NY-ELD Elder Law NY

Short title. This chapter shall be known as the "Elder Law".

Office for the aging; director. 1. There is hereby created

within the executive department an office for the aging.

2. The head of such office shall be a director, who shall be appointed

by the governor, by and with the advice and consent of the senate, and

shall hold office during the pleasure of the governor. The director

shall receive an annual salary to be fixed by the governor within the

amount available therefor by appropriation. The director shall also be

entitled to receive reimbursement for expenses actually and necessarily

incurred by him or her in the performance of his or her duties.

3. The director may appoint such officers, employees, agents,

consultants and special committees as he or she may deem necessary,

prescribe their duties, fix their compensation and provide for

reimbursement of their expenses within the amounts available therefor by

appropriation. The director, with the advice of the advisory committee

for the aging, may promulgate, adopt, amend or rescind rules and

regulations necessary to carry out the provisions of this article.

4. In carrying out its powers and duties under this title, the office

is organized and operated to have as a primary purpose informing and

instructing the public, especially the elderly themselves, on subjects

beneficial to the community which relate to the needs, abilities,

resources, opportunities, rights, entitlements, and other issues

affecting older people in New York state.

5. For the purposes of this chapter, "office" shall refer to the state

office for the aging created pursuant to this section, and "director"

shall refer to the director of the state office for the aging

established by this section.

General powers and duties of office. The office shall have the

following powers and duties:

1. to advise and assist the governor in developing policies designed

to help meet the needs of the aging and to encourage the full

participation of the aging in society;

2. to coordinate state programs and activities relating to the aging;

3. to stimulate community interest in the problems of the aging;

4. to promote public awareness of resources available for the aging,

and to refer the public to the appropriate departments and agencies of

the state and federal governments for advice, assistance and available

services in connection with particular problems;

5. to cooperate with and assist political subdivisions of the state in

the development of local programs for the aging;

6. to consult and cooperate with universities, colleges and

institutions in the state for the development of courses of study for

persons engaged in public and private programs for the aging;

7. to make such studies of needs of the aging as the director may deem

appropriate or as may be requested by the governor;

8. to foster and support studies, research and education relating to

problems of and services for the aging;

9. to serve as a clearinghouse for information relating to the needs

of the aging;

10. to sponsor conferences relating to problems of and services for

the aging;

11. to enter into contracts, within the amount available by

appropriation therefor, with individuals, organizations and

institutions, in the exercise of any of its powers or the performance of

any of its duties;

12. to make recommendations to the governor for the presentation of an

annual award to a senior citizen for outstanding and unusual

contribution to his or her community;

13. to conduct a program of education and information on age

discrimination and the preparation and filing of complaints relating to

persons sixty years of age or older;

14. to, in cooperation with the department of state:

(a) prepare or cause to be prepared and made available to cities,

towns and villages model zoning and planning guidelines that foster

age-integrated communities including provisions to allow for accessory

senior citizen units in areas zoned for single family residences and for

mixed-use development accommodating senior citizen residential housing;

and

(b) make recommendations, in consultation with the division of housing

and community renewal, to the governor and legislature for assisting

mixed-use age-integrated housing development or redevelopment

demonstration projects in urban, suburban and rural areas of the state.

The director of the office for the aging and secretary of state shall

establish an advisory committee for purposes of this subdivision. Such

committee shall include, but not be limited to, top representatives of

local government, senior citizen organizations, developers, senior

service providers and planners;

15. to periodically, in consultation with the state commissioner of

veterans' services, review the programs operated by the office to ensure

that the needs of the state's aging veteran population are being met and

to develop improvements to programs to meet such needs;

16. to the extent appropriations are available, and in consultation

with the office of children and family services, conduct a public

education campaign that emphasizes zero-tolerance for elder abuse. Such

campaign shall include information about the signs and symptoms of elder

abuse, identification of potential causes of elder abuse, which includes

identity theft, resources available to assist in the prevention of elder

abuse, where suspected elder abuse can be reported, contact information

for programs offering services to victims of elder abuse such as

counseling, and assistance with arranging personal care and shelter.

Such campaign may include, but not be limited to: printed educational

and informational materials; audio, video, electronic, other media; and

public service announcements or advertisements; and

17. subject to an appropriation, make available to designated agencies

as defined in paragraph (a) of subdivision one of section two hundred

fourteen of this title, a training program for the purpose of raising

awareness, removing barriers and improving services for older adults

based on their sexual orientation and gender identity or expression as

defined in section two hundred ninety-two of the executive law. Such

training program may include:

(i) an overview of the history, unique needs, and concerns of lesbian,

gay, bisexual, transgender, asexual, gender non-conforming and gender

non-binary older adults;

(ii) reasons why lesbian, gay, bisexual, transgender, asexual, gender

non-conforming and gender non-binary older adults may choose not to

self-identify; and

(iii) tools that may be used to incorporate lesbian, gay, bisexual,

transgender, asexual, gender non-conforming and gender non-binary older

adult concerns into direct care and steps that may be taken to improve

the quality of services and support provided.

Programs for the aging. 1. The office shall submit to the

federal department of health and human services a state plan for

purposes of the federal Older Americans Act of 1965 and subsequent

amendments thereto. The office shall be the single state agency for

supervising the administration of such plan and shall be primarily

responsible for coordination of state programs for the aging for

purposes of such federal act. The office shall act for the state in any

negotiations relative to the submission and approval of such plan and

may make such arrangements, not inconsistent with law, as may be

required by or pursuant to federal law to obtain and retain such

approval and to secure for the state the benefits of the provisions of

such federal act. For the purposes of administering such state plan

approved by the federal department of health and human services, when

targeting program services and supports based on "greatest social need",

the office shall consider the need caused by non-economic factors which

shall include, but not be limited to: physical or mental disability;

Alzheimer's disease or other forms of dementia; language barriers

including limited English proficiency and low literacy; and cultural,

social, or geographic isolation caused by, among other things, racial

and ethnic status, sexual orientation, gender identity or expression,

rural residence, homebound status, caregiver status, risk of

institutionalization, or HIV status when such isolation restricts the

ability of an individual to perform normal daily tasks or threatens the

ability of the individual to live independently.

