* § 4655. Certification procedures and requirements. 1.
Notwithstanding any other provision of law, an assisted living operator
may apply to the department to obtain an enhanced assisted living
certificate pursuant to this section.

(a) Such application shall be on a form approved by the department.

(b) An assisted living operator may apply for such a certificate for
the entire facility or any number of beds at the facility.

(c) To obtain an enhanced assisted living certificate, the applicant
must submit a plan to the department setting forth how the additional
needs of residents will be safely and appropriately met at such
residence. Such plan shall include, but need not be limited to, a
written description of services, staffing levels, staff education and
training, work experience, and any environmental modifications that have
been made or will be made to protect the health, safety and welfare of
such persons in the residence.

(d) In addition to any other requirements of assisted living, an
operator of enhanced assisted living may hire care staff directly
pursuant to standards developed by the department or contract with a
home care services agency which has been approved to operate pursuant to
article thirty-six of this chapter.

(e) No assisted living residence shall be certified as enhanced
assisted living unless and until the applicant obtains the written
approval of the department.

2. No resident shall be permitted to continue to age in place under
the terms of an enhanced assisted living certificate unless the
operator, the resident's physician, and, if applicable, the resident's
licensed or certified home care agency, agree that the additional needs
of the resident can be safely and appropriately met at the residence. A
resident eligible for enhanced assisted living or his or her
representative shall submit to the residence a written report from a
physician, which report shall state that:

(a) the physician has physically examined the resident within the last
month; and

(b) the resident is not in need of twenty-four hour skilled nursing
care or medical care which would require placement in a hospital or
residential health care facility.

3. The residence must notify a resident that, while the residence will
make reasonable efforts to facilitate the resident's ability to age in
place pursuant to an individualized service plan, there may be a point
reached where the needs of the resident cannot be safely or
appropriately met at the residence, requiring the transfer of the
resident to a more appropriate facility in accordance with the
provisions of this article.

4. If a resident reaches the point where he or she is in need of
twenty-four hour skilled nursing care or medical care required to be
provided by facilities licensed pursuant to article twenty-eight of this
chapter or article nineteen, thirty-one or thirty-two of the mental
hygiene law, then the resident must be discharged from the residence and
the operator shall initiate proceedings for the termination of the
residency agreement of such resident in accordance with the provisions
of section four hundred sixty-one-h of the social services law.
Provided, however, a resident may remain at the residence if each of the
following conditions are met:

(a) a resident in need of twenty-four hour skilled nursing care or
medical care hires appropriate nursing, medical or hospice staff to care
for his or her increased needs;

(b) the resident's physician and home care services agency both
determine and document that, with the provision of such additional
nursing, medical or hospice care, the resident can be safely cared for
in the residence, and would not require placement in a hospital, nursing
home or other facility licensed under article twenty-eight of this
chapter or article nineteen, thirty-one or thirty-two of the mental
hygiene law;

(c) the operator agrees to retain the resident and to coordinate the
care provided by the operator and the additional nursing, medical or
hospice staff; and

(d) the resident is otherwise eligible to reside at the residence.

5. In addition to the requirements otherwise required for licensure as
assisted living, any residence that advertises or markets itself as
serving individuals with special needs, including, but not limited to,
individuals with dementia or cognitive impairments, must submit a
special needs plan to the department setting forth how the special needs
of such residents will be safely and appropriately met at such
residence. Such plan shall include, but need not be limited to, a
written description of specialized services, staffing levels, staff
education and training, work experience, professional affiliations or
special characteristics relevant to serving persons with special needs,
and any environmental modifications that have been made or will be made
to protect the health, safety and welfare of such persons in the
residence. In approving an application for special needs certification,
the department shall develop standards to ensure adequate staffing and
training in order to safely meet the needs of the resident. The
standards shall be based upon recommendations of the task force
established by section five of the chapter of the laws of two thousand
four which added this section. No residence shall market themselves as
providing specialized services unless and until the department has
approved such applicant for a special needs assisted living certificate.

6. An enhanced assisted living certificate shall not be required of an
adult care facility, or part thereof, which has obtained approval by the
department to operate an assisted living program pursuant to section
four hundred sixty-one-l of the social services law. Provided, however,
such exemption shall only apply to those beds at the facility which are
subject to the assisted living program.

* NB There are 2 § 4655's