A PARTICIPATING HOSPITAL
WHO, ACCORDING TO THE PATIENT'S ATTENDING PHYSICIAN:
  (I) IS READY TO BE DISCHARGED AS AN INPATIENT, BUT NEEDS TO BE TRANSI-
TIONED TO POST-ACUTE CARE;
  (II) LACKS CAPACITY TO CONSENT TO THE DISCHARGE AND  TO  ADMISSION  TO
POST-ACUTE CARE;
  (III)  DOES  NOT HAVE A GUARDIAN, HEALTH CARE AGENT OR POWER OF ATTOR-
NEY, OR A FAMILY MEMBER, FRIEND OR OTHER REPRESENTATIVE WHO  IS  WILLING
AND  LEGALLY  AUTHORIZED  TO  MAKE  A  TRANSITION DECISION ON HIS OR HER
BEHALF, AND WHOSE CONSENT WOULD BE ACCEPTED  BY  A  PROPOSED  POST-ACUTE
CARE PROVIDER;
  (IV)  HAS  A  DISCHARGE PLAN THAT IDENTIFIES AN APPROPRIATE POST-ACUTE
CARE PROVIDER THAT IS OR MAY BE WILLING TO ADMIT THE PATIENT IF A  TRAN-
SITION  AUTHORIZATION  PANEL  WERE  TO  AUTHORIZE THE TRANSITION AND, IF
NECESSARY, MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS; AND
  (V) HAS NOT EXPRESSED AN OBJECTION TO ANY OF THE FOREGOING FINDINGS OR
TO BEING TRANSITIONED TO THE PROPOSED POST-ACUTE FACILITY OR SERVICE OR,
IF APPLICABLE, THE PROPOSED TRANSITION-RELATED FINANCIAL ARRANGEMENTS;
  (B) "PARTICIPATING HOSPITAL" MEANS ANY  OF  THE  FOLLOWING  HOSPITALS,
UPON  THE  CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFYING THE COMMIS-
SIONER IN WRITING THAT THE HOSPITAL ELECTS TO BE A PARTICIPATING  HOSPI-
TAL,  AND UNTIL THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFIES THE
COMMISSIONER IN WRITING THAT  THE  HOSPITAL  ELECTS  TO  CEASE  BEING  A
PARTICIPATING HOSPITAL:
  (I) CROUSE HOSPITAL, SYRACUSE, NY.
  (II) GLENS FALLS HOSPITAL, GLENS FALLS, NY.
  (III) MEMORIAL HOSPITAL, ALBANY, NY.
  (IV) SAMARITAN HOSPITAL, TROY, NY.
  (V) UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY.
  (VI) WYCOFF HEIGHTS MEDICAL CENTER, BROOKLYN, NY.
  (C)  "POST-ACUTE  CARE" MEANS CARE PROVIDED BY A NURSING HOME, TRANSI-
TIONAL CARE UNIT, HOME HEALTH AGENCY,  ASSISTED  LIVING  PROGRAM,  ADULT
CARE  FACILITY,  AN INPATIENT TREATMENT FACILITY OR RESIDENTIAL FACILITY
LICENSED OR OPERATED BY THE OFFICE OF  ALCOHOLISM  AND  SUBSTANCE  ABUSE
SERVICES,  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OF MENTAL RETARDA-
TION AND DEVELOPMENTAL DISABILITIES, OR AN INPATIENT TREATMENT  FACILITY
OR  RESIDENTIAL  FACILITY LICENSED BY A HEALTH, MENTAL HYGIENE OR SOCIAL
SERVICES AGENCY OF ANOTHER STATE.
  (D) "TRANSITION AUTHORIZATION" MEANS A DECISION, MADE BY A  TRANSITION
AUTHORIZATION  PANEL  PURSUANT TO THIS ARTICLE, TO AUTHORIZE THE TRANSI-

A. 8647--A                          3

TION OF AN ELIGIBLE PATIENT FROM A PARTICIPATING HOSPITAL TO A  SPECIFIC
POST-ACUTE CARE PROVIDER.
  (E) "TRANSITION AUTHORIZATION PANEL AGENT" MEANS AN INDIVIDUAL AUTHOR-
IZED  BY  THE  TRANSITION  AUTHORIZATION  PANEL  TO CARRY OUT TRANSITION
RELATED FINANCIAL ARRANGEMENTS.
  (F) "TRANSITION  AUTHORIZATION  PANEL"  MEANS  A  THREE-PERSON  PANEL,
CONVENED  PURSUANT  TO  THIS  ARTICLE, TO AUTHORIZE THE TRANSITION OF AN
ELIGIBLE PATIENT FROM A PARTICIPATING  HOSPITAL  TO  A  POST-ACUTE  CARE
PROVIDER, AND TO MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS.
  (G)  "TRANSITION  AUTHORIZATION  PANEL  POOL"  MEANS  THE FULL POOL OF
PERSONS QUALIFIED AND DESIGNATED TO SERVE  ON  TRANSITION  AUTHORIZATION
PANELS AT A PROGRAM SITE.
  (H) "TRANSITION-RELATED FINANCIAL ARRANGEMENTS" MEANS ACTS NECESSARY:
  (I) TO EXPEND THE ELIGIBLE PATIENT'S FUNDS FOR POST-ACUTE CARE FOR ONE
HUNDRED  TWENTY DAYS OR UNTIL THE COURT APPOINTMENT OF A GUARDIAN OF THE
PERSON PURSUANT TO ARTICLE EIGHTY-ONE OF THE MENTAL HYGIENE LAW,  WHICH-
EVER OCCURS FIRST.
  (II)  TO  APPLY  FOR  THE ELIGIBLE PATIENT'S ENROLLMENT IN MEDICAID OR
MEDICARE.
  (III) TO ACCESS FINANCIAL INFORMATION ABOUT THE ELIGIBLE PATIENT  FROM
FINANCIAL  INSTITUTIONS  TO  THE  EXTENT  NECESSARY FOR THE PURPOSES SET
FORTH IN SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH.
  (I) "FINANCIAL INSTITUTION" MEANS A FINANCIAL INSTITUTION  AS  DEFINED
IN SUBDIVISION FIVE OF SECTION 5-1501 OF THE GENERAL OBLIGATIONS LAW.
  (J)  "ADMINISTRATOR"  MEANS  THE  ADMINISTRATOR OF THE PROGRAM FOR THE
PARTICIPATING  HOSPITAL  DESIGNATED  UNDER  SUBDIVISION  THREE  OF  THIS
SECTION.
  3. EACH PARTICIPATING HOSPITAL SHALL:
  (A) DESIGNATE A PERSON AS ADMINISTRATOR OF THE PROGRAM WITH RESPECT TO
THAT PROGRAM SITE; AND
  (B)  CARRY OUT, AND BEAR THE COSTS OF, THE ADMINISTRATIVE RESPONSIBIL-
ITIES OF THE PROGRAM AS SET FORTH IN THIS SECTION, WITH RESPECT TO  THAT
PROGRAM SITE.
  4.  (A) A PARTICIPATING HOSPITAL MAY CREATE A TRANSITION AUTHORIZATION
PANEL POOL AT A PROGRAM SITE, WHICH SHALL HAVE THREE CLASSES OF MEMBERS:
  (I) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY  THE
HOSPITAL;
  (II) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY THE
LOCAL SOCIAL SERVICES COMMISSIONER; AND
  (III)  ONE  CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS JOINTLY DESIG-
NATED BY THE HOSPITAL AND LOCAL SOCIAL SERVICES  COMMISSIONER,  WHO  ARE
NOT EMPLOYED BY EITHER.
  (B)  FOR  THE  PURPOSES  OF  THIS PARAGRAPH, "QUALIFIED PERSONS" MEANS
ADULT PERSONS WITH RECOGNIZED EXPERTISE OR DEMONSTRATED INTEREST IN  THE
CARE AND TREATMENT OF HOSPITAL AND POST-ACUTE CARE PATIENTS, AND WHO CAN
BE  EXPECTED  TO  APPLY  THE STANDARDS OF THIS ARTICLE IN GOOD FAITH AND
WITH SIGNIFICANT SENSITIVITY TO THE INTERESTS OF THE ELIGIBLE PATIENT.
  (C) THE PARTICIPATING HOSPITAL AND THE LOCAL SOCIAL  SERVICES  COMMIS-
SIONER  SHALL  JOINTLY  APPOINT  ONE  MEMBER  AS CHAIR OF THE TRANSITION
AUTHORIZATION PANEL POOL.
  5. (A) THE REVIEW OF REQUESTS FOR  TRANSITION  AUTHORIZATION  AND  FOR
TRANSITION-RELATED  FINANCIAL ARRANGEMENTS SHALL BE UNDERTAKEN BY PANELS
OF THREE MEMBERS DRAWN FROM THE TRANSITION AUTHORIZATION PANEL POOL, ONE
FROM EACH CLASS. THE MEMBER FROM THE JOINTLY APPOINTED CLASS SHALL SERVE
AS PANEL CHAIR.

A. 8647--A                          4

  (B) NO PERSON WHO IS A HEALTH CARE PROFESSIONAL ACTIVELY  INVOLVED  IN
THE  TREATMENT  OF  THE  PATIENT  WHOSE CASE IS UNDER CONSIDERATION BY A
PANEL MAY SERVE ON THE PANEL WITH  RESPECT  TO  SUCH  PATIENT,  ALTHOUGH
OTHER HOSPITAL PERSONNEL MAY SERVE ON THE PANEL IF OTHERWISE QUALIFIED.
  6. (A) THE ATTENDING PHYSICIAN OF AN ELIGIBLE PATIENT MAY REQUEST THAT
A  PANEL  BE CONVENED BY SUBMITTING A WRITTEN REQUEST TO THE ADMINISTRA-
TOR. THE REQUEST MUST:
  (I) INDICATE THAT IT IS A REQUEST FOR THE PANEL TO AUTHORIZE THE TRAN-
SITION OF THE PATIENT TO POST-ACUTE CARE AND,  IF  APPLICABLE,  TO  MAKE
TRANSITION-RELATED FINANCIAL ARRAIGNMENTS;
  (II) SET FORTH THE REASONS FOR BELIEVING THAT THE PATIENT IS AN ELIGI-
BLE PATIENT; AND
  (III)  SET  FORTH THE PROPOSED POST-ACUTE CARE PROVIDER (OR PROVIDERS,
IF APPLICATIONS HAVE OR WILL BE MADE TO MORE THAN ONE);
  (B) UPON RECEIPT OF THE REQUEST, THE ADMINISTRATOR MAY:
  (I) SET A TIME, DATE AND PLACE FOR THE TRANSITION AUTHORIZATION  PANEL
TO  REVIEW  THE  REQUEST.  SUCH REVIEW MAY BE SCHEDULED FOR ANY TIME AND
DATE AT LEAST THREE DAYS  AFTER  THE  REQUEST  AND  NOTICE  IS  SENT  AS
PROVIDED  BELOW;  HOWEVER,  THE REVIEW MAY BE HELD EARLIER OR LATER THAN
THE DATA SET FORTH IN THE NOTICE IF ALL  PERSONS  WHO  ARE  ENTITLED  TO
NOTICE, AS SET FORTH BELOW, AGREE, IN WRITING OR VERBALLY (AS DOCUMENTED
BY THE ADMINISTRATOR), TO THE TIME, PLACE AND DATE OF THE REVIEW.
  (II)  SEND  A  COPY  OF  THE REQUEST AND NOTICE, BY HAND, MAIL, FAX OR
E-MAIL, TO THE FOLLOWING PERSONS:
  (A) THREE MEMBERS OF THE TRANSITION AUTHORIZATION PANEL POOL, ONE FROM
EACH CLASS, SELECTED BY THE POOL CHAIR, WHO  ARE  WILLING  AND  ABLE  TO
SERVE AS A PANEL FOR THE PURPOSE OF THIS REVIEW;
  (B)  THE  PATIENT, IF THERE IS ANY INDICATION OF THE PATIENT'S ABILITY
TO COMPREHEND SUCH NOTICE;
  (C) TO A FAMILY MEMBER OR FRIEND OF  THE  PATIENT  WHO  IS  REASONABLY
AVAILABLE,  AND  WHO  HAS BEEN INVOLVED IN THE PATIENT'S CARE OR WHO HAS
DEMONSTRATED CONCERN ABOUT THE PATIENT'S WELFARE, IF THERE IS  ANY  SUCH
PERSON;
  (D)  IF THE PATIENT WAS ADMITTED FROM A FACILITY OR RESIDENCE LICENSED
BY THE OFFICE OF MENTAL HEALTH OR THE OFFICE OR MENTAL  RETARDATION  AND
DEVELOPMENTAL  DISABILITIES, TO  THE FACILITY DIRECTOR AND TO THE MENTAL
HYGIENE LEGAL SERVICES OFFICE FOR THAT JUDICIAL DEPARTMENT; AND
  (E) TO THE PATIENT'S ATTENDING PHYSICIAN.
  (III) PROVIDE NOTICE TO  THE  PATIENT  AND  TO  MENTAL  HYGIENE  LEGAL
SERVICES  WHICH SHALL INFORM THE PATIENT THAT HE OR SHE WILL BE AFFORDED
AN OPPORTUNITY TO ADDRESS THE  PANEL,  MAY  BE  PRESENT  FOR  ANY  OTHER
ADDRESSES  MADE  TO THE PANEL, AND MAY BE PRESENT FOR OTHER PARTS OF THE
PANEL REVIEW AS THE CHAIR MAY PERMIT, BUT THAT HE OR  SHE  WILL  NOT  BE
PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  (IV)  PROVIDE  NOTICE TO A PERSON DESCRIBED IN CLAUSES (B) THROUGH (E)
OF THIS SUBPARAGRAPH WHICH SHALL INFORM THE PERSON THAT HE OR  SHE  WILL
BE  AFFORDED AN OPPORTUNITY TO ADDRESS THE PANEL, AND MAY BE PRESENT FOR
SUCH OTHER PARTS OF THE PANEL REVIEW AS THE CHAIR MAY PERMIT,  THAT  THE
PATIENT  AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A PATIENT)
MAY BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE PANEL,  AND  THAT  NO
PERSON  DESCRIBED  IN CLAUSES (B) THROUGH (E) OF THIS SUBPARAGRAPH SHALL
BE PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  7. (A) PRIOR TO OR DURING THE REVIEW, THE PANEL CHAIR MAY REQUEST AND,
NOTWITHSTANDING ANY OTHER LAW TO THE  CONTRARY,  SHALL  BE  ENTITLED  TO
RECEIVE  FROM  ANY  HEALTH  CARE  PROVIDER AND DISCLOSE TO THE PANEL ANY
INFORMATION WHICH IS RELEVANT TO THE PANEL'S REVIEW.  INFORMATION  WHICH