2. In addition to the powers and duties contained in section two

hundred two of this title, the office is hereby authorized, to the

extent appropriations are available therefor, to establish, operate and

maintain, or to contract with counties, cities, towns, villages, school

districts or public or private nonprofit corporations, associations,

institutions, or agencies concerned with the aging, for the operation

and maintenance of programs for the aging. Pursuant to the rules and

regulations of the office, such programs may include, but need not be

limited to, the following:

(a) coordination and community planning;

(b) information services;

(c) counselling services;

(d) home care and protection services;

(e) operation of multi-service centers; and

(f) retired senior volunteer programs.

3. The director, with the advice of the advisory committee for the

aging, shall make appropriate rules and regulations governing the

submission and approval of applications for the operation of programs

for the aging pursuant to subdivision two of this section. If an

application is disapproved, the applicant, upon request, shall be

afforded a hearing before the director or his or her designee.

4. (a) As required by the office, each county, city, town, village,

school district or public or private nonprofit corporation, association,

institution or agency operating a program for the aging pursuant to

subdivision two of this section shall submit to the office (1) a

quarterly estimate of anticipated expenditures for operation and

maintenance of such program, including rental of buildings, purchase of

equipment, administrative expenses, miscellaneous personal expenses of

older persons incurred in the provision of volunteer services, and

approved expenditures for minor alterations or repairs, not less than

thirty days before the first day of the months of April, July, October

and January, and (2) a verified accounting of the financial operations

of such program during the preceding calendar quarter, together with a

claim for reimbursement as provided in this title, on or before the

thirtieth day of April, July, October and January. The director may

permit the submission of such accountings with respect to periods

exceeding three months, but not exceeding one year.

(b) After receipt of a satisfactory quarterly estimate and verified

accounting pursuant to paragraph (a) of this subdivision, the director

shall certify to the comptroller, for payment by the state to each such

county, city, town, village, school district or public or private

nonprofit corporation, association, institution or agency, the

expenditures thereof, approved by the office, as follows:

(i) the amount of federal funds, if any, properly received for such

expenditures; and

(ii) up to fifty percentum of such expenditures, after first deducting

therefrom any federal funds properly received with respect to such

expenditures.

5. Notwithstanding the provisions of subdivision four of this section,

but subject to and in the manner specified in this subdivision, the

office, in its discretion, may entertain and approve applications for

interim payments.

(a) Such an application may be approved by the office, upon being

satisfied that the requirement for filing a verified accounting of the

financial operation of a program during the preceding calendar quarter

before a claim for reimbursement based on the expenditures for such

quarter may be made, is likely to cause a financial hardship to the

applicant.

(b) Such an application may be made at the time of filing the

quarterly estimate of anticipated expenditures as specified in

subdivision four of this section or at such other time as the office

shall specify.

(c) After receipt of a satisfactory quarterly estimate, the office may

direct the director to certify to the comptroller for payment an interim

payment in such amount as the office shall specify.

(d) The amount of the interim payment which the office may authorize

shall not exceed an amount equal to one-third of the amount which the

applicant may reasonably be entitled to receive in accordance with the

provisions of subdivision four of this section, for the three month

period for which a satisfactory quarterly statement has been filed,

based on such satisfactory quarterly estimate. The amount of an interim

payment received by the applicant shall be subtracted from the amount

payable to the applicant for such three-month period.

6. The director is hereby authorized, within amounts appropriated

therefor, to make grants-in-aid to existing foster grandparent grantee

agencies for the engagement of foster grandparents in qualified

residential group homes for neglected and disadvantaged children, in

private homes, day care centers, special education classes in public

schools, or other public or private nonprofit institutions or agencies

providing care for neglected and disadvantaged children who lack close

personal relationships. Up to twenty percent of such grants-in-aid may

be expended for the administrative purposes of such grantee agencies,

with the approval of the office. Such grants shall be for a period of

twelve months or less, shall not be used to match other state funds,

shall not be used as a substitute for federal allocations, and shall be

made in a manner which does not conflict with federal law, rule or

regulation pursuant to title II of the United States domestic volunteer

services act of nineteen hundred seventy-three, as amended. Grants may

be used to match federal funds but must be used for expansion of

existing federal programs, not as a substitute for presently required

non-federal shares. Each grantee shall file reports at such time and

containing such information as the office shall require. For the purpose

of administering such grants-in-aid the office may make such agreements

with other public agencies as are deemed necessary.

7. The director is hereby authorized, within amounts appropriated

therefor, to make grants-in-aid to retired and senior volunteer programs

for the engagement of individuals fifty-five years of age or over to

serve as volunteers for the betterment of their community and

themselves. Such volunteer activities may include but shall not be

limited to assisting with the preparation of meals at nutrition sites;

leading activities at child care centers; delivering meals to homebound

elderly; providing telephone reassurance and/or friendly visits to the

frail elderly; tutoring adults or children; assisting with services for

the homeless and assisting school districts which request volunteers for

the purpose of notifying a person in parental relation to any elementary

school pupil when such pupil is deemed absent from required attendance

at his or her designated school. The services of these volunteers will

be performed in the community where such individuals reside or in nearby

communities. Up to ten percent of such grants-in-aid may be expended for

the administrative purposes of such programs, with the approval of the

office. Such grants shall be for a period of twelve months or less,

shall not be used to match other state funds, shall not be used as a

substitute for federal allocations, and shall be made in a manner which

does not conflict with federal law, rule or regulation pursuant to title

II of the United States domestic volunteer services act of nineteen

hundred seventy-three, as amended. Grants may be used to match federal

funds, but not as a substitute for presently required non-federal

shares. Each grantee shall file reports at such time and containing such

information as the office shall require. For the purpose of

administering such grants-in-aid the office may make such agreements

with other public agencies as are deemed necessary.

* 8. The director, in consultation with the commissioner of health,

shall establish a program to be known as the NY Connects: Choices for

Long Term Care. The purpose of this initiative is to provide consistent,

comprehensive, locally-based information and assistance on long term

care services to consumers, caregivers and families to help them make

educated choices. This program shall provide individuals, caregivers,

and families with objective information and assistance about home,

community-based and institutional long term care services. NY Connects

will be available on a voluntary basis to consumers, caregivers and

their families. There shall be an on-going education and outreach

campaign to educate the public about long term care services available

in their community and to assist consumers in preparing for their long

term care needs.

