S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9023
 
                           I N  A S S E M B L Y
 
                             January 21, 2022
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation  to  independent  assessment of person-centered service plans
   for long term care assistance; and to repeal certain provisions of the
   social services law relating thereto

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (i)  of  paragraph  (e) of subdivision 2 of
 section 365-a of the social services law, as amended  by  section  2  of
 part  MM  of  chapter  56  of  the laws of 2020,   is amended to read as
 follows:
   (i) personal care  services,  including  personal  emergency  response
 services,  shared aide and an individual aide, subject to the provisions
 of subparagraphs (ii), (iii), (iv), (v)  and  (vi)  of  this  paragraph,
 furnished  to  an  individual  who  is not an inpatient or resident of a
 hospital, nursing facility, intermediate care facility  for  individuals
 with  intellectual  disabilities,  or institution for mental disease, as
 determined to meet the recipient's needs for assistance when cost effec-
 tive and appropriate, and when prescribed by a  [qualified  independent]
 physician  [selected or approved by the department of health], PHYSICIAN
 ASSISTANT OR NURSE PRACTITIONER in accordance with the recipient's  plan
 of  treatment  and  provided by individuals who are qualified to provide
 such services, who are supervised by a registered nurse and who are  not
 members of the recipient's family, and furnished in the recipient's home
 or other location;
   §  2.  Subdivision  10  of section 365-a of the social services law is
 REPEALED.
   § 3. Section 365-a of the social services law is amended by  adding  a
 new subdivision 10 to read as follows:
   10. (A) (I) LONG TERM CARE ASSISTANCE UNDER THIS ARTICLE SHALL REQUIRE
 A  PERSON-CENTERED SERVICE PLAN (WHICH MAY BE REFERRED TO IN THIS SUBDI-
 VISION AS A  "SERVICE  PLAN")  FOR  THE  RECIPIENT.  A  "PERSON-CENTERED
 SERVICE  PLAN" IS A WRITTEN DOCUMENT OF SPECIFIC HEALTH CARE GOALS TO BE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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 ACHIEVED AND THE AMOUNT, DURATION AND SCOPE OF THE COVERED  SERVICES  TO
 BE  PROVIDED TO A MEDICAL ASSISTANCE RECIPIENT IN ORDER TO ACHIEVE THOSE
 GOALS. THE SERVICE PLAN SHALL BE BASED ON ASSESSMENT OF THE  RECIPIENT'S
 HEALTH  CARE  NEEDS AND DEVELOPED IN CONSULTATION WITH THE RECIPIENT AND
 THE RECIPIENT'S  INFORMAL  SUPPORTS.  THE  SERVICE  PLAN  SHALL  INCLUDE
 CONSIDERATION  OF THE CURRENT AND SPECIFIC PSYCHO-SOCIAL, COGNITIVE, AND
 MEDICAL NEEDS AND HISTORY OF THE RECIPIENT, AS WELL AS  THE  RECIPIENT'S
 FUNCTIONAL  LEVEL  AND SUPPORT SYSTEMS.   THE SERVICE PLAN SHALL INCLUDE
 THE PLAN OF CARE DETERMINED BY AN INDEPENDENT ASSESSOR WHICH STATES  THE
 TYPE  OF  LONG TERM CARE SERVICES APPROPRIATE TO A RECIPIENT'S NEEDS AND
 THE NUMBER OF HOURS OF CARE PER WEEK NECESSARY TO MEET THOSE NEEDS.
   (II)  THE EFFECTIVENESS AND APPROPRIATENESS OF THE RECIPIENT'S SERVICE
 PLAN SHALL BE MONITORED THROUGH REASSESSMENT AND A DETERMINATION  AS  TO
 WHETHER  THE HEALTH CARE GOALS ARE BEING MET.  THE SERVICE PLAN SHALL BE
 REASSESSED AND REVIEWED, AND REVISED APPROPRIATELY, AT LEAST ANNUALLY.
   (III)  SERVICES NOT COVERED BY MEDICAL  ASSISTANCE  WHICH  INTERRELATE
 WITH THE COVERED SERVICES IDENTIFIED IN THE SERVICE PLAN AND SERVICES OF
 INFORMAL  SUPPORTS NECESSARY TO SUPPORT THE HEALTH CARE GOALS AND EFFEC-
 TIVENESS AND APPROPRIATENESS OF THE COVERED SERVICES SHOULD  BE  CLEARLY
 IDENTIFIED  IN  THE  SERVICE  PLAN  OR  ELSEWHERE IN THE CARE MANAGEMENT
 RECORD.
   (B) THE ASSESSMENT OF THE RECIPIENT AND THE DEVELOPMENT OF THE SERVICE
 PLAN SHALL BE CONDUCTED BY AN INDEPENDENT ASSESSOR  THAT  IS  AN  ENTITY
 THAT  IS  UNAFFILIATED WITH ANY MANAGED LONG TERM CARE PLAN AND HAS BEEN
 CONTRACTED BY THE COMMISSIONER FOR THIS PURPOSE.  INDEPENDENT  ASSESSORS
 SHALL  BE  NOT-FOR-PROFIT  ORGANIZATIONS THAT HAVE DEMONSTRATED CULTURAL
 AND LINGUISTIC COMPETENCE AND EXPERTISE IN EVALUATING SERVICE  NEEDS  OF
 INDIVIDUALS NEEDING LONG TERM CARE, INCLUDING INDIVIDUALS WITH DISABILI-
 TIES, SEEKING TO LIVE IN THE COMMUNITY.
   §  4.  Paragraph  (g) of subdivision 7 of section 4403-f of the public
 health law, as amended by section 41-b of part H of chapter  59  of  the
 laws  of  2011,  subparagraph (i) as amended by section 1 of part GGG of
 chapter 59 of the laws of 2017, subparagraph (iii) as amended by section
 54 of part A of chapter 56 of the laws of  2013,  subparagraph  (iv)  as
 amended  by  section 22 of part MM of chapter 56 of the laws of 2020, is
 amended to read as follows:
   (g) (i) Managed long term care plans  and  demonstrations  may  enroll
 eligible  persons  in the plan or demonstration upon the completion of a
 [comprehensive assessment that shall include, but not be limited to,  an
 evaluation of the medical, social, cognitive, and environmental needs of
 each  prospective enrollee in such program] PERSON-CENTERED SERVICE PLAN
 UNDER SUBDIVISION TEN OF  SECTION  THREE  HUNDRED  SIXTY-FIVE-A  OF  THE
 SOCIAL  SERVICES LAW. This [assessment] SERVICE PLAN shall also serve as
 the basis for the development and provision of an  appropriate  plan  of
 care  for  the  enrollee.  Upon  approval of federal waivers pursuant to
 paragraph (b) of  this  subdivision  which  require  medical  assistance
 recipients who require community-based long term care services to enroll
 in  a  plan, and upon approval of the commissioner, a plan may enroll an
 applicant who is currently receiving home and  community-based  services
 and complete the [comprehensive assessment] PERSON-CENTERED SERVICE PLAN
 within  thirty  days  of  enrollment provided that the plan continues to
 cover transitional care until such time as the [assessment] SERVICE PLAN
 is completed.
   (ii) [The assessment shall be completed by  a  representative  of  the
 managed  long  term care plan or demonstration, in consultation with the
 prospective  enrollee's  health  care  practitioner  as  necessary.  The
 A. 9023                             3