A. 8647--A                          5

IS  CONFIDENTIAL,  AS PROVIDED FOR BY LAW, SHALL BE KEPT CONFIDENTIAL BY
THE PANEL AND ANY LIMITATIONS ON THE FURTHER RELEASE THEREOF IMPOSED  BY
LAW UPON THE PARTY FURNISHING THE INFORMATION SHALL APPLY TO THE PANEL.
  (B) THE PANEL SHALL MEET IN PERSON TO CONDUCT ITS REVIEW.
  (C)  THE  PANEL  CHAIR MAY REQUEST THE ATTENDANCE AT THE REVIEW OF ANY
PERSON WHO MIGHT ASSIST THE PANEL IN ITS REVIEW.
  (D) THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A
PATIENT) MAY BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE PANEL.
  (E) WHERE PRACTICABLE, THE PANEL MEMBERS  SHALL  PERSONALLY  INTERVIEW
AND OBSERVE THE PATIENT PRIOR TO MAKING THEIR DECISION.
  (F)  NO  PERSON  DESCRIBED  IN CLAUSES (B) THROUGH (E) OF SUBPARAGRAPH
(II) OF PARAGRAPH (B) OF  SUBDIVISION  SIX  OF  THIS  SECTION  SHALL  BE
PERMITTED TO BE PRESENT DURING THE PANEL DELIBERATION.
  (G) THE PANEL CHAIR MAY ADJOURN AND RECONVENE THE PANEL AS NECESSARY.
  (H)  THE  ADMINISTRATOR  SHALL  TAKE AND MAINTAIN MINUTES OF ANY PANEL
MEETING, BUT NO RECORDING OR  TRANSCRIPTION  SHALL  BE  REQUIRED  EXCEPT
WHERE  REQUESTED  BY  A  PERSON  DESCRIBED IN CLAUSES (B) THROUGH (E) OF
SUBPARAGRAPH (II) OF PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION.
  8. (A) THE PANEL SHALL MAKE A DETERMINATION, BY MAJORITY VOTE,  AS  TO
WHETHER  THE  PATIENT  IS  AN ELIGIBLE PATIENT, WHETHER TO AUTHORIZE THE
PROPOSED TRANSITION, AND WHETHER TO AUTHORIZE TRANSITION-RELATED  FINAN-
CIAL  ARRANGEMENTS.  THE DETERMINATION SHALL BE SET FORTH IN WRITING AND
SHALL BE SIGNED BY THE CHAIR ON BEHALF OF THE PANEL.
  (B) IF THE PANEL  DETERMINES  TO  AUTHORIZE  THE  PROPOSED  TRANSITION
AND/OR  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS,  THE  AUTHORIZATION
SHALL BE SET FORTH IN AN ORDER, SIGNED BY THE CHAIR  ON  BEHALF  OF  THE
PANEL.  THE ORDER SHALL DESCRIBE THE SCOPE OF SUCH AUTHORIZATION AND, IF
IT AUTHORIZES TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS,  DESIGNATE  A
TRANSITION AUTHORIZATION PANEL AGENT.
  (C)  THE  DETERMINATION,  AND THE ORDER IF THERE IS ONE, SHALL BE MADE
PART OF THE PATIENT'S MEDICAL RECORD.
  (D) NOTWITHSTANDING ANY LAW TO THE CONTRARY, THE ADMINISTRATOR AND THE
AGENT SHALL DISCLOSE THE ORDER TO SUCH  PERSONS  AS  NECESSARY  FOR  THE
PURPOSE OF CARRYING OUT ITS TERMS.
  (E)  THE  ORDER  SHALL BE, AND MAY BE RELIED UPON BY THE PARTICIPATING
HOSPITAL, BY POST-ACUTE CARE PROVIDERS, BY FINANCIAL  INSTITUTIONS,  AND
BY  OTHER THIRD-PARTIES AS, LEGAL AUTHORITY FOR THEM TO PERFORM OR COOP-
ERATE IN THE PERFORMANCE OF THE AUTHORIZED ACTS, INCLUDING LEGAL AUTHOR-
ITY:
  (I) FOR THE PARTICIPATING HOSPITAL TO DISCHARGE THE PATIENT;
  (II) FOR THE POST-ACUTE CARE PROVIDER TO ADMIT THE PATIENT;
  (III) FOR THE TRANSITION AUTHORIZATION PANEL  AGENT  TO  MAKE  TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS; AND
  (IV) FOR MEDICAID, FINANCIAL INSTITUTIONS AND OTHER PARTIES TO PROVIDE
FINANCIAL  AND  OTHER  PERSONAL INFORMATION ABOUT THE PATIENT RELATED TO
THE TRANSITION AND  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS  TO  THE
ADMINISTRATOR OR AGENT, AND TO OTHERWISE COOPERATE IN THE TRANSITION-RE-
LATED FINANCIAL ARRANGEMENTS.
  9. A PARTICIPATING HOSPITAL, THE LOCAL SOCIAL SERVICES DEPARTMENT, AND
ANY OTHER PERSON MAY, BUT SHALL NOT BE REQUIRED TO, ENTER INTO AN AGREE-
MENT  WITH  A POST-ACUTE CARE PROVIDER FOR SUCH HOSPITAL, DEPARTMENT, OR
OTHER PERSON TO PETITION FOR THE APPOINTMENT OF A GUARDIAN UNDER ARTICLE
EIGHTY-ONE OF THE MENTAL HYGIENE LAW FOR A PATIENT TRANSITIONED PURSUANT
TO THE ORDER OF A TRANSITION AUTHORIZATION PANEL, EITHER BEFORE OR AFTER
THE TRANSITION, AS A WAY TO PROVIDE FOR BROADER AND  LONGER  TERM  DECI-
SIONMAKING AUTHORITY WITH RESPECT TO THE TRANSITIONED PATIENT. THE CHIEF

A. 8647--A                          6

EXECUTIVE  OFFICER  OF A PARTICIPATING HOSPITAL, OR HIS OR HER DESIGNEE,
THAT ENTERS INTO SUCH AGREEMENT PRIOR TO THE PATIENT'S  DISCHARGE  SHALL
BE  DEEMED  TO HAVE THE AUTHORITY TO COMMENCE A PETITION UNDER PARAGRAPH
SEVEN OF SUBDIVISION (A) OF SECTION 81.06 OF THE MENTAL HYGIENE LAW.
  10. NO PERSON SHALL BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR SANC-
TION  BY  A GOVERNMENTAL AGENCY FOR ACTIONS TAKEN REASONABLY AND IN GOOD
FAITH PURSUANT TO THIS ARTICLE (A) AS A MEMBER OR AGENT OF A  TRANSITION
AUTHORIZATION  PANEL,  OR AS ADMINISTRATOR OF A TRANSITION AUTHORIZATION
PROGRAM; (B) DISCHARGING, TRANSFERRING OR ADMITTING A PATIENT FROM OR TO
A FACILITY PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL;  OR
(C)  DISCLOSING  FINANCIAL  INFORMATION  ABOUT  A  PATIENT OR DISBURSING
PATIENT FUNDS PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL.
  11. (A) THE ADMINISTRATOR OF EACH PANEL SHALL SUBMIT AN ANNUAL  REPORT
TO  THE  COMMISSIONER OF HEALTH, DUE WITHIN THIRTY DAYS OF EACH ANNIVER-
SARY OF THE EFFECTIVE DATE OF THIS SECTION.  THE REPORT SHALL SET FORTH:
  (I) WITH RESPECT TO EACH CASE CONSIDERED  BY  A  PANEL,  THE  TYPE  OF
POST-ACUTE  CARE  REQUESTED;    THE  LENGTH OF TIME FROM THE DATE OF THE
REQUEST UNTIL (A) THE PANEL CONVENED, (B) THE PANEL ISSUED ITS  DETERMI-
NATION, AND (C) THE PATIENT WAS DISCHARGED FROM THE PARTICIPATING HOSPI-
TAL  (IF  THE  DETERMINATION APPROVED THE TRANSITION); THE CATEGORIES OF
PERSONS WHO ADDRESSED THE PANEL; THE NUMBER OF UNANIMOUS AND  NON-UNANI-
MOUS PANEL VOTES; WHETHER THE ORDER CALLED FOR TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS AND IF SO WHETHER THOSE ARRANGEMENTS WERE SUCCESSFULLY
MADE;  AND  ANY DATA OR OTHER INFORMATION AVAILABLE TO THE ADMINISTRATOR
REGARDING THE IMPACT OF THE  DEMONSTRATION  ON  THE  HOSPITAL'S  AVERAGE
INPATIENT LENGTH OF STAY.
  (II) THE PARTICIPATING HOSPITAL AND LOCAL SOCIAL SERVICES DEPARTMENT'S
RECOMMENDATIONS  FOR  AMENDMENTS  TO  THIS  SECTION, AND RECOMMENDATIONS
REGARDING THE MERIT OF EXTENDING THIS DEMONSTRATION PROGRAM OR  ADOPTING
A PERMANENT AND STATEWIDE TRANSITION AUTHORIZATION PROGRAM.
  (B) THE COMMISSIONER SHALL COMPILE THE REPORTS SUBMITTED TO HIM OR HER
AS  REQUIRED  ABOVE,  AND  PROMPTLY SUBMIT SUCH REPORTS TO THE TEMPORARY
PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
ER OF THE SENATE AND THE MINORITY LEADER OF THE  ASSEMBLY.  THE  COMMIS-
SIONER MAY ADD HIS OR HER OWN RECOMMENDATIONS TO THAT COMPILATION.
  S  3.  This act shall take effect immediately, and shall expire and be
deemed repealed three years and ninety days after it shall have become a
law.

co-Sponsors

2009-A8647B - Details

Current Committee:: Assembly Codes
Law Section:: Public Health Law
Laws Affected:: Add §2803-s, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A2473

2009-A8647B - Summary

2009-A8647B - Sponsor Memo

                                BILL NUMBER:A8647B

TITLE  OF  BILL:   An act to amend the public health law, in relation to
establishing a demonstration program to study  transition  authorization
panels  as  an  approach to secure decisions regarding the transition of
incapable patients who do not  have  legally  authorized  decisionmakers
from  inpatient care to post-acute care; and providing for the repeal of
such provisions upon expiration thereof

PURPOSE: To determine whether transition authorization panels will serve
the interests of patients, families, providers and the public by facili-
tating the transition of incapable, non-objecting hospital  patients  to
more appropriate settings.