* NB Effective until August 19, 2027

* 8. The director, in consultation with the commissioner of health,

shall establish a program to be known as the NY Connects: Choices for

Long Term Care. The purpose of this initiative is to provide consistent,

comprehensive, locally-based information and assistance on long term

care services to consumers, caregivers and families to help them make

educated choices. This program shall provide individuals, caregivers,

and families with objective information and assistance about home,

community-based and institutional long term care services, including

programs and services for individuals suffering from Alzheimer's disease

or other forms of dementia. NY Connects shall be available on a

voluntary basis to consumers, caregivers and their families. There shall

be an on-going education and outreach campaign to educate the public

about long term care services and programs and services for individuals

suffering from Alzheimer's disease or other forms of dementia available

in their community and to assist consumers in preparing for their long

term care needs.

* NB Effective August 19, 2027

9. The director of the office for the aging is hereby authorized, to

the extent appropriations are available therefor, to establish, operate

and maintain, under the control of the office for the aging or in

conjunction with an association, institution, agency, or other public or

private entity, or community program engaged in the care of animals, one

or more senior pet companionship programs. The purpose and intent of a

senior pet companionship program shall be to match seniors who have

limited social contact with pets, including cats and dogs and other

small animals, to improve the lives of such seniors by enhancing their

emotional and mental well-being through such companionship.

10. The director is hereby authorized, to the extent appropriations

are available therefor, to establish grants to a not-for-profit

organization, through a request for proposal process, to provide

training, outreach and education to agencies, individuals and other

appropriate entities who provide services to the lesbian, gay, bisexual,

and transgender senior populations.

11. (a) The director shall develop a list of programs and services

offered by local area agencies on aging along with contact information

for the local area agencies on aging and NYConnects organized by county.

(b) The information developed pursuant to paragraph (a) of this

subdivision shall be made available on the office's website and provided

to hospital discharge coordinators located in the state.

12. (a) The director is hereby authorized to implement private pay

protocols for programs and services administered by the office. These

protocols may be implemented by area agencies on aging at their option

and such protocols shall not be applied to services for a participant

when being paid for with federal funds or funds designated as federal

match, or for individuals with an income below two hundred and fifty

percent of the federal poverty level. All private payments received

directly by an area agency on aging or indirectly by one of its

contractors shall be used to supplement, not supplant, funds by state,

federal, or county appropriations. Such private pay payments shall be

set at a cost to the participant of not more than twenty percent above

either the unit cost to the area agency on aging to provide the program

or service directly, or the amount that the area agency on aging pays to

its contractor to provide the program or service. Private pay payments

received under this subdivision shall be used by the area agency on

aging to first reduce any unmet need for programs and services, and then

to support and enhance services or programs provided by the area agency

on aging. No participant, regardless of income, shall be required to pay

for any program or service that they are receiving at the time these

protocols are implemented by the area agency on aging. This subdivision

shall not prevent cost sharing for the programs and services established

pursuant to section two hundred fourteen of this title. Consistent with

federal and state statute and regulations, when providing programs and

services, area agencies on aging and their contractors shall continue to

give priority for programs and services to individuals with the greatest

economic or social needs. In the event that the capacity to provide

programs and services is limited, such programs and services shall be

provided to individuals with incomes below two hundred and fifty percent

of the federal poverty level before such programs and services are

provided to those participating in the private pay protocol pursuant to

this subdivision.

(b) Area agencies on aging participating in the private pay protocol

shall annually report to the office the unmet need, if any, for all

programs and services offered, the number of participants that privately

paid for each program or service for that year, the rates participants

were charged for each program or service provided, and how unmet need

for programs or services offered by the area agency on aging were

affected by revenue from the private pay protocol. Such annual report

shall also be shared with the Temporary President of the Senate and the

Speaker of the Assembly no later than July first, two thousand

twenty-one and shall be updated and reissued on an annual basis

thereafter.

Records of available space. 1. The office shall have the

responsibility to compile and maintain an inventory of space available

for placing eligible aged citizens in facilities under the jurisdiction

of the dormitory authority; the office shall also take whatever action

necessary to locate those aged citizens of New York, who, according to

standards to be promulgated by the office, are available for residence

in facilities under the jurisdiction of the dormitory authority; the

office shall initiate, assist, coordinate, supervise, and approve the

plan of relocation of such aged citizens, in facilities under the

jurisdiction of the dormitory authority, by any not-for-profit

corporation or political subdivision of the state or the state, or in

the absence of the foregoing entities, by the office itself; in

addition, the office shall carry out the purposes of the public

authorities law pertaining to the use of dormitory authority facilities

for the aged.

2. In carrying out the duties and responsibilities under this title,

the office shall periodically review existing aged residents' use of

dormitory authority facilities, and to establish and enforce such rules

and regulations as may be necessary to assure the office that the needs

of aged residents, as determined by the office, are being met.

Exclusion from mandatory retirement. Notwithstanding any other

provision of law, an employee of the office or an employee of a local

public agency whose position is in whole or in part funded through the

office, or the federal older Americans act of 1965 as amended, shall not

be subject to any mandatory retirement provision based on the age of

such employee.

Informal caregiver training. 1. The director is hereby

authorized and directed, to the extent appropriations are available

therefor, to develop, establish and operate training and technical

assistance programs, including caregiver resource centers, caregiver

networks, and other support activities, for informal caregivers

throughout the state for the purposes of assisting such caregivers and

improving the quality of care provided to frail and disabled persons.

The director shall also make available and encourage the utilization of

such training programs in consultation with the commissioner of health,

the commissioner of the office of children and family services, the

commissioner of mental health, and the commissioner of the office for

people with developmental disabilities.

2. Definitions. For the purposes of this section: (a) "Informal

caregiver" shall mean the family member or other natural person who

normally provides the daily care or supervision of a frail or disabled

person, or any family member or other natural person who contributes to

and is involved in the caretaking responsibilities for such frail or

disabled person. Such informal caregiver may, but need not, reside in

the same household as the frail or disabled person.

(b) "Frail or disabled person" shall mean any person who is unable to

attend to his or her daily needs without the assistance or regular

supervision of an informal caregiver due to mental or physical

impairment. Such definition shall not exclude persons under eighteen

years of age who suffer from mental or physical impairment.