 commissioner  shall prescribe the forms on which the assessment shall be
 made.
   (iii)]  The  enrollment  application shall be submitted by the managed
 long term care plan or demonstration to the  entity  designated  by  the
 department  prior to the commencement of services under the managed long
 term care plan or demonstration. Enrollments  conducted  by  a  plan  or
 demonstration  shall be subject to review and audit by the department or
 a contractor selected pursuant to paragraph (d) of this subdivision.
   [(iv)] (III) Continued enrollment in a managed long term care plan  or
 demonstration  paid  for  by  government  funds  shall  be  based upon a
 [comprehensive assessment of the medical, social and environmental needs
 of the recipient of the services]  PERSON-CENTERED  SERVICE  PLAN  UNDER
 SUBDIVISION  TEN  OF  SECTION  THREE  HUNDRED SIXTY-FIVE-A OF THE SOCIAL
 SERVICES LAW, INCLUDING PERIODIC REVISIONS OF THE  SERVICE  PLAN.  [Such
 assessment  shall be performed a least annually by the managed long term
 care plan serving the enrollee.   The commissioner shall  prescribe  the
 forms on which the assessment will be made.]
   §  5.  Subparagraph  (i)  of paragraph (g) of subdivision 7 of section
 4403-f of the public health law, as added by section 65-c of part  A  of
 chapter 57 of the laws of 2006 and as relettered by section 20 of part C
 of chapter 58 of the laws of 2007, is amended to read as follows:
   (i)  Managed long term care plans and demonstrations may enroll eligi-
 ble persons in the plan  or  demonstration  upon  the  completion  of  a
 [comprehensive  assessment that shall include, but not be limited to, an
 evaluation of the  medical,  social  and  environmental  needs  of  each
 prospective enrollee in such program] PERSON-CENTERED SERVICE PLAN UNDER
 SUBDIVISION  TEN  OF  SECTION  THREE  HUNDRED SIXTY-FIVE-A OF THE SOCIAL
 SERVICES LAW. This [assessment] SERVICE PLAN shall  also  serve  as  the
 basis  for  the development and provision of an appropriate plan of care
 for the prospective enrollee.
   § 6. This act shall take effect immediately; provided,  however,  that
 sections three and four of this act shall take effect on the one hundred
 eightieth  day after it shall have become a law; provided, further, that
 the amendments to paragraph (g) of subdivision 7 of  section  4403-f  of
 the  public  health law as amended by sections four and five of this act
 shall not affect the repeal of such section and shall be deemed repealed
 therewith; and provided, further, that the  amendments  to  subparagraph
 (i)  of  paragraph  (g) of subdivision 7 of section 4403-f of the public
 health law made by section four of this act  shall  be  subject  to  the
 expiration  and  reversion  of such subparagraph when upon such date the
 provisions of section five of this act shall  take  effect.    Effective
 immediately,  the commissioner of health shall make regulations and take
 other actions reasonably necessary to implement those sections  on  that
 date.