SUMMARY  OF  PROVISIONS:    Section  1  sets forth legislative findings,
including findings that:

*in many instances there are hospital patients who are  medically  ready
to  transition  to a different level of care, such as nursing home care,
home care or assisted living, but they lack capacity  to  authorize  the
transition,  and  also  lack  a  family  member  or other person who can
authorize the transition on their behalf.

*as a result, such patients can  be  subject  to  inordinate  delays  in
accomplishing a needed transition, and can remain as hospital inpatients
for long periods.

*delay  is  harmful  to  the  interests of those patients, as well as to
other persons who may need the scarce inpatient resources, to hospitals,
to payors and to the public in general.

*it would be valuable to study an alternative, approach to secure  deci-
sions  relating  to  the  transition of isolated incapable patients from
inpatient care to post-acute care.

*the transition authorization panel demonstration program shows  promise
as  means  to  protect the rights and interests of incapable patients in
the transition decision, while allowing such decisions to be made within
a reasonable timeframe.

Section 2 adds a new section 2803-s to the  Public  Health  Law,  called
"Transition authorization panel demonstration program."

Subsection  1  would state that the transition authorization panel (TAP)
program is established at five sites.

Subsection 2 sets forth definitions. Significantly, it defines "eligible
patient" to mean an inpatient at a participating hospital who, according
to the patient's attending physician:

(i) is ready to be discharged as an inpatient, but needs to  be  transi-
tioned to post-acute care;

(ii)  lacks  capacity  to  consent  to the discharge and to admission to
post-acute care;

(iii)  does not have a guardian, health care agent or power of attorney,
or a family member, friend or other  representative  who  is  reasonably
available  and  willing  to  make  a  transition  decision on his or her
behalf,and whose consent would be accepted by a proposed post-acute care
provider;

(iv) has a discharge plan that identifies an appropriate post-acute care
provider that is or may be willing to admit the patient if a  transition
authorization  panel were to authorize the transition and, if necessary,
make transition-related financial arrangements; and

(v) has not expressed an objection to any of the foregoing  findings  or
to being transitioned to the proposed post-acute facility or service or,
if applicable, the proposed transition-related financial arrangements;

This subsection also defines "Participating hospital" to mean any of the
following  hospitals: (i) Crouse Hospital, Syracuse NY; (ii) Glens Falls
Hospital, Glens Falls NY;  (ii)  Memorial  Hospital,  Albany  NY;  (iii)
Samaritan  Hospital,  Troy,  NY;  (iv)  University  of Rochester Medical
Center, Rochester NY, and Wyckoff Heights Medical Center, Brooklyn, NY.

This subsection also defines  "Post-acute  care,"  "Transition  authori-
zation,"  "Transition  authorization  panel agent," "Transition authori-
zation panel," "Transition authorization panel pool" and "Transition-re-
lated financial arrangements."

Subsection 3 sets forth the responsibilities of participating hospitals,
including the responsibility to designate a person as  administrator  of
the  program  at that site, and to carry out, and bear the costs of, the
administrative responsibilities of the program and create  and  maintain
records related to requests, panels convened and actions taken.

Subsection  4 authorizes each participating hospital to create a transi-
tion authorization pool the collection of persons at each site  who  can
serve on transition authorization panels.

Subsection 5 provides that requests for transition authorization and for
transition-related  financial  arrangements may be undertaken by transi-
tion authorization panels, and describes the selection  and  composition
of such panels.

Subsection  6  sets  forth the procedure for requesting a panel, and for
notice to involved persons.

Subsection 7 sets forth the procedure for review by a transition author-
ization panel.

Subsection 8 specifies what the panel may determine and authorize.

Subsection 9 provides that a participating hospital, the social services
department, and any other person may, but  shall  not  be  required  to,
enter  into  an  agreement with a post-acute provider for such hospital,
department or other person to petition for the appointment of a guardian
under  Mental Hygiene Law Art. 81 for a patient transitioned pursuant to
the order of a panel,

Subsection 10 provides immunity to persons who  act  in  good  faith  as
panel members, and others who act in good faith pursuant to this Act.

Subsection  11  requires  the  administrator  of each panel to submit an
annual report to the commissioner of health, and specifies the  contents
of the report.

Section 3 provides for the Act to take effect immediately.

EXISTING LAW:  In general, when a hospital, inpatient needs to be trans-
ferred  to  post-acute  care,  the patient must consent to the discharge
from the hospital, the admission to the post-acute  care  provider,  and
the  financial  arrangements  with  the post-acute care provider. When a
patient lacks capacity, hospitals will often try  to  turn  to  a  close
family member to make this decision. However:

1.  Unless the family member is guardian (e.g., under MHL Article 81) or
a health care agent, the family member will not have clear legal author-
ity to authorize the patient's discharge from the hospital or  admission
to  the  post-acute care facility. While some post-acute care facilities
will admit incapable patients based on a family member  consent,  others
will not;

2.  Unless  the  family member is a guardian of the property, or holds a
power of authority of authority from the patient, or jointly owns  prop-
erty with the patient, the family member is unlikely to be able make the
financial arrangements on behalf of the patient that may be necessary to
secure admission to the post-acute care facility.

3.  Many patients do not have family members or close friends. For those
isolated patients, no-one has the authority to consent to the  patient's
discharge from the hospital or admission to the post acute care setting,
or to make the financial arrangements with the post acute care provider.

If  the  proposed  Family Health Care Decisions Act (S.3164 / A.7729) is
passed, it will help with problem #1 above, because it will  give  clear
authority  to family members and close friends to make health care deci-
sions - which would probably encompass the discharge and admission deci-
sion. But it will not help with problems #2 and #3.

Currently, in many instances when an incapable inpatient is ready to  be
discharged,  but  lacks  a  health care or financial decision-maker, the
hospital or social services district find it necessary to bring a  guar-
dianship  under MHL Article 81 in order to give someone the authority to

accomplish the transition. A guardianship proceeding can take  weeks  or
months, during which time the patient is unnecessarily hospitalized.

STATEMENT IN SUPPORT:  In many instances there are hospital patients who
are  medically ready to transition to a different level of care, such as
nursing home care, home care or assisted living, but they lack  capacity
to  authorize  the  transition,  and  also lack a family member or other
person who can authorize the transition on their behalf.  As  a  result,
such  patients  can  be  subject to inordinate delays in accomplishing a
needed transition, and can remain as hospital inpatients for long  peri-
ods.  That  delay is harmful to the interests of those patients, as well
as to other persons who may need  the  scarce  inpatient  resources,  to
hospitals, to payors and to the public in general.

While  Article 81 of the Mental Hygiene Law provides a procedure for the
court-appointment of guardians who could be empowered to authorize tran-
sition for such patients, that procedure was  designed  for  longer-term
assistance with an incapacitated person's personal and property affairs,
and  includes features that appear to go beyond what is needed for tran-
sition-related decisions alone. As a result, the guardianship proceeding
can require far more time, effort and expense than is warranted for this
limited, non-contested decision.

This bill would test an alternative approach to secure decisions  relat-
ing to the transition of isolated incapable patients from inpatient care
to  post-acute  care. The approach would be tested at six sites - Crouse
Hospital in Syracuse, Glens Falls Hospital, Memorial Hospital in Albany,
Samaritan Hospital in Troy, the University of Rochester  Medical  Center
in Rochester and Wycoff Heights Medical Center in Brooklyn. Each partic-
ipating  hospital would establish a "transition panel pool" - a group of
persons qualified to serve on "transition authorization panels.

When the hospital identifies a person who appears  to  be  an  "eligible
patient,"  it  could  convene a "transition authorization panel" to make
the transition authorization decision and transition  related  financial
arrangements.

An eligible patient is a patient who (1) is ready to be discharged as an
inpatient,  but  needs to be transitioned to post-acute care; (ii) lacks
capacity to consent to the discharge  and  to  admission  to  post-acute
care;  (iii)  does  not  have  a guardian, health care agent or power of
attorney, or a family member, friend  or  other  representative  who  is
willing  and  legally authorized to make a transition decision on his or
her behalf, and whose consent would be accepted by a proposed post-acute
care provider; (iv) has a discharge plan that identifies an  appropriate
post-acute  care provider that is or may be willing to admit the patient
if a panel were to authorize the  transition  and,  if  necessary,  make
transition-related  financial arrangements; and (v) has not expressed an
objection to any of the foregoing findings or to being  transitioned  to
the  proposed  post-acute  facility  or  service  or, if applicable, the
proposed transition-related financial arrangements;

The transition authorization panel, or TAP, would be composed  of  three
persons  --  one  person appointed by the hospital, one appointed by the
local social services district, and one jointly appointed. The TAP could
be convened quickly and, while employing basic  procedural  protections,
could  decide  whether  the  patient  is in fact eligible. It could then
authorize an appropriate discharge, as well  as  the  discharge  related
financial arrangements.

In  many  cases,  the  patient  will still need a guardian for long term
personal or property management. But the TAP process will make it possi-
ble for the guardianship to occur after the patient has been  discharged
to an appropriate care setting, rather than while in the hospital.

It  is  hoped  that the TAP process will prove to be an ethically sound,
practical approach to facilitate the transition of incapable  inpatients
from  the  hospital  to  appropriate post-acute settings. If so, the TAP
process will benefit  patients,  families,  providers,  and  the  public
generally.

This  is  only  a  demonstration bill; the authority granted by it would
expire in three years and ninety days.  Each  of  the  five  sites  will
collect  data  on their experience and annually forward that data to the
NYS Department of Health. The  Department  will  compile  the  data  and
forward  a  report to the Legislature. The Legislature will then be in a
position to decide whether  to  continue,  end,  or  modify  the  demon-
stration, or apply the model more broadly.

BUDGET IMPLICATIONS: The bill will have no appreciable budgetary impact.

EFFECTIVE  DATE:  Immediately and shall expire 3 years and 90 days after
it becomes law.