(c) "Program" shall mean the program of informal caregiver training

and technical assistance established by this section.

(d) "Caregiver resource center" shall mean a project funded pursuant

to this section which provides services and activities which are

responsive to the needs and contracts of informal caregivers in regard

to their caregiving responsibilities.

(e) "Caregiver networks" shall mean local coalitions which develop,

coordinate, and implement action plans to identify and mobilize

resources to address the unmet needs of frail and disabled persons and

their caregivers.

3. (a) The duties of the director pursuant to this section shall

include, but not be limited to:

(1) developing and make available or approve a curriculum for informal

caregiver training which considers and is easily adapted to an array of

personal needs and disabilities, and which is sensitive to ethnic and

community characteristics;

(2) providing technical assistance and training to appropriate

organizations and groups, including caregiver resource centers and

caregiver networks, which, in turn, shall provide training and

assistance to informal caregivers; and

(3) providing grants to appropriate organizations and groups,

including caregiver resource centers and caregiver networks, to develop

and make available approved curricula for informal caregiver training as

well as disseminate information regarding the curriculum.

(4) develop guidelines for local area agencies on aging in order to

provide the following:

(i) information and assistance regarding gaining access to available

services to assist informal caregivers;

(ii) resource referrals for informal caregivers regarding

decision-making on behalf of the individual receiving care; and

(iii) counseling referrals for informal caregivers.

(b) Training and technical assistance shall include, but not be

limited to:

(1) knowledge of major health problems and diseases, mental and

physical disabilities, and the aging process;

(2) practical skills required in providing personal care and support;

(3) stress awareness and methods of dealing with stress caused by

providing care;

(4) financial management; and

(5) identification and utilization of available resources, including

benefits, entitlements, and other programs and assistance.

4. The director shall:

(a) Promulgate any rules and regulations necessary to carry out the

provisions of this section.

(b) On or before the first day of January every other year, submit a

report to the governor, the temporary president of the senate and the

speaker of the assembly, which shall include, but not be limited to:

(1) a financial report of the program's operation;

(2) a profile of persons or groups receiving training and technical

assistance pursuant to this section; and

(3) an analysis of the program's success in assisting informal

caregivers and improving the quality of care provided by such persons.

Foster grandparents program for vulnerable infants and

children. 1. Definitions. For purposes of this section the following

terms shall have the following meanings:

(a) "Qualified area agencies on aging" shall mean those agencies which

operate a foster grandparent program for the care of vulnerable infants

and children and for the assistance of high risk mothers.

(b) "Foster grandparents program" shall mean those activities for

which grants may be provided pursuant to subdivision six of section two

hundred three of this title, and shall include, but not be limited to,

(1) visiting participating hospitals or other interim care facilities

for a specified number of hours and providing care, love and stimulation

to one or more vulnerable infants and children; and (2) visiting high

risk mothers in their homes for a specified number of hours in order to

assist such mothers in developing parenting skills and in providing a

safe and suitable home for their children.

(c) "Vulnerable infants and children" shall mean infants or children

who reside in hospitals or other interim care facilities because no

suitable foster home or other appropriate placement is available.

(d) "High risk mothers" shall mean single young women for whom the

teaching of parenting skills is necessary either to prevent family

breakdown or to enable them to assume responsibility for their own child

or children who are in or awaiting foster care.

2. The director, in consultation with the commissioner of the office

of children and family services, is hereby authorized and directed,

within appropriations which are available therefor, to award grants to

qualified area agencies on aging to operate foster grandparent programs

for the care of vulnerable infants and children and for the assistance

of high risk mothers.

3. The duties of the director shall include, but not be limited to:

(a) the selection of qualified area agencies on aging to receive

grants for the operation of foster grandparent programs for the care of

vulnerable infants and children and for the assistance of high risk

mothers, which programs have been approved pursuant to this subdivision.

Applications for such grants shall demonstrate to the extent possible:

the need within the jurisdiction of the qualified area agency to provide

services to infants and children left in hospitals beyond medical

necessity and the need to provide services to infants and children

placed in interim care facilities, the experience of such agency in

providing such services to this or related populations, the capacity of

such agency in providing such services to effectively operate and

administer such program, the capacity of such agency to coordinate its

services with hospitals which provide social work counseling and home

visit assessments by social work staff to high risk mothers; and

(b) the reviewing of foster grandparent programs for the care of

vulnerable infants and children and for the assistance of high risk

mothers conducted by qualified area agencies on aging and the approval

of such programs for funding pursuant to paragraph (a) of this

subdivision.

4. The director may promulgate such rules and regulations as he or she

deems necessary to effectuate the purposes of this section.

Respite program. 1. The director is hereby authorized to

establish and monitor respite projects for the purposes of encouraging

the initiation and expansion of respite, evaluating the effectiveness of

respite in deterring and/or delaying institutionalization, evaluating

the demand for respite and of the cost of utilization of different

service modes.

2. For the purposes of this section:

(a) "Respite" shall mean the provision of infrequent and temporary

substitute care or supervision of frail or disabled adults on behalf of

and in the absence of the care-giver, for the purpose of providing

relief from the stresses or responsibilities concomitant with providing

care, so as to enable the care-giver to maintain a normal routine.

Respite shall not exceed one hundred days in any calendar year for any

individual. Respite may be provided by any service or combination of

services supplied by individuals, a public agency, a public corporation

or a private not-for-profit corporation or any proprietary provider.

(b) "Care-giver" shall mean the family member or other natural person

who normally provides the daily care or supervision of a frail or

disabled adult. Such care-giver may, but need not, reside in the same

household as the frail or disabled adult.

(c) "Provider" shall mean any entity enumerated in paragraph (a) of

this subdivision which is the supplier of services providing respite.

(d) "Sponsor" shall mean the provider, public agency or community

group approved by the director which establishes a contractual

relationship with the office for the purposes of a project pursuant to

this section, and which is responsible for the recruitment of providers,

the coordination and arrangement of provider services in a manner which

meets client needs, the general supervision of the local program, and

the submission of such information or reports as may be required by the

director.

(e) "Frail or disabled adult" shall mean any adult who is unable to

attend to his or her daily needs without the assistance or regular

supervision of a care-giver due to mental or physical impairment and who

is otherwise eligible for services on the basis of his or her level of

impairment. Priority shall be given in all cases to frail or disabled

adults sixty years of age or older.

3. (a) Notwithstanding any inconsistent provision of law to the

contrary, entities qualifying as providers or sponsors pursuant to the

provisions of paragraphs (a), (c) and (d) of subdivision two of this

section are hereby authorized to conduct or participate in respite

projects as approved and extended by the director.

(b) The director shall publicize the existence of, and make available,

application forms for such projects seeking the advice and counsel of

the advisory committee for the aging established pursuant to section two

hundred ten of this title.

(c) Such application forms shall require the submission of such

information as the director deems necessary for the evaluation of such

proposed projects. This information shall include, but not be limited

to:

(1) the identity and qualifications of the sponsor;

(2) the identity and qualifications of the provider or providers and a

plan for the coordination of their services;

(3) an assessment of the community need for respite services including

documentation;

(4) plans for the coordination and arrangement of provider services in

a manner which meets client needs;

(5) a fiscal plan, including specific provisions for the utilization

of existing reimbursement and funding sources and the development of

local financial support;

(6) plans for publicizing the purpose of the project and the services

to be provided, including the identities, services and charges of each

participating provider;

(7) indications of broad-based community support and participation;

and

(8) identification of the unserved or underserved population to be

served.

(d) The director shall review, require any necessary modifications,

and upon such modification, approve a number of applications and, within

the amounts appropriated therefor, award grants for the operation of

respite projects. Such an approved application shall constitute a plan

of service which may be rendered only in the manner and for the period

for which such plan has been approved or from time to time extended by

the director. The director shall ensure that each such plan of service

is coordinated with the "designated agency" as defined in section two

hundred fourteen of this title, the local social services district or

districts, and the local public health agency or agencies in which the

services are to be provided in order to help ensure that every effort

will be made to utilize existing funding sources for eligible

individuals and to avoid unnecessary duplication of services.

(e) Within the amounts appropriated therefor, the director shall give

first priority to the six existing respite projects established under

the provisions of the respite demonstration program authorized pursuant

to chapter seven hundred sixty-seven of the laws of nineteen hundred

eighty-one.

(f) Further consideration shall be given to proposals that:

(1) develop new or expand existing respite care projects/programs to

provide care to one or more target populations that are currently

unserved or underserved in the community;

(2) provide for respite in a geographical area of the state that is

currently without community-based respite care services;

(3) provide services that are responsive to the individual's needs and

circumstances in the targeted area;

(4) show utilization of existing services, coordination of services

with other agencies/resources; and utilization of various service

components, such as personal emergency response systems, adult day

services, and nutrition services, where appropriate.

4. (a) The director in consultation with the commissioner of the

office of children and family services may apply for the appropriate

waivers under federal law and regulation and may, subject to the

approval of the director of the budget, waive any provision of the

social services law or regulation of the office of children and family

services as may be necessary to make funds which are available pursuant

to the provisions of title XIX or XX of the federal social security act,

the emergency assistance for families program or the emergency

assistance for adults program available to eligible providers if the

recipients of such services are otherwise eligible to receive benefits

or services pursuant to the provisions of such programs.

(b) In the event that waivers under federal law and regulation are not

received, nothing contained in this section shall be construed to

require the expenditure of funds by the state or any locality in an

amount greater than if such waivers had been received.

5. Nothing contained in this section shall be construed to limit,

modify or otherwise affect the provision of care and services of a

long-term home health care program pursuant to article thirty-six of the

public health law.

6. For purposes of determining the eligibility for benefits pursuant

to this chapter, when applicable, only the financial eligibility of the

frail or disabled adult shall be taken into consideration.

7. In addition, the director, within appropriations provided, may

establish a training program for respite workers. The six existing

respite projects established pursuant to chapter seven hundred

sixty-seven of the laws of nineteen hundred eighty-one shall, insofar as

they are able, assist in providing such a training program.

The director may also enter into contracts with boards of cooperative

educational services pursuant to sections nineteen hundred fifty and

forty-six hundred two of the education law to provide courses in

training for respite care workers. This training program shall be

optional for existing programs.

8. Every two years beginning on January first, two thousand five, the

director shall submit a report to the governor, the temporary president

of the senate and the speaker of the assembly which shall include, but

not be limited to:

(a) A financial report for each project;

(b) A qualitative and quantitative profile of sponsors, providers,

care-givers, and frail or disabled adults participating in the project;

(c) A comparative assessment of the costs and effectiveness of each

type of service or combinations of services provided;

(d) An assessment of the nature and extent of the demand for services

which provide respite and an evaluation of the success of such projects

in meeting this demand;

(e) Specific identification of any factors which significantly enhance

or inhibit the successful provision of respite;

(f) A review of the extent to which priority has been given to persons

aged sixty and over;

(g) The coordination of the projects with other agencies, facilities

and institutions providing similar services as well as the utilization

and networking with case management programs;

(h) The ability of the projects to provide service at various economic

levels;

(i) The adherence of the program to its original or amended respite

proposal; and

(j) An assessment of the extent of the demand for the services the

project provides.

Naturally occurring retirement community supportive service

program. 1. As used in this section:

(a) "Older adults" shall mean persons who are sixty years of age or

older.

(b) "Eligible applicant" shall mean a not-for-profit agency

specializing in housing, health or other human services which serves or

would serve the community within which a naturally occurring retirement

community is located.

(c) "Health indicators/performance improvement" shall mean a survey

tool, database, and process that provides grantees with performance

outcomes data.

(d) "Eligible services" shall mean the following services provided by

a classic or neighborhood NORC program, or in coordination with other

entities, including, but not limited to: person centered planning, case

assistance, care coordination, information and assistance, application

and benefit assistance, health care management and assistance, volunteer

services, health promotion and linkages to prevention services and

screenings, linkages to in-home services, health indicators/performance

improvement, housekeeping/chore, personal care, counseling, shopping

and/or meal preparation assistance, escort, telephone reassurance,

transportation, friendly visiting, support groups, personal emergency

response systems (PERS), meals, recreation, bill paying assistance,

education regarding the signs of elder abuse or exploitation and

available resources for a senior who is a suspected victim of elder

abuse or exploitation, or identity theft, chemical dependence counseling

provided by credentialed alcoholism and substance abuse counselors as

defined in paragraph three of subdivision (d) of section 19.07 of the

mental hygiene law and referrals to appropriate chemical dependence

counseling providers, and other services designed to address the needs

of residents of classic and neighborhood NORCS by helping them extend

their independence, improve their quality of life, and maximize their

well-being.