2009-A8647B - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 8647--B

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                              June 2, 2009
                               ___________

Introduced  by  M. of A. CANESTRARI, GORDON -- read once and referred to
  the Committee on Health -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee --  recommitted
  to  the Committee on Health in accordance with Assembly Rule 3, sec. 2
  -- committee discharged, bill amended, ordered  reprinted  as  amended
  and recommitted to said committee

AN  ACT  to  amend  the public health law, in relation to establishing a
  demonstration program to study transition authorization panels  as  an
  approach  to  secure  decisions  regarding the transition of incapable
  patients who do not have legally authorized decisionmakers from  inpa-
  tient  care  to  post-acute care; and providing for the repeal of such
  provisions upon expiration thereof

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  The legislature finds and declares that in many instances
there are hospital patients who are medically ready to transition  to  a
different  level  of  care,  such  as  nursing  home  care, home care or
assisted living, but they lack capacity to authorize the transition, and
also lack a family member or other person who can authorize the  transi-
tion on their behalf. As a result, such patients can be subject to inor-
dinate  delays  in  accomplishing a needed transition, and can remain as
hospital inpatients for long periods.  That  delay  is  harmful  to  the
interests  of  those  patients, as well as to other persons who may need
the scarce inpatient resources, to  hospitals,  to  payors  and  to  the
public in general.
  The  legislature  further  finds  that  while article 81 of the mental
hygiene law provides a procedure for the court-appointment of  guardians
who  could  be empowered to authorize transition for such patients, such
procedure was designed for longer-term assistance with an  incapacitated
person's personal and property affairs, and includes features that often
go  beyond  what  is needed for transition-related decisions alone. As a

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11971-06-0

A. 8647--B                          2

result, the guardianship proceeding can require far  more  time,  effort
and expense than is warranted for this limited, non-contested decision.
  Accordingly,  the legislature finds that it would be valuable to study
an alternative approach to secure decisions relating to  the  transition
of  isolated  incapable patients from inpatient care to post-acute care.
Specifically, the transition authorization panel  demonstration  program
shows  promise as means to protect the rights and interests of incapable
patients in the transition decision, while allowing such decisions to be
made within a reasonable timeframe.
  S 2. The public health law is amended by adding a new  section  2803-s
to read as follows:
  S  2803-S.  TRANSITION  AUTHORIZATION PANEL DEMONSTRATION PROGRAM.  1.
THERE IS HEREBY ESTABLISHED  A  TRANSITION  AUTHORIZATION  PANEL  DEMON-
STRATION  PROGRAM,  CONDUCTED  AT  FIVE  PROGRAM  SITES,  TO EVALUATE AN
APPROACH TO SECURE DECISIONS RELATING  TO  THE  TRANSITION  OF  ISOLATED
PATIENTS FROM INPATIENT CARE TO POST-ACUTE CARE.
  2. AS USED IN THIS SECTION:
  (A)  "ELIGIBLE PATIENT" MEANS AN INPATIENT AT A PARTICIPATING HOSPITAL
WHO, ACCORDING TO THE PATIENT'S ATTENDING PHYSICIAN:
  (I) IS READY TO BE DISCHARGED AS AN INPATIENT, BUT NEEDS TO BE TRANSI-
TIONED TO POST-ACUTE CARE;
  (II) LACKS CAPACITY TO CONSENT TO THE DISCHARGE AND  TO  ADMISSION  TO
POST-ACUTE CARE;
  (III)  DOES  NOT HAVE A GUARDIAN, HEALTH CARE AGENT OR POWER OF ATTOR-
NEY, OR A FAMILY MEMBER, FRIEND OR OTHER REPRESENTATIVE WHO  IS  REASON-
ABLY  AVAILABLE  AND WILLING TO MAKE A TRANSITION DECISION ON HIS OR HER
BEHALF, WHOSE CONSENT WOULD BE ACCEPTED BY A  PROPOSED  POST-ACUTE  CARE
PROVIDER,  AND  WHO  IS  LEGALLY AUTHORIZED TO MAKE ALL REQUIRED TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS;
  (IV) HAS A DISCHARGE PLAN THAT IDENTIFIES  AN  APPROPRIATE  POST-ACUTE
CARE  PROVIDER THAT IS OR MAY BE WILLING TO ADMIT THE PATIENT IF A TRAN-
SITION AUTHORIZATION PANEL WERE TO  AUTHORIZE  THE  TRANSITION  AND,  IF
NECESSARY, MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS; AND
  (V) HAS NOT EXPRESSED AN OBJECTION TO ANY OF THE FOREGOING FINDINGS OR
TO BEING TRANSITIONED TO THE PROPOSED POST-ACUTE FACILITY OR SERVICE OR,
IF APPLICABLE, THE PROPOSED TRANSITION-RELATED FINANCIAL ARRANGEMENTS;
  (B)  "PARTICIPATING  HOSPITAL"  MEANS  ANY OF THE FOLLOWING HOSPITALS,
UPON THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFYING  THE  COMMIS-
SIONER  IN WRITING THAT THE HOSPITAL ELECTS TO BE A PARTICIPATING HOSPI-
TAL, AND UNTIL THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFIES  THE
COMMISSIONER  IN  WRITING  THAT  THE  HOSPITAL  ELECTS  TO CEASE BEING A
PARTICIPATING HOSPITAL:
  (I) CROUSE HOSPITAL, SYRACUSE, NY.
  (II) GLENS FALLS HOSPITAL, GLENS FALLS, NY.
  (III) MEMORIAL HOSPITAL, ALBANY, NY.
  (IV) SAMARITAN HOSPITAL, TROY, NY.
  (V) UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY.
  (VI) WYCKOFF HEIGHTS MEDICAL CENTER, BROOKLYN, NY.
  (C) "POST-ACUTE CARE" MEANS CARE PROVIDED BY A NURSING  HOME,  TRANSI-
TIONAL  CARE  UNIT,  HOME  HEALTH AGENCY, ASSISTED LIVING PROGRAM, ADULT
CARE FACILITY, AN INPATIENT TREATMENT FACILITY OR  RESIDENTIAL  FACILITY
LICENSED  OR  OPERATED  BY  THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES, THE OFFICE OF MENTAL HEALTH OR THE OFFICE OF  MENTAL  RETARDA-
TION  AND DEVELOPMENTAL DISABILITIES, OR AN INPATIENT TREATMENT FACILITY
OR RESIDENTIAL FACILITY LICENSED BY A HEALTH, MENTAL HYGIENE  OR  SOCIAL
SERVICES AGENCY OF ANOTHER STATE.

A. 8647--B                          3

  (D)  "TRANSITION AUTHORIZATION" MEANS A DECISION, MADE BY A TRANSITION
AUTHORIZATION PANEL PURSUANT TO THIS ARTICLE, TO AUTHORIZE  THE  TRANSI-
TION  OF AN ELIGIBLE PATIENT FROM A PARTICIPATING HOSPITAL TO A SPECIFIC
POST-ACUTE CARE PROVIDER.
  (E) "TRANSITION AUTHORIZATION PANEL AGENT" MEANS AN INDIVIDUAL AUTHOR-
IZED  BY  THE  TRANSITION  AUTHORIZATION  PANEL  TO CARRY OUT TRANSITION
RELATED FINANCIAL ARRANGEMENTS.
  (F) "TRANSITION  AUTHORIZATION  PANEL"  MEANS  A  THREE-PERSON  PANEL,
CONVENED  PURSUANT  TO  THIS  ARTICLE, TO AUTHORIZE THE TRANSITION OF AN
ELIGIBLE PATIENT FROM A PARTICIPATING  HOSPITAL  TO  A  POST-ACUTE  CARE
PROVIDER, AND TO MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS.
  (G)  "TRANSITION  AUTHORIZATION  PANEL  POOL"  MEANS  THE FULL POOL OF
PERSONS QUALIFIED AND DESIGNATED TO SERVE  ON  TRANSITION  AUTHORIZATION
PANELS AT A PROGRAM SITE.
  (H) "TRANSITION-RELATED FINANCIAL ARRANGEMENTS" MEANS ACTS NECESSARY:
  (I) TO EXPEND THE ELIGIBLE PATIENT'S FUNDS FOR POST-ACUTE CARE FOR ONE
HUNDRED  TWENTY DAYS OR UNTIL THE COURT APPOINTMENT OF A GUARDIAN OF THE
PROPERTY PURSUANT TO ARTICLE  EIGHTY-ONE  OF  THE  MENTAL  HYGIENE  LAW,
WHICHEVER OCCURS FIRST.
  (II)  TO  APPLY  FOR  THE ELIGIBLE PATIENT'S ENROLLMENT IN MEDICAID OR
MEDICARE.
  (III) TO ACCESS FINANCIAL INFORMATION ABOUT THE ELIGIBLE PATIENT  FROM
FINANCIAL  INSTITUTIONS  TO  THE  EXTENT  NECESSARY FOR THE PURPOSES SET
FORTH IN SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH.
  (I) "FINANCIAL INSTITUTION" MEANS A FINANCIAL INSTITUTION  AS  DEFINED
IN SUBDIVISION FIVE OF SECTION 5-1501 OF THE GENERAL OBLIGATIONS LAW.
  (J)  "ADMINISTRATOR"  MEANS  THE  ADMINISTRATOR OF THE PROGRAM FOR THE
PARTICIPATING  HOSPITAL  DESIGNATED  UNDER  SUBDIVISION  THREE  OF  THIS
SECTION.
  3. EACH PARTICIPATING HOSPITAL SHALL:
  (A) DESIGNATE A PERSON AS ADMINISTRATOR OF THE PROGRAM WITH RESPECT TO
THAT PROGRAM SITE;
  (B)  CARRY OUT, AND BEAR THE COSTS OF, THE ADMINISTRATIVE RESPONSIBIL-
ITIES OF THE PROGRAM AS SET FORTH IN THIS SECTION, WITH RESPECT TO  THAT
PROGRAM SITE; AND
  (C)  CREATE  AND MAINTAIN RECORDS OF (I) ALL REQUESTS, PANELS CONVENED
AND ACTIONS TAKEN PURSUANT TO THIS SECTION, AND (II) ALL  TRANSITION-RE-
LATED  FINANCIAL  ARRANGEMENTS  MADE  PURSUANT  TO  THIS SECTION.   SUCH
RECORDS SHALL BE MADE AVAILABLE TO THE DEPARTMENT UPON REQUEST.
  4. (A) A PARTICIPATING HOSPITAL MAY CREATE A TRANSITION  AUTHORIZATION
PANEL POOL AT A PROGRAM SITE, WHICH SHALL HAVE THREE CLASSES OF MEMBERS:
  (I)  ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY THE
HOSPITAL;
  (II) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY THE
LOCAL SOCIAL SERVICES COMMISSIONER; AND
  (III) ONE CLASS OF MEMBERS SHALL BE QUALIFIED  PERSONS  DESIGNATED  BY
THE NEW YORK STATE OFFICE OF LONG TERM CARE OMBUDSMAN.
  (B)  FOR  THE  PURPOSES  OF  THIS PARAGRAPH, "QUALIFIED PERSONS" MEANS
ADULT PERSONS WITH RECOGNIZED EXPERTISE OR DEMONSTRATED INTEREST IN  THE
CARE AND TREATMENT OF HOSPITAL AND POST-ACUTE CARE PATIENTS, AND WHO CAN
BE  EXPECTED  TO  APPLY  THE STANDARDS OF THIS ARTICLE IN GOOD FAITH AND
WITH SIGNIFICANT SENSITIVITY TO THE INTERESTS OF THE ELIGIBLE PATIENT.
  (C) THE PARTICIPATING HOSPITAL AND THE LOCAL SOCIAL  SERVICES  COMMIS-
SIONER  SHALL  JOINTLY  APPOINT  ONE  MEMBER  AS CHAIR OF THE TRANSITION
AUTHORIZATION PANEL POOL.