(e) "Naturally occurring retirement community", "classic naturally

occurring retirement community" or "classic NORC" shall mean an

apartment building or housing complex which:

(1) was not predominantly built for older adults;

(2) does not restrict admissions solely to older adults;

(3) (A) at least forty percent of the units have an occupant who is an

older adult; and

(B) in which at least two hundred fifty of the residents of an

apartment building are older adults or five hundred residents of a

housing complex are older adults; and

(4) a majority of the older adults to be served are low or moderate

income, as defined by the United States Department of Housing and Urban

Development.

(f) "Neighborhood naturally occurring retirement community" or

"neighborhood NORC" shall mean a residential dwelling or group of

residential dwellings in a geographically defined neighborhood or group

of contiguous neighborhoods which:

(1) was not predominantly developed for older adults;

(2) does not predominantly restrict admission to older adults;

(3) (A) in a non-rural area, has at least thirty percent of the

residents who are older adults or the units have an occupant who is an

older adult; (B) in a rural area, has at least twenty percent of the

residents who are older adults or the units have an occupant who is an

older adult; and

(4) is made up of low-rise buildings six stories or less and/or single

and multi-family homes, provided, however, that apartment buildings and

housing complexes, including those that exceed six stories, may be

included.

(g) "Rural areas" shall mean counties within the state having a

population of less than two hundred thousand persons including the

municipalities, individuals, institutions, communities, programs, and

such other entities or resources as are found therein; or, in counties

with a population of two hundred thousand or more, towns with a

population density of less than one hundred and fifty persons per square

mile including the villages, individuals, institutions, communities,

programs, and such other entities or resources as are found therein.

(h) "Non-rural areas" shall mean any county, city, or town that has a

population or population density greater than that which defines a rural

area pursuant to this subdivision.

2. A naturally occurring retirement community supportive service

program is established as a program to be administered by the director.

3. The director shall develop appropriate criteria for the selection

of grantees of funds provided pursuant to this section.

4. The criteria for the award of grants shall be consistent with the

provisions of this section and shall include, at a minimum:

(a) the number, size, type and location of the projects to be served,

including the number, size, type and location of residential dwellings

or group of residential dwellings selected as candidates for inclusion

in a neighborhood naturally occurring retirement community; provided,

that the director shall make reasonable efforts to assure that

geographic balance in the distribution of such projects is maintained,

consistent with the needs to be addressed, funding available,

applications for eligible applicants, ability to coordinate services,

other requirements of this section, and other criteria developed by the

director;

(b) the appropriate number and concentration of older adult residents

to be served by an individual project; provided, that such criteria need

not specify, in the case of a project which includes several buildings,

the number of older adults to be served in any individual building;

(c) the demographic characteristics of the residents to be served;

(d) a requirement that the applicant demonstrate community wide

support from residents, neighborhood associations, community groups,

nonprofit organizations and others;

(e) in the case of neighborhood naturally occurring retirement

communities, a requirement that the boundaries of the geographic area to

be served are clear and coherent and create an identifiable program and

supportive community;

(f) the financial or in-kind support required to be provided to the

project by the owners, managers and residents of the housing development

or geographically defined area; provided, however, that such criteria

need not address whether the funding is public or private, or the source

of such support;

(g) the scope and intensity of the services to be provided, and their

appropriateness for the residents proposed to be served. The applicant

shall have conducted a needs assessment on the basis of which such

applicant shall establish the nature and extent of services to be

provided; and further that such services shall provide a mix of

appropriate services that provide active and meaningful participation

for residents. The criteria shall not require that the applicant agency

be the sole provider of such services, but shall require that the

applicant at a minimum actively manage the provision of such services.

Such services may be the same as services provided by the local

municipality or other community-based organization provided that those

services are not available to or do not entirely meet the needs of the

residents of the classic or neighborhood naturally occurring retirement

community;

(h) the experience and financial stability of the applicant agency,

who shall demonstrate to the satisfaction of the director their fiscal

and managerial stability and programmatic success in serving residents;

(i) the plan for active, meaningful participation for residents

proposed to be served in project design, implementation, monitoring,

evaluation, and governance;

(j) an agreement by the applicant to participate in data collection

and evaluation necessary to implement performance measures for health

indicators/performance improvement and complete the report required by

this section;

(k) the policy and program roles of the applicant agency and any other

agencies involved in the provision of services or the management of the

project, including community-based organizations, the housing

development governing body, or other owners or managers of the apartment

buildings and housing complexes and the residents of such apartment

buildings and housing complexes. The criteria shall require a clear

delineation of such policy and program roles;

(l) a requirement that each eligible agency document the need for the

project and financial commitments to it from such sources as the

director shall deem appropriate given the character and nature of the

proposed project, and written evidence of support from the appropriate

housing development governing body or other owners or managers of the

apartment buildings and housing complexes in the case of classic

naturally occurring retirement communities, or the geographically

defined neighborhood in the case of neighborhood naturally occurring

retirement communities. The purpose of such documentation shall be to

demonstrate the need for the project, support for it in the areas to be

served, and the financial and managerial ability to sustain the project;

(m) a requirement that any aid provided pursuant to this section be

matched by an amount equal to one quarter of the aid provided,

consisting of monetary support, in-kind support, or some combination

thereof from other sources, provided that such in-kind support be

utilized only upon approval from the director and only to the extent

matching funds are not available and that at least fifty percent of such

required match be contributed by the housing development governing body

or other owners or managers and residents of the apartment buildings and

housing complexes, or geographically defined area, in which the project

is proposed, or, upon approval by the director, sources in neighborhoods

contiguous to the boundaries of the geographic areas served where

services may also be provided pursuant to subdivision six of this

section;

(n) the circumstances under which the director may waive all or part

of the requirement for provision of an equal amount of funding from

other sources required pursuant to paragraph (m) of this subdivision,

provided that such criteria shall include provision for waiver at the

discretion of the director upon a finding by the director that the

program will serve a low income or hardship community, and that such

waiver is required to assure that such community receive a fair share of

the funding available. The director shall develop appropriate criteria

for determining whether a community is a low income or hardship

community;

(o) the policy and program roles of the applicant agency and any other

agencies involved in the provision of services or the management of the

neighborhood naturally occurring retirement community, provided that the

criteria shall require a clear delineation of such policy and program

roles; and

(p) a plan for coordination with the designated area agency on aging

to leverage additional services for classic or neighborhood NORC

participants.

4-a. The director shall develop a list of priority and optional

services from the eligible services listed in paragraph (d) of

subdivision one of this section which may be used in the selection of

grantees pursuant to this section.

4-b. Notwithstanding any provision of law to the contrary, priority

shall be given in any competitive bidding or request for proposals

process conducted for the naturally occurring retirement community

supportive services program to applicants that propose to serve a

building, housing complex, or catchment area that is being served at the

time of the competitive bidding or request for proposals process.

5. Within amounts specifically appropriated therefor and consistent

with the criteria developed and required pursuant to this section the

director shall approve grants to eligible applicants. Individual grants

awarded for classic NORC programs shall be in amounts not to exceed

three hundred thousand ($300,000) dollars and for neighborhood NORCs not

less than sixty thousand ($60,000) dollars in any twelve month period.

6. The director may allow services provided by a naturally occurring

retirement community supportive service program or by a neighborhood

naturally occurring retirement community to also include services to

residents who live in neighborhoods contiguous to the boundaries of the

geographic area served by such programs if: (a) the persons served are

older adults; (b) the services affect the health and welfare of such

persons; and (c) the services are provided on a one-time basis in the

year in which they are provided, and not in a manner which is said or

intended to be continuous. The director may also consent to the

provision of such services by such program if the program has received a

grant which requires services to be provided beyond the geographic

boundaries of the program. The director shall establish procedures under

which a program may request the ability to provide such services. The

provision of such services shall not affect the funding provided to the

program by the department pursuant to this section.

7. The director shall promulgate rules and regulations as necessary to

carry out the provisions of this section.

* 8. On or before March first, two thousand nineteen, and every five

years thereafter, the director shall report to the governor and the

finance committee of the senate and the ways and means committee of the

assembly concerning the effectiveness of the naturally occurring

retirement community supportive services program in achieving the

objectives set forth by this section, which include helping to address

the needs of residents in such classic and neighborhood naturally

occurring retirement communities, assuring access to a continuum of

necessary services, increasing private, philanthropic and other public

funding for programs, and preventing unnecessary hospital and nursing

home stays. The report shall also include recommendations concerning

continuation or modification of the program from the director. The

director shall provide the required information and any other

information deemed appropriate to the report in such form and detail as

will be helpful to the legislature and the governor in determining to

extend, eliminate or modify the program including, but not limited to,

the following:

(a) the number, size, type and location of the projects developed and

funded, including the number, kinds and functions of staff in each

program;

(b) the age, sex, religion and other appropriate demographic

information concerning the residents served;

(c) the services provided to residents, reported in such manner as to

allow comparison of services by demographic group and region;

(d) a listing of the services provided by eligible applicants,

including the number, kind and intensity of such services; and

(e) a listing of partner organizations providing services, the number,

kind and intensity of such services, and, to the extent practicable, the

outcomes of such referrals.

* NB Effective until September 1, 2024

* 8. On or before March first, two thousand nineteen, and every five

years thereafter, the director shall report to the governor and the

finance committee of the senate and the ways and means committee of the

assembly concerning the effectiveness of the naturally occurring

retirement community supportive services program in achieving the

objectives set forth by this section, which include helping to address

the needs of residents in such classic and neighborhood naturally

occurring retirement communities, assuring access to a continuum of

necessary services, increasing private, philanthropic and other public

funding for programs, and preventing unnecessary hospital and nursing

home stays. The report shall also include recommendations concerning

continuation or modification of the program from the director. The

director shall provide the required information and any other

information deemed appropriate to the report in such form and detail as

will be helpful to the legislature and the governor in determining to

extend, eliminate or modify the program including, but not limited to,

the following:

(a) the number, size, type and location of the projects developed and

funded, including the number, kinds and functions of staff in each

program;

(b) the age, sex, religion and other appropriate demographic

information concerning the residents served;

(c) the services provided to residents, reported in such manner as to

allow comparison of services by demographic group and region;

(d) a listing of the services provided by eligible applicants,

including the number, kind and intensity of such services;

(e) a listing of partner organizations providing services, the number,

kind and intensity of such services, and, to the extent practicable, the

outcomes of such referrals; and

(f) the number of residents participating in programs or services

provided under this section who report suffering from social isolation

and loneliness and the services provided to residents.

* NB Effective September 1, 2024

9. In the event that a classic or neighborhood NORC is no longer

funded under this section, the director shall, to the best of the

director's ability, provide information about nearby services available

to older adults who currently live in such classic or neighborhood NORC.

Advisory committee. 1. There shall be within the office an

advisory committee for the aging, consisting of not more than

thirty-five members, appointed by the governor. In making such

appointments, the governor shall give due consideration to

representation from the major regions of the state. One member of the

advisory committee shall be designated as chairperson by the governor

and shall serve as chairperson at the pleasure of the governor. The

advisory committee shall meet from time to time at the call of such

chairperson or the director. The director shall seek the advice of the

advisory committee with respect to the needs of the aging and, if so

requested by the director, such committee shall make particular studies

relating to the aging.

2. The members of the advisory committee shall serve without salary,

but each member shall be entitled to reimbursement for his or her actual

and necessary expenses incurred in the performance of his or her

official duties.

3. All members of the advisory committee shall be appointed for terms

of three years provided, however, that of the members first appointed,

one-third shall be appointed for one-year terms, and one-third shall be

appointed for two-year terms. Any member chosen to fill a vacancy

created otherwise than by expiration of term shall be appointed for the

unexpired term of the member he or she is to succeed.

4. Sixty percent of the members of the advisory committee appointed on

and after the effective date of this subdivision shall be sixty years of

age or over.