A. 8647--B                          4

  5. (A) THE REVIEW OF REQUESTS FOR  TRANSITION  AUTHORIZATION  AND  FOR
TRANSITION-RELATED  FINANCIAL ARRANGEMENTS SHALL BE UNDERTAKEN BY PANELS
OF THREE MEMBERS DRAWN FROM THE TRANSITION AUTHORIZATION PANEL POOL, ONE
FROM EACH CLASS. THE MEMBER FROM THE JOINTLY APPOINTED CLASS SHALL SERVE
AS PANEL CHAIR.
  (B)  NO  PERSON WHO IS A HEALTH CARE PROFESSIONAL ACTIVELY INVOLVED IN
THE TREATMENT OF THE PATIENT WHOSE CASE  IS  UNDER  CONSIDERATION  BY  A
PANEL  MAY  SERVE  ON  THE  PANEL WITH RESPECT TO SUCH PATIENT, ALTHOUGH
OTHER HOSPITAL PERSONNEL MAY SERVE ON THE PANEL IF OTHERWISE QUALIFIED.
  6. (A) THE ATTENDING PHYSICIAN OF AN ELIGIBLE PATIENT MAY REQUEST THAT
A PANEL BE CONVENED BY SUBMITTING A WRITTEN REQUEST TO  THE  ADMINISTRA-
TOR. THE REQUEST MUST:
  (I) INDICATE THAT IT IS A REQUEST FOR THE PANEL TO AUTHORIZE THE TRAN-
SITION  OF  THE  PATIENT  TO POST-ACUTE CARE AND, IF APPLICABLE, TO MAKE
TRANSITION-RELATED FINANCIAL ARRAIGNMENTS;
  (II) SET FORTH THE REASONS FOR BELIEVING THAT THE PATIENT IS AN ELIGI-
BLE PATIENT; AND
  (III) SET FORTH THE PROPOSED POST-ACUTE CARE PROVIDER  (OR  PROVIDERS,
IF APPLICATIONS HAVE OR WILL BE MADE TO MORE THAN ONE);
  (B) UPON RECEIPT OF THE REQUEST, THE ADMINISTRATOR MAY:
  (I)  SET A TIME, DATE AND PLACE FOR THE TRANSITION AUTHORIZATION PANEL
TO REVIEW THE REQUEST. SUCH REVIEW MAY BE SCHEDULED  FOR  ANY  TIME  AND
DATE  AT  LEAST  THREE  DAYS  AFTER  THE  REQUEST  AND NOTICE IS SENT AS
PROVIDED BELOW; HOWEVER, THE REVIEW MAY BE HELD EARLIER  OR  LATER  THAN
THE  DATA  SET  FORTH  IN  THE NOTICE IF ALL PERSONS WHO ARE ENTITLED TO
NOTICE, AS SET FORTH BELOW, AGREE, IN WRITING OR VERBALLY (AS DOCUMENTED
BY THE ADMINISTRATOR), TO THE TIME, PLACE AND DATE OF THE REVIEW.
  (II) SEND A COPY OF THE REQUEST AND NOTICE,  BY  HAND,  MAIL,  FAX  OR
E-MAIL, TO THE FOLLOWING PERSONS:
  (A) THREE MEMBERS OF THE TRANSITION AUTHORIZATION PANEL POOL, ONE FROM
EACH  CLASS,  SELECTED  BY  THE  POOL CHAIR, WHO ARE WILLING AND ABLE TO
SERVE AS A PANEL FOR THE PURPOSE OF THIS REVIEW;
  (B) THE PATIENT, IF THERE IS ANY INDICATION OF THE  PATIENT'S  ABILITY
TO COMPREHEND SUCH NOTICE;
  (C)  TO A FAMILY MEMBER OR FRIEND OF THE PATIENT WHO MAY BE REASONABLY
AVAILABLE AND WILLING TO MAKE  A  TRANSITION  DECISION  ON  HIS  OR  HER
BEHALF, IF THERE IS ANY SUCH PERSON;
  (D)  IF THE PATIENT WAS ADMITTED FROM A FACILITY OR RESIDENCE LICENSED
BY THE OFFICE OF MENTAL HEALTH OR THE OFFICE OR MENTAL  RETARDATION  AND
DEVELOPMENTAL  DISABILITIES, TO  THE FACILITY DIRECTOR AND TO THE MENTAL
HYGIENE LEGAL SERVICES OFFICE FOR THAT JUDICIAL DEPARTMENT; AND
  (E) TO THE PATIENT'S ATTENDING PHYSICIAN.
  (III) PROVIDE NOTICE TO  THE  PATIENT  AND  TO  MENTAL  HYGIENE  LEGAL
SERVICES  WHICH SHALL INFORM THE PATIENT THAT HE OR SHE WILL BE AFFORDED
AN OPPORTUNITY TO ADDRESS THE  PANEL,  MAY  BE  PRESENT  FOR  ANY  OTHER
ADDRESSES  MADE  TO THE PANEL, AND MAY BE PRESENT FOR OTHER PARTS OF THE
PANEL REVIEW AS THE CHAIR MAY PERMIT, BUT THAT HE OR  SHE  WILL  NOT  BE
PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  (IV)  PROVIDE  NOTICE TO A PERSON DESCRIBED IN CLAUSES (B) THROUGH (E)
OF SUBPARAGRAPH (II) OF THIS PARAGRAPH WHICH  SHALL  INFORM  THE  PERSON
THAT HE OR SHE WILL BE AFFORDED AN OPPORTUNITY TO ADDRESS THE PANEL, AND
MAY BE PRESENT FOR SUCH OTHER PARTS OF THE PANEL REVIEW AS THE CHAIR MAY
PERMIT, THAT THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRES-
ENTING  A  PATIENT)  MAY  BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE
PANEL, AND THAT NO PERSON  DESCRIBED  IN  CLAUSES  (B)  THROUGH  (E)  OF

A. 8647--B                          5

SUBPARAGRAPH  (II)  OF  THIS  PARAGRAPH SHALL BE PERMITTED TO BE PRESENT
DURING THE PANEL'S DELIBERATION.
  7. (A) PRIOR TO OR DURING THE REVIEW, THE PANEL CHAIR MAY REQUEST AND,
NOTWITHSTANDING  ANY  OTHER  LAW  TO  THE CONTRARY, SHALL BE ENTITLED TO
RECEIVE FROM ANY HEALTH CARE PROVIDER AND  DISCLOSE  TO  THE  PANEL  ANY
INFORMATION  WHICH  IS RELEVANT TO THE PANEL'S REVIEW. INFORMATION WHICH
IS CONFIDENTIAL, AS PROVIDED FOR BY LAW, SHALL BE KEPT  CONFIDENTIAL  BY
THE  PANEL AND ANY LIMITATIONS ON THE FURTHER RELEASE THEREOF IMPOSED BY
LAW UPON THE PARTY FURNISHING THE INFORMATION SHALL APPLY TO THE PANEL.
  (B) THE PANEL SHALL MEET IN PERSON TO CONDUCT ITS REVIEW.
  (C) THE PANEL CHAIR MAY REQUEST THE ATTENDANCE AT THE  REVIEW  OF  ANY
PERSON WHO MIGHT ASSIST THE PANEL IN ITS REVIEW.
  (D) THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A
PATIENT) MAY BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE PANEL.
  (E)  WHERE  PRACTICABLE,  THE PANEL MEMBERS SHALL PERSONALLY INTERVIEW
AND OBSERVE THE PATIENT PRIOR TO MAKING THEIR DECISION.
  (F) NO PERSON DESCRIBED IN CLAUSES (B)  THROUGH  (E)  OF  SUBPARAGRAPH
(II)  OF  PARAGRAPH  (B)  OF  SUBDIVISION  SIX  OF THIS SECTION SHALL BE
PERMITTED TO BE PRESENT DURING THE PANEL DELIBERATION.
  (G) THE PANEL CHAIR MAY ADJOURN AND RECONVENE THE PANEL AS NECESSARY.
  (H) THE ADMINISTRATOR SHALL TAKE AND MAINTAIN  MINUTES  OF  ANY  PANEL
MEETING,  BUT  NO  RECORDING  OR  TRANSCRIPTION SHALL BE REQUIRED EXCEPT
WHERE REQUESTED BY A PERSON DESCRIBED IN  CLAUSES  (B)  THROUGH  (E)  OF
SUBPARAGRAPH (II) OF PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION.
  (I) IN ITS REVIEW, THE PANEL SHALL CONSIDER WHETHER THE PROPOSED TRAN-
SITION  IS  TO  A  FACILITY OR PROGRAM THAT APPEARS ABLE (I) TO MEET THE
PATIENT'S NEEDS, AND (II) TO DO SO  IN  THE  LEAST  RESTRICTIVE  SETTING
REASONABLY AVAILABLE TO THE PATIENT.
  8.  (A)  THE PANEL SHALL MAKE A DETERMINATION, BY MAJORITY VOTE, AS TO
WHETHER THE PATIENT IS AN ELIGIBLE PATIENT,  WHETHER  TO  AUTHORIZE  THE
PROPOSED  TRANSITION, AND WHETHER TO AUTHORIZE TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS. THE DETERMINATION SHALL BE SET FORTH IN  WRITING  AND
SHALL BE SIGNED BY THE CHAIR ON BEHALF OF THE PANEL.
  (B)  IF  THE  PANEL  DETERMINES  TO  AUTHORIZE THE PROPOSED TRANSITION
AND/OR  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS,  THE  AUTHORIZATION
SHALL  BE  SET  FORTH  IN AN ORDER, SIGNED BY THE CHAIR ON BEHALF OF THE
PANEL. THE ORDER SHALL DESCRIBE THE SCOPE OF SUCH AUTHORIZATION AND,  IF
IT  AUTHORIZES  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS, DESIGNATE A
TRANSITION AUTHORIZATION PANEL AGENT.
  (C) THE DETERMINATION, AND THE ORDER IF THERE IS ONE,  SHALL  BE  MADE
PART OF THE PATIENT'S MEDICAL RECORD.
  (D) NOTWITHSTANDING ANY LAW TO THE CONTRARY, THE ADMINISTRATOR AND THE
AGENT  SHALL  DISCLOSE  THE  ORDER  TO SUCH PERSONS AS NECESSARY FOR THE
PURPOSE OF CARRYING OUT ITS TERMS.
  (E) THE ORDER AUTHORIZING THE PROPOSED TRANSITION SHALL BE, AND MAY BE
RELIED UPON BY THE PARTICIPATING HOSPITAL, BY POST-ACUTE CARE PROVIDERS,
BY FINANCIAL INSTITUTIONS, AND BY OTHER THIRD-PARTIES AS LEGAL AUTHORITY
FOR THEM TO PERFORM OR COOPERATE IN THE PERFORMANCE  OF  THE  AUTHORIZED
ACTS, INCLUDING LEGAL AUTHORITY:
  (I) FOR THE PARTICIPATING HOSPITAL TO DISCHARGE THE PATIENT;
  (II) FOR THE POST-ACUTE CARE PROVIDER TO ADMIT THE PATIENT;
  (III)  FOR  THE  TRANSITION  AUTHORIZATION PANEL AGENT TO MAKE TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS; AND
  (IV) FOR MEDICAID, FINANCIAL INSTITUTIONS AND OTHER PARTIES TO PROVIDE
FINANCIAL AND OTHER PERSONAL INFORMATION ABOUT THE  PATIENT  RELATED  TO
THE  TRANSITION  AND  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS TO THE

A. 8647--B                          6

ADMINISTRATOR OR AGENT, AND TO OTHERWISE COOPERATE IN THE TRANSITION-RE-
LATED FINANCIAL ARRANGEMENTS.
  SUCH  PARTIES SHALL BE IMMUNE FROM LIABILITY FOR ACTIONS TAKEN IN GOOD
FAITH AND REASONABLE RELIANCE UPON SUCH ORDER.
  9. A PARTICIPATING HOSPITAL, THE LOCAL SOCIAL SERVICES DEPARTMENT, AND
ANY OTHER PERSON MAY, BUT SHALL NOT BE REQUIRED TO, ENTER INTO AN AGREE-
MENT WITH A POST-ACUTE CARE PROVIDER FOR SUCH HOSPITAL,  DEPARTMENT,  OR
OTHER PERSON TO PETITION FOR THE APPOINTMENT OF A GUARDIAN UNDER ARTICLE
EIGHTY-ONE OF THE MENTAL HYGIENE LAW FOR A PATIENT TRANSITIONED PURSUANT
TO THE ORDER OF A TRANSITION AUTHORIZATION PANEL, EITHER BEFORE OR AFTER
THE  TRANSITION,  AS  A WAY TO PROVIDE FOR BROADER AND LONGER TERM DECI-
SIONMAKING AUTHORITY WITH RESPECT TO THE TRANSITIONED PATIENT. THE CHIEF
EXECUTIVE OFFICER OF A PARTICIPATING HOSPITAL, OR HIS OR  HER  DESIGNEE,
THAT  ENTERS  INTO SUCH AGREEMENT PRIOR TO THE PATIENT'S DISCHARGE SHALL
BE DEEMED TO HAVE THE AUTHORITY TO COMMENCE A PETITION  UNDER  PARAGRAPH
SEVEN OF SUBDIVISION (A) OF SECTION 81.06 OF THE MENTAL HYGIENE LAW.
  10. NO PERSON SHALL BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR SANC-
TION  BY  A GOVERNMENTAL AGENCY FOR ACTIONS TAKEN REASONABLY AND IN GOOD
FAITH PURSUANT TO THIS ARTICLE (A) AS A MEMBER OR AGENT OF A  TRANSITION
AUTHORIZATION  PANEL,  OR AS ADMINISTRATOR OF A TRANSITION AUTHORIZATION
PROGRAM; (B) DISCHARGING, TRANSFERRING OR ADMITTING A PATIENT FROM OR TO
A FACILITY PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL;  OR
(C)  DISCLOSING  FINANCIAL  INFORMATION  ABOUT  A  PATIENT OR DISBURSING
PATIENT FUNDS PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL.
  11. (A) THE ADMINISTRATOR OF EACH PANEL SHALL SUBMIT AN ANNUAL  REPORT
TO  THE  COMMISSIONER OF HEALTH, DUE WITHIN THIRTY DAYS OF EACH ANNIVER-
SARY OF THE EFFECTIVE DATE OF THIS SECTION.  THE REPORT SHALL SET FORTH:
  (I) WITH RESPECT TO EACH CASE CONSIDERED  BY  A  PANEL,  THE  TYPE  OF
POST-ACUTE  CARE  REQUESTED;    THE  LENGTH OF TIME FROM THE DATE OF THE
REQUEST UNTIL (A) THE PANEL CONVENED, (B) THE PANEL ISSUED ITS  DETERMI-
NATION, AND (C) THE PATIENT WAS DISCHARGED FROM THE PARTICIPATING HOSPI-
TAL  (IF  THE  DETERMINATION APPROVED THE TRANSITION); THE CATEGORIES OF
PERSONS WHO ADDRESSED THE PANEL; THE NUMBER OF UNANIMOUS AND  NON-UNANI-
MOUS PANEL VOTES; WHETHER THE ORDER CALLED FOR TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS AND IF SO WHETHER THOSE ARRANGEMENTS WERE SUCCESSFULLY
MADE;  AND  ANY DATA OR OTHER INFORMATION AVAILABLE TO THE ADMINISTRATOR
REGARDING THE IMPACT OF THE  DEMONSTRATION  ON  THE  HOSPITAL'S  AVERAGE
INPATIENT LENGTH OF STAY.
  (II) THE PARTICIPATING HOSPITAL AND LOCAL SOCIAL SERVICES DEPARTMENT'S
EVALUATION  OF  THE  SUCCESS  OF  THE  TRANSITION  PLANS APPROVED BY THE
PROGRAM IN MEETING THE NEEDS OF PATIENTS AND THEIR  RECOMMENDATIONS  FOR
AMENDMENTS  TO  THIS SECTION, AND RECOMMENDATIONS REGARDING THE MERIT OF
EXTENDING THIS DEMONSTRATION PROGRAM OR ADOPTING A PERMANENT AND  STATE-
WIDE TRANSITION AUTHORIZATION PROGRAM.
  (B) THE COMMISSIONER SHALL COMPILE THE REPORTS SUBMITTED TO HIM OR HER
AS  REQUIRED  ABOVE,  AND  PROMPTLY SUBMIT SUCH REPORTS TO THE TEMPORARY
PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
ER OF THE SENATE AND THE MINORITY LEADER OF THE  ASSEMBLY.  THE  COMMIS-
SIONER MAY ADD HIS OR HER OWN RECOMMENDATIONS TO THAT COMPILATION.
  S  3.  This act shall take effect immediately, and shall expire and be
deemed repealed three years and ninety days after it shall have become a
law.

co-Sponsors

2009-A8647C (ACTIVE) - Details

Current Committee:: Assembly Codes
Law Section:: Public Health Law
Laws Affected:: Add §2803-s, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A2473

2009-A8647C (ACTIVE) - Summary

2009-A8647C (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 8647--C

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                              June 2, 2009
                               ___________

Introduced  by  M. of A. CANESTRARI, GORDON -- read once and referred to
  the Committee on Health -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee --  recommitted
  to  the Committee on Health in accordance with Assembly Rule 3, sec. 2
  -- committee discharged, bill amended, ordered  reprinted  as  amended
  and  recommitted  to  said  committee  -- reported and referred to the
  Committee on Codes --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN  ACT  to  amend  the public health law, in relation to establishing a
  demonstration program to study transition authorization panels  as  an
  approach  to  secure  decisions  regarding the transition of incapable
  patients who do not have legally authorized decisionmakers from  inpa-
  tient  care  to  post-acute care; and providing for the repeal of such
  provisions upon expiration thereof

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  The legislature finds and declares that in many instances
there are hospital patients who are medically ready to transition  to  a
different  level  of  care,  such  as  nursing  home  care, home care or
assisted living, but they lack capacity to authorize the transition, and
also lack a family member or other person who can authorize the  transi-
tion on their behalf. As a result, such patients can be subject to inor-
dinate  delays  in  accomplishing a needed transition, and can remain as
hospital inpatients for long periods.  That  delay  is  harmful  to  the
interests  of  those  patients, as well as to other persons who may need
the scarce inpatient resources, to  hospitals,  to  payors  and  to  the
public in general.
  The  legislature  further  finds  that  while article 81 of the mental
hygiene law provides a procedure for the court-appointment of  guardians
who  could  be empowered to authorize transition for such patients, such
procedure was designed for longer-term assistance with an  incapacitated

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11971-08-0

A. 8647--C                          2

person's personal and property affairs, and includes features that often
go  beyond  what  is needed for transition-related decisions alone. As a
result, the guardianship proceeding can require far  more  time,  effort
and expense than is warranted for this limited, non-contested decision.
  Accordingly,  the legislature finds that it would be valuable to study
an alternative approach to secure decisions relating to  the  transition
of  isolated  incapable patients from inpatient care to post-acute care.
Specifically, the transition authorization panel  demonstration  program
shows  promise as means to protect the rights and interests of incapable
patients in the transition decision, while allowing such decisions to be
made within a reasonable timeframe.
  S 2. The public health law is amended by adding a new  section  2803-s
to read as follows:
  S  2803-S.  TRANSITION  AUTHORIZATION PANEL DEMONSTRATION PROGRAM.  1.
THERE IS HEREBY ESTABLISHED  A  TRANSITION  AUTHORIZATION  PANEL  DEMON-
STRATION  PROGRAM,  CONDUCTED  AT  SIX  PROGRAM  SITES,  TO  EVALUATE AN
APPROACH TO SECURE DECISIONS RELATING  TO  THE  TRANSITION  OF  ISOLATED
PATIENTS FROM INPATIENT CARE TO POST-ACUTE CARE.
  2. AS USED IN THIS SECTION:
  (A)  "ELIGIBLE PATIENT" MEANS AN INPATIENT AT A PARTICIPATING HOSPITAL
WHO, ACCORDING TO THE PATIENT'S ATTENDING PHYSICIAN:
  (I) IS READY TO BE DISCHARGED AS AN INPATIENT, BUT NEEDS TO BE TRANSI-
TIONED TO POST-ACUTE CARE;
  (II) LACKS CAPACITY TO CONSENT TO THE DISCHARGE AND  TO  ADMISSION  TO
POST-ACUTE CARE;
  (III)  DOES  NOT HAVE A GUARDIAN, HEALTH CARE AGENT OR POWER OF ATTOR-
NEY, OR A FAMILY MEMBER, FRIEND OR OTHER REPRESENTATIVE WHO  IS  REASON-
ABLY  AVAILABLE  AND WILLING TO MAKE A TRANSITION DECISION ON HIS OR HER
BEHALF, WHOSE CONSENT WOULD BE ACCEPTED BY A  PROPOSED  POST-ACUTE  CARE
PROVIDER,  AND  WHO  IS  LEGALLY AUTHORIZED TO MAKE ALL REQUIRED TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS;
  (IV) HAS A DISCHARGE PLAN THAT IDENTIFIES  AN  APPROPRIATE  POST-ACUTE
CARE  PROVIDER THAT IS OR MAY BE WILLING TO ADMIT THE PATIENT IF A TRAN-
SITION AUTHORIZATION PANEL WERE TO  AUTHORIZE  THE  TRANSITION  AND,  IF
NECESSARY, MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS; AND
  (V) HAS NOT EXPRESSED AN OBJECTION TO ANY OF THE FOREGOING FINDINGS OR
TO BEING TRANSITIONED TO THE PROPOSED POST-ACUTE FACILITY OR SERVICE OR,
IF APPLICABLE, THE PROPOSED TRANSITION-RELATED FINANCIAL ARRANGEMENTS;
  (B)  "PARTICIPATING  HOSPITAL"  MEANS  ANY OF THE FOLLOWING HOSPITALS,
UPON THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFYING  THE  COMMIS-
SIONER  IN WRITING THAT THE HOSPITAL ELECTS TO BE A PARTICIPATING HOSPI-
TAL, AND UNTIL THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL NOTIFIES  THE
COMMISSIONER  IN  WRITING  THAT  THE  HOSPITAL  ELECTS  TO CEASE BEING A
PARTICIPATING HOSPITAL:
  (I) CROUSE HOSPITAL, SYRACUSE, NY.
  (II) GLENS FALLS HOSPITAL, GLENS FALLS, NY.
  (III) MEMORIAL HOSPITAL, ALBANY, NY.
  (IV) SAMARITAN HOSPITAL, TROY, NY.
  (V) UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY.
  (VI) WYCKOFF HEIGHTS MEDICAL CENTER, BROOKLYN, NY.
  (C) "POST-ACUTE CARE" MEANS CARE PROVIDED BY A RESIDENTIAL HEALTH CARE
FACILITY, TRANSITIONAL CARE UNIT, HOME CARE  SERVICES,  ASSISTED  LIVING
PROGRAM, ADULT CARE FACILITY, HOSPICE, AND AN INPATIENT TREATMENT FACIL-
ITY  OR RESIDENTIAL FACILITY LICENSED OR OPERATED BY THE OFFICE OF ALCO-
HOLISM AND SUBSTANCE ABUSE SERVICES, THE OFFICE OF MENTAL HEALTH OR  THE
OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES, OR AN INPA-

A. 8647--C                          3

TIENT  TREATMENT  FACILITY OR RESIDENTIAL FACILITY LICENSED BY A HEALTH,
MENTAL HYGIENE OR SOCIAL SERVICES AGENCY OF ANOTHER STATE.
  (D)  "TRANSITION AUTHORIZATION" MEANS A DECISION, MADE BY A TRANSITION
AUTHORIZATION PANEL PURSUANT TO THIS SECTION, TO AUTHORIZE  THE  TRANSI-
TION  OF AN ELIGIBLE PATIENT FROM A PARTICIPATING HOSPITAL TO A SPECIFIC
POST-ACUTE CARE PROVIDER, AND "AUTHORIZE A TRANSITION" OR "AUTHORIZE THE
TRANSITION" MEANS TO MAKE SUCH DECISION.
  (E) "TRANSITION AUTHORIZATION PANEL AGENT" OR "AGENT" MEANS  AN  INDI-
VIDUAL  AUTHORIZED  BY  THE  TRANSITION AUTHORIZATION PANEL TO CARRY OUT
TRANSITION RELATED FINANCIAL ARRANGEMENTS.
  (F) "TRANSITION AUTHORIZATION PANEL" OR "PANEL" MEANS  A  THREE-PERSON
PANEL, CONVENED PURSUANT TO THIS SECTION, TO AUTHORIZE THE TRANSITION OF
AN  ELIGIBLE  PATIENT FROM A PARTICIPATING HOSPITAL TO A POST-ACUTE CARE
PROVIDER, AND TO MAKE TRANSITION-RELATED FINANCIAL ARRANGEMENTS.
  (G) "TRANSITION AUTHORIZATION PANEL  POOL"  MEANS  THE  FULL  POOL  OF
PERSONS  QUALIFIED  AND  DESIGNATED TO SERVE ON TRANSITION AUTHORIZATION
PANELS AT A PROGRAM SITE.
  (H) "TRANSITION-RELATED FINANCIAL ARRANGEMENTS" MEANS ACTS NECESSARY:
  (I) TO EXPEND THE ELIGIBLE PATIENT'S FUNDS FOR POST-ACUTE CARE FOR ONE
HUNDRED TWENTY DAYS OR UNTIL THE COURT APPOINTMENT OF A GUARDIAN OF  THE
PROPERTY  PURSUANT  TO  ARTICLE  EIGHTY-ONE  OF  THE MENTAL HYGIENE LAW,
WHICHEVER OCCURS FIRST.
  (II) TO APPLY FOR THE ELIGIBLE PATIENT'S  ENROLLMENT  IN  MEDICAID  OR
MEDICARE.
  (III)  TO ACCESS FINANCIAL INFORMATION ABOUT THE ELIGIBLE PATIENT FROM
FINANCIAL INSTITUTIONS TO THE EXTENT  NECESSARY  FOR  THE  PURPOSES  SET
FORTH IN SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH.
  (I)  "FINANCIAL  INSTITUTION" MEANS A FINANCIAL INSTITUTION AS DEFINED
IN SUBDIVISION FIVE OF SECTION 5-1501 OF THE GENERAL OBLIGATIONS LAW.
  (J) "ADMINISTRATOR" MEANS THE ADMINISTRATOR OF  THE  PROGRAM  FOR  THE
PARTICIPATING  HOSPITAL  DESIGNATED  UNDER  SUBDIVISION  THREE  OF  THIS
SECTION.
  3. EACH PARTICIPATING HOSPITAL SHALL:
  (A) DESIGNATE A PERSON AS ADMINISTRATOR OF THE PROGRAM WITH RESPECT TO
THAT PROGRAM SITE;
  (B) CARRY OUT, AND BEAR THE COSTS OF, THE ADMINISTRATIVE  RESPONSIBIL-
ITIES  OF THE PROGRAM AS SET FORTH IN THIS SECTION, WITH RESPECT TO THAT
PROGRAM SITE; AND
  (C) CREATE AND MAINTAIN RECORDS OF (I) ALL REQUESTS,  PANELS  CONVENED
AND  ACTIONS TAKEN PURSUANT TO THIS SECTION, AND (II) ALL TRANSITION-RE-
LATED FINANCIAL ARRANGEMENTS  MADE  PURSUANT  TO  THIS  SECTION.    SUCH
RECORDS SHALL BE MADE AVAILABLE TO THE DEPARTMENT UPON REQUEST.
  4.  (A) A PARTICIPATING HOSPITAL MAY CREATE A TRANSITION AUTHORIZATION
PANEL POOL AT A PROGRAM SITE, WHICH SHALL HAVE THREE CLASSES OF MEMBERS:
  (I) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY  THE
HOSPITAL;
  (II) ONE CLASS OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY THE
LOCAL SOCIAL SERVICES COMMISSIONER; AND
  (III)  ONE  CLASS  OF MEMBERS SHALL BE QUALIFIED PERSONS DESIGNATED BY
THE NEW YORK STATE OFFICE OF LONG TERM CARE OMBUDSMAN.
  (B) FOR THE PURPOSES OF THIS SUBDIVISION,  "QUALIFIED  PERSONS"  MEANS
ADULT  PERSONS WITH RECOGNIZED EXPERTISE OR DEMONSTRATED INTEREST IN THE
CARE AND TREATMENT OF HOSPITAL AND POST-ACUTE CARE PATIENTS, AND WHO CAN
BE EXPECTED TO APPLY THE STANDARDS OF THIS SECTION IN GOOD FAITH AND  IN
THE BEST INTERESTS OF THE ELIGIBLE PATIENT.

A. 8647--C                          4

  (C)  THE  PARTICIPATING HOSPITAL AND THE LOCAL SOCIAL SERVICES COMMIS-
SIONER SHALL JOINTLY APPOINT ONE  MEMBER  AS  CHAIR  OF  THE  TRANSITION
AUTHORIZATION PANEL POOL.
  5.  (A)  THE  REVIEW  OF REQUESTS FOR TRANSITION AUTHORIZATION AND FOR
TRANSITION-RELATED FINANCIAL ARRANGEMENTS SHALL BE UNDERTAKEN BY  PANELS
OF THREE MEMBERS DRAWN FROM THE TRANSITION AUTHORIZATION PANEL POOL, ONE
FROM  EACH CLASS. THE PARTICIPATING HOSPITAL SHALL APPOINT ONE MEMBER AS
PANEL CHAIR.
  (B) NO PERSON WHO IS A HEALTH CARE PROFESSIONAL ACTIVELY  INVOLVED  IN
THE  TREATMENT  OF  THE  PATIENT  WHOSE CASE IS UNDER CONSIDERATION BY A
PANEL MAY SERVE ON THE PANEL WITH  RESPECT  TO  SUCH  PATIENT,  ALTHOUGH
OTHER HOSPITAL PERSONNEL MAY SERVE ON THE PANEL IF OTHERWISE QUALIFIED.
  6. (A) THE ATTENDING PHYSICIAN OF AN ELIGIBLE PATIENT MAY REQUEST THAT
A  PANEL  BE CONVENED BY SUBMITTING A WRITTEN REQUEST TO THE ADMINISTRA-
TOR. THE REQUEST MUST:
  (I) INDICATE THAT IT IS A REQUEST FOR THE PANEL TO AUTHORIZE THE TRAN-
SITION OF THE PATIENT TO POST-ACUTE CARE AND,  IF  APPLICABLE,  TO  MAKE
TRANSITION-RELATED FINANCIAL ARRANGEMENTS;
  (II) SET FORTH THE REASONS FOR BELIEVING THAT THE PATIENT IS AN ELIGI-
BLE PATIENT; AND
  (III)  SET  FORTH THE PROPOSED POST-ACUTE CARE PROVIDER (OR PROVIDERS,
IF APPLICATIONS HAVE OR WILL BE MADE TO MORE THAN ONE);
  (B) UPON RECEIPT OF THE REQUEST, THE ADMINISTRATOR MAY EITHER  DECLINE
THE  REQUEST  AND NOTIFY THE ATTENDING PHYSICIAN OF THE REASON WHICH MAY
INCLUDE BUT NOT BE LIMITED TO THE FACT  THAT  ALTHOUGH  THE  PATIENT  IS
ELIGIBLE,  A  TRANSITION CAN BE ACCOMPLISHED WITHOUT THE NEED TO CONVENE
THE PANEL, OR ELSE TAKE THE FOLLOWING STEPS TO CONVENE THE PANEL:
  (I) SET A TIME, DATE AND PLACE FOR THE TRANSITION AUTHORIZATION  PANEL
TO  REVIEW  THE  REQUEST.  SUCH REVIEW MAY BE SCHEDULED FOR ANY TIME AND
DATE AT LEAST THREE DAYS  AFTER  THE  REQUEST  AND  NOTICE  IS  SENT  AS
PROVIDED IN THIS PARAGRAPH; HOWEVER, THE REVIEW SHALL BE HELD EARLIER OR
LATER THAN THE DATE SET FORTH IN THE NOTICE IF ALL PERSONS WHO ARE ENTI-
TLED  TO  NOTICE,  AS  SET FORTH IN THIS PARAGRAPH, AGREE, IN WRITING OR
VERBALLY (AS DOCUMENTED BY THE ADMINISTRATOR), TO THE  TIME,  PLACE  AND
DATE OF THE REVIEW.
  (II)  SEND  A  COPY  OF  THE REQUEST AND NOTICE, BY HAND, MAIL, FAX OR
E-MAIL, TO THE FOLLOWING PERSONS:
  (A) THREE MEMBERS OF THE TRANSITION AUTHORIZATION PANEL POOL, ONE FROM
EACH CLASS, SELECTED BY THE POOL CHAIR, WHO  ARE  WILLING  AND  ABLE  TO
SERVE AS A PANEL FOR THE PURPOSE OF THIS REVIEW;
  (B)  THE  PATIENT, IF THERE IS ANY INDICATION OF THE PATIENT'S ABILITY
TO COMPREHEND SUCH NOTICE;
  (C) TO A FAMILY MEMBER OR FRIEND OF THE PATIENT WHO MAY BE  REASONABLY
AVAILABLE  AND  WILLING  TO  MAKE  A  TRANSITION  DECISION ON HIS OR HER
BEHALF, IF THERE IS ANY SUCH PERSON;
  (D) IF THE PATIENT WAS ADMITTED FROM A FACILITY OR RESIDENCE  LICENSED
BY  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OR MENTAL RETARDATION AND
DEVELOPMENTAL DISABILITIES, TO  THE FACILITY DIRECTOR AND TO THE  MENTAL
HYGIENE  LEGAL  SERVICES  OFFICE UNDER ARTICLE FORTY-SEVEN OF THE MENTAL
HYGIENE LAW; AND
  (E) TO THE PATIENT'S ATTENDING PHYSICIAN.
  (III) PROVIDE NOTICE TO  THE  PATIENT  AND  TO  MENTAL  HYGIENE  LEGAL
SERVICES  WHICH SHALL INFORM THE PATIENT THAT HE OR SHE WILL BE AFFORDED
AN OPPORTUNITY TO ADDRESS THE  PANEL,  MAY  BE  PRESENT  FOR  ANY  OTHER
ADDRESSES  MADE  TO THE PANEL, AND MAY BE PRESENT FOR OTHER PARTS OF THE

A. 8647--C                          5

PANEL REVIEW AS THE CHAIR MAY PERMIT, BUT THAT HE OR  SHE  WILL  NOT  BE
PERMITTED TO BE PRESENT DURING THE PANEL'S DELIBERATION.
  (IV) PROVIDE NOTICE TO PERSONS DESCRIBED IN CLAUSES (B) THROUGH (E) OF
SUBPARAGRAPH  (II)  OF THIS PARAGRAPH WHICH SHALL INFORM THE PERSON THAT
HE OR SHE WILL BE AFFORDED AN OPPORTUNITY TO ADDRESS THE PANEL, AND  MAY
BE  PRESENT  FOR  SUCH  OTHER PARTS OF THE PANEL REVIEW AS THE CHAIR MAY
PERMIT, THAT THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRES-
ENTING A PATIENT) MAY BE PRESENT WHEN ANY  OTHER  PERSON  ADDRESSES  THE
PANEL,  AND  THAT  NO  PERSON  DESCRIBED  IN  CLAUSES (B) THROUGH (E) OF
SUBPARAGRAPH (II) OF THIS PARAGRAPH SHALL BE  PERMITTED  TO  BE  PRESENT
DURING THE PANEL'S DELIBERATION.
  7. (A) PRIOR TO OR DURING THE REVIEW, THE PANEL CHAIR MAY REQUEST AND,
NOTWITHSTANDING  ANY  OTHER  LAW  TO  THE CONTRARY, SHALL BE ENTITLED TO
RECEIVE FROM ANY HEALTH CARE PROVIDER AND  DISCLOSE  TO  THE  PANEL  ANY
INFORMATION  WHICH  IS RELEVANT TO THE PANEL'S REVIEW. INFORMATION WHICH
IS CONFIDENTIAL, AS PROVIDED FOR BY LAW, SHALL BE KEPT  CONFIDENTIAL  BY
THE  PANEL AND ANY LIMITATIONS ON THE FURTHER RELEASE THEREOF IMPOSED BY
LAW UPON THE PARTY FURNISHING THE INFORMATION SHALL APPLY TO THE PANEL.
  (B) THE PANEL SHALL MEET IN PERSON OR BY VIDEO CONFERENCE  TO  CONDUCT
ITS REVIEW.
  (C)  THE  PANEL  CHAIR MAY REQUEST THE ATTENDANCE AT THE REVIEW OF ANY
PERSON WHO MIGHT ASSIST THE PANEL IN ITS REVIEW.
  (D) THE PATIENT AND MENTAL HYGIENE LEGAL SERVICES (WHEN REPRESENTING A
PATIENT) MAY BE PRESENT WHEN ANY OTHER PERSON ADDRESSES THE PANEL.
  (E) WHERE PRACTICABLE, THE PANEL MEMBERS  SHALL  PERSONALLY  INTERVIEW
AND OBSERVE THE PATIENT PRIOR TO MAKING THEIR DECISION.
  (F)  NO  PERSON  DESCRIBED  IN CLAUSES (B) THROUGH (E) OF SUBPARAGRAPH
(II) OF PARAGRAPH (B) OF  SUBDIVISION  SIX  OF  THIS  SECTION  SHALL  BE
PERMITTED TO BE PRESENT DURING THE PANEL DELIBERATION.
  (G) THE PANEL CHAIR MAY ADJOURN AND RECONVENE THE PANEL AS NECESSARY.
  (H)  THE ADMINISTRATOR SHALL ARRANGE FOR MINUTES TO BE TAKEN AND MAIN-
TAINED OF ANY PANEL MEETING, BUT NO RECORDING OR TRANSCRIPTION SHALL  BE
REQUIRED.
  (I) IN ITS REVIEW, THE PANEL SHALL CONSIDER WHETHER THE PROPOSED TRAN-
SITION  IS  TO  A  FACILITY OR PROGRAM THAT APPEARS ABLE (I) TO MEET THE
PATIENT'S NEEDS, AND (II) TO DO SO  IN  THE  LEAST  RESTRICTIVE  SETTING
REASONABLY AVAILABLE TO THE PATIENT.
  8.  (A) THE PANEL SHALL MAKE A DETERMINATION, BY MAJORITY VOTE, AS TO:
(I) WHETHER THE PATIENT IS AN ELIGIBLE PATIENT, (II) WHETHER TO  AUTHOR-
IZE THE PROPOSED TRANSITION (PROVIDED THAT, IF THE PATIENT HAS A GUARDI-
AN,  HEALTH CARE AGENT, SURROGATE OR OTHER REPRESENTATIVE WHO IS REASON-
ABLY AVAILABLE AND WILLING TO MAKE A TRANSITION DECISION ON HIS  OR  HER
BEHALF,  BUT  WHO  IS  NOT LEGALLY AUTHORIZED TO MAKE FINANCIAL ARRANGE-
MENTS, THEN SUCH PERSON AND  NOT  THE  PANEL  SHALL  DECIDE  WHETHER  TO
AUTHORIZE THE PROPOSED TRANSITION), AND (III) WHETHER TO AUTHORIZE TRAN-
SITION-RELATED  FINANCIAL ARRANGEMENTS.   THE DETERMINATION SHALL BE SET
FORTH IN WRITING AND SHALL BE SIGNED BY  THE  CHAIR  ON  BEHALF  OF  THE
PANEL.
  (B)  IF  THE  PANEL  DETERMINES  TO  AUTHORIZE THE PROPOSED TRANSITION
AND/OR  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS,  THE  AUTHORIZATION
SHALL  BE  SET  FORTH  IN AN ORDER, SIGNED BY THE CHAIR ON BEHALF OF THE
PANEL. THE ORDER SHALL DESCRIBE THE SCOPE OF SUCH AUTHORIZATION AND,  IF
IT  AUTHORIZES  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS, DESIGNATE A
TRANSITION AUTHORIZATION PANEL AGENT.
  (C) THE DETERMINATION, AND THE ORDER IF THERE IS ONE,  SHALL  BE  MADE
PART OF THE PATIENT'S MEDICAL RECORD.

A. 8647--C                          6

  (D) NOTWITHSTANDING ANY LAW TO THE CONTRARY, THE ADMINISTRATOR AND THE
AGENT  SHALL  DISCLOSE  THE  ORDER  TO SUCH PERSONS AS NECESSARY FOR THE
PURPOSE OF CARRYING OUT ITS TERMS.
  (E) THE ORDER AUTHORIZING THE PROPOSED TRANSITION SHALL BE, AND MAY BE
RELIED UPON BY THE PARTICIPATING HOSPITAL, BY POST-ACUTE CARE PROVIDERS,
BY FINANCIAL INSTITUTIONS, AND BY OTHER THIRD-PARTIES AS LEGAL AUTHORITY
FOR  THEM  TO  PERFORM OR COOPERATE IN THE PERFORMANCE OF THE AUTHORIZED
ACTS, INCLUDING LEGAL AUTHORITY:
  (I) FOR THE PARTICIPATING HOSPITAL TO DISCHARGE THE PATIENT;
  (II) FOR THE POST-ACUTE CARE PROVIDER TO ADMIT THE PATIENT;
  (III) FOR THE TRANSITION AUTHORIZATION PANEL  AGENT  TO  MAKE  TRANSI-
TION-RELATED FINANCIAL ARRANGEMENTS; AND
  (IV) FOR MEDICAID, FINANCIAL INSTITUTIONS AND OTHER PARTIES TO PROVIDE
FINANCIAL  AND  OTHER  PERSONAL INFORMATION ABOUT THE PATIENT RELATED TO
THE TRANSITION AND  TRANSITION-RELATED  FINANCIAL  ARRANGEMENTS  TO  THE
ADMINISTRATOR OR AGENT, AND TO OTHERWISE COOPERATE IN THE TRANSITION-RE-
LATED FINANCIAL ARRANGEMENTS.
  SUCH  PARTIES SHALL BE IMMUNE FROM LIABILITY FOR ACTIONS TAKEN IN GOOD
FAITH AND REASONABLE RELIANCE UPON SUCH ORDER.
  (F) A TRANSITION AUTHORIZATION PANEL AGENT, IN THE PERFORMANCE OF  HIS
OR HER DUTIES UNDER THIS SECTION, SHALL BE DEEMED THE PERSONAL REPRESEN-
TATIVE  OF  THE  PATIENT FOR PURPOSES OF FEDERAL REGULATIONS RELATING TO
THE PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (HIPAA).
  9. A PARTICIPATING HOSPITAL, THE LOCAL SOCIAL SERVICES DEPARTMENT, AND
ANY OTHER PERSON MAY, BUT SHALL NOT BE REQUIRED TO, ENTER INTO AN AGREE-
MENT WITH A POST-ACUTE CARE PROVIDER FOR SUCH HOSPITAL,  DEPARTMENT,  OR
OTHER PERSON TO PETITION FOR THE APPOINTMENT OF A GUARDIAN UNDER ARTICLE
EIGHTY-ONE OF THE MENTAL HYGIENE LAW FOR A PATIENT TRANSITIONED PURSUANT
TO THE ORDER OF A TRANSITION AUTHORIZATION PANEL, EITHER BEFORE OR AFTER
THE  TRANSITION,  AS  A WAY TO PROVIDE FOR BROADER AND LONGER TERM DECI-
SIONMAKING AUTHORITY WITH RESPECT TO THE TRANSITIONED PATIENT. THE CHIEF
EXECUTIVE OFFICER OF A PARTICIPATING HOSPITAL, OR HIS OR  HER  DESIGNEE,
THAT  ENTERS  INTO SUCH AGREEMENT PRIOR TO THE PATIENT'S DISCHARGE SHALL
BE DEEMED TO HAVE THE AUTHORITY TO COMMENCE A PETITION  UNDER  PARAGRAPH
SEVEN OF SUBDIVISION (A) OF SECTION 81.06 OF THE MENTAL HYGIENE LAW.
  10. NO PERSON SHALL BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR SANC-
TION  BY  A GOVERNMENTAL AGENCY FOR ACTIONS TAKEN REASONABLY AND IN GOOD
FAITH PURSUANT TO THIS ARTICLE (A) AS A MEMBER OR AGENT OF A  TRANSITION
AUTHORIZATION  PANEL,  OR AS ADMINISTRATOR OF A TRANSITION AUTHORIZATION
PROGRAM; (B) DISCHARGING, TRANSFERRING OR ADMITTING A PATIENT FROM OR TO
A FACILITY PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL;  OR
(C)  DISCLOSING  FINANCIAL  INFORMATION  ABOUT  A  PATIENT OR DISBURSING
PATIENT FUNDS PURSUANT TO AN ORDER OF A TRANSITION AUTHORIZATION PANEL.
  11. (A) THE ADMINISTRATOR OF EACH PANEL SHALL SUBMIT AN ANNUAL  REPORT
TO  THE  COMMISSIONER, DUE WITHIN THIRTY DAYS OF EACH ANNIVERSARY OF THE
EFFECTIVE DATE OF THIS SECTION.  THE REPORT SHALL SET FORTH:
  (I) WITH RESPECT TO EACH REQUEST TO CONVENE BY A PANEL,  THE  TYPE  OF
POST-ACUTE  CARE  REQUESTED;    THE  LENGTH OF TIME FROM THE DATE OF THE
REQUEST UNTIL (A) THE PANEL CONVENED, (B) THE PANEL ISSUED ITS  DETERMI-
NATION, AND (C) THE PATIENT WAS DISCHARGED FROM THE PARTICIPATING HOSPI-
TAL  (IF  THE  DETERMINATION APPROVED THE TRANSITION); THE CATEGORIES OF
PERSONS WHO ADDRESSED THE PANEL; THE NUMBER OF UNANIMOUS AND  NON-UNANI-
MOUS PANEL VOTES; WHETHER THE ORDER CALLED FOR TRANSITION-RELATED FINAN-
CIAL ARRANGEMENTS AND IF SO WHETHER THOSE ARRANGEMENTS WERE SUCCESSFULLY
MADE;  WHETHER  THE PATIENT AND/OR FAMILY MEMBER OBJECTED TO THE PANEL'S
DECISION; AND ANY DATA OR OTHER INFORMATION AVAILABLE TO THE ADMINISTRA-

A. 8647--C                          7

TOR REGARDING THE IMPACT OF THE DEMONSTRATION ON THE HOSPITAL'S  AVERAGE
INPATIENT LENGTH OF STAY.
  (II)  AN  EVALUATION  BY  THE PARTICIPATING HOSPITAL, THE LOCAL SOCIAL
SERVICES DEPARTMENT, AND THE NEW YORK STATE OFFICE  OF  LONG  TERM  CARE
OMBUDSMAN  REGARDING  WHETHER TRANSITION AUTHORIZATION PANELS ADEQUATELY
PROTECTED THE INTERESTS AND RIGHTS OF PATIENTS INCLUDING THEIR  INTEREST
IN BEING TRANSITIONED TO THE LEAST RESTRICTIVE SETTING REASONABLY AVAIL-
ABLE, AND THE SUCCESS OF THE TRANSITION PLANS APPROVED BY THE PROGRAM IN
MEETING  THE  NEEDS OF PATIENTS AND THEIR RECOMMENDATIONS FOR AMENDMENTS
TO THIS SECTION, AND RECOMMENDATIONS REGARDING THE  MERIT  OF  EXTENDING
THIS DEMONSTRATION PROGRAM OR ADOPTING A PERMANENT AND STATEWIDE TRANSI-
TION AUTHORIZATION PROGRAM.
  (B) THE COMMISSIONER SHALL COMPILE THE REPORTS SUBMITTED TO HIM OR HER
AS REQUIRED BY THIS SUBDIVISION, AND PROMPTLY SUBMIT SUCH REPORTS TO THE
TEMPORARY  PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE
MINORITY LEADER OF THE SENATE AND THE MINORITY LEADER OF  THE  ASSEMBLY,
AND  MAKE SUCH REPORTS AVAILABLE TO THE PUBLIC. THE COMMISSIONER MAY ADD
HIS OR HER OWN RECOMMENDATIONS TO THAT COMPILATION.
  S 3. This act shall take effect immediately, and shall expire  and  be
deemed repealed three years and ninety days after it shall have become a
law.

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Assembly Bill A8647

Sponsored By

Archive: Last Bill Status - In Assembly Committee

Bill Amendments

co-Sponsors

2009-A8647 - Details

2009-A8647 - Summary

2009-A8647 - Sponsor Memo

2009-A8647 - Bill Text download pdf

co-Sponsors

2009-A8647A - Details

2009-A8647A - Summary

2009-A8647A - Sponsor Memo

2009-A8647A - Bill Text download pdf

co-Sponsors

2009-A8647B - Details

2009-A8647B - Summary

2009-A8647B - Sponsor Memo

2009-A8647B - Bill Text download pdf

co-Sponsors

2009-A8647C (ACTIVE) - Details

2009-A8647C (ACTIVE) - Summary

2009-A8647C (ACTIVE) - Bill Text download pdf

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Assembly Bill A8647

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Sponsored By

CANESTRARI

Archive: Last Bill Status - In Assembly Committee

Bill Amendments

co-Sponsors

Timothy P. Gordon

2009-A8647 - Details

2009-A8647 - Summary

2009-A8647 - Sponsor Memo

2009-A8647 - Bill Text download pdf

co-Sponsors

Timothy P. Gordon

2009-A8647A - Details

2009-A8647A - Summary

2009-A8647A - Sponsor Memo

2009-A8647A - Bill Text download pdf

co-Sponsors

Timothy P. Gordon

2009-A8647B - Details

2009-A8647B - Summary

2009-A8647B - Sponsor Memo

2009-A8647B - Bill Text download pdf

co-Sponsors

Timothy P. Gordon

2009-A8647C (ACTIVE) - Details

2009-A8647C (ACTIVE) - Summary

2009-A8647C (ACTIVE) - Bill Text download pdf

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