Assistance of other agencies. To effectuate the purposes of

this title, the director may request from any department, division,

board, bureau, commission or other agency of the state or of any

political subdivision thereof, and the same are authorized to provide,

such facilities, assistance and data, as will enable the office properly

to exercise its powers and perform its duties hereunder.

Grants or gifts. The director, with the approval of the

governor, may accept as agent of the state any gift, grant, devise or

bequest, whether conditional or unconditional (notwithstanding the

provisions of section eleven of the state finance law), and including

federal grants, for any of the purposes of this article. Any moneys so

received may be expended by the office to effectuate any purpose of this

title, subject to the same limitations as to approval of expenditures

and audit as are prescribed for state moneys appropriated for the

purposes of this title.

Reports. 1. The office shall from time to time report to the

governor, and shall make an annual report to the governor and

legislature.

2. Such annual report shall:

(a) Describe the progress, problems and other matters related to the

provision of services to older persons by programs administered by the

office including, but not limited to the federal older Americans act of

1965, the community services for the aging program and the recreation

program for the elderly;

(b) Assess the effectiveness of the community services for aging

program pursuant to section two hundred fourteen of this title in

coordinating and improving the local delivery of services to the

elderly; and

(c) Include recommendations for expanding or replicating service

programs that have been determined effective in helping needy elderly

remain in the community and to avoid institutional care, including

recommendations for traditionally underserved aged populations,

including, but not limited to, populations based on race, creed, color,

national origin, sexual orientation, gender identity or expression,

military status, sex, marital status, disability, familial status, and

language; and

(d) Assess the progress, problems, and effectiveness of the provisions

of services to older persons by programs administered by the office

delivered to traditionally underserved populations, including but not

limited to, aged populations based on actual or perceived race, creed,

color, national origin, sexual orientation, gender identity or

expression, military status, sex, marital status, disability, familial

status, language, or people who are associated with an individual who is

or is perceived to be a member of any of these traditionally underserved

populations.

3. Such annual report shall also present in quantitative, as well as

in qualitative, terms, a report on the quality of life of the aged in

our state, including:

(a) A report on the impact of inflation on the aged.

(b) A report on mortality trends in the upper age brackets, including

chronic disease trends among older persons.

(c) A report on crime trends impacting on the aged.

(d) A report on the numbers of elderly living in substandard housing,

numbers of new housing facilities for the aged in public, non-profit or

limited profit housing.

(e) A report on coverage of the aged in the state by various public

social security programs, pension plans, private retirement plans, and

assistance programs.

(f) A report on unemployment and employment of older persons,

including prevalence of age discrimination in the labor market and

efforts to provide education, information, and recommendations for

legislation, trends toward early or later retirement, duration of

unemployment by age groupings, self-employment and partial employment of

older persons.

(g) A report on the hot meal program within the state, including costs

per meal, number of aged served, as well as a report on the

meals-on-wheels program.

(h) A report on the recreational services for the aged, including

numbers of senior centers and clubs, membership and programming

provided.

(i) A report on the extent to which the aged are provided adult

education courses in public schools or are attending college courses.

(j) A report on institutionalization of aged, including trends in

mental hospitals, skilled nursing homes, health related facilities,

adult homes, including length of stay, costs, occupancy rates, extent to

which local communities are providing care for institutionally released

aged.

(k) A report on the specific needs of traditionally underserved aged

populations, including, but not limited to, populations based on actual

or perceived race, creed, color, national origin, sexual orientation,

gender identity or expression, military status, sex, marital status,

disability, familial status, and language.

(l) A report on the number of older adults who are primary caregivers

or guardians of minors including prevalence by age range, circumstances

that lead to older adults becoming primary caregivers or guardians to

minors, an analysis of what services are available through the office

and other state agencies to assist these older adult primary caregivers

and guardians, and recommendations regarding support for older adults

who are primary caregivers or guardians for minor children.

(m) A report on substance use disorders among older adults including

prevalence of substance use disorders, what programs and services are

available from or in conjunction with the office, an analysis of what

services are needed to assist older adults dealing with substance use

disorders, and recommendations regarding how the office can assist and

participate in efforts to assist older adults dealing with substance use

disorders.

4. The legislature hereby declares that, as a matter of state policy,

caring services and programs for seniors should be shaped by the

principles of strengthening independence, affirming dignity, and

maximizing choice, and a recognition that seniors and their families and

intimates provide a vast potential source of social, cultural, historic,

and spiritual enrichment and leadership.

The office shall enunciate these principles in the form of a bill of

rights for seniors, and shall, in addition to any other report required

by this section, report annually, not later than June first of each

year, on the progress being made in their advancement by state agencies

and local governments in the development and operation of programs for

seniors. Such report shall discuss progress in the following principles

with respect to programs for seniors:

(a) Seniors needing long term care in an institution or in an

appropriate community-based alternative should be able to obtain such

care at an affordable cost in a timely manner from reliable and

responsible providers who can provide choices that meet the preferences

of these seniors, and who have the capacity to provide a smooth

transition to other forms of long term care when appropriate. Such

programs should, whenever possible, provide a continuum of quality

health care, either within a single institution, or through a consortium

of providers.

(b) Public policy should affirm seniors' desire to maintain a high

quality of life by living with dignity in their own communities, by

supporting the efforts of informal caregivers such as family, friends

and neighbors who provide eighty percent of all personal care and

assistance to seniors.

(c) A goal of policy and programs in New York should be to help

seniors obtain or maintain affordable and secure housing that allows

them to age in place in their own communities with supportive assistance

and access to health related services in a manner that ameliorates

problems of income, changes in family structure, health, threats to

personal safety, and architectural and structural inadequacies.

(d) Programs intended to offset excessive health care and prescription

drug costs for seniors, and to make health care, particularly wellness

and prevention programs, more affordable, should be designed to expand

choice and promote ease of access for seniors rather than to simply

provide ease of management and control for bureaucrats and program

managers.

(e) State and local policies and program guidelines should support the

most creative and flexible approaches to providing care for seniors, so

as to promote and sustain the autonomy and mobility of seniors, and to

tap their potential to enrich their communities.

(f) Seniors should be able to continue their productive lives in the

community of New York without fear of discrimination based on age, and

public policy should seek means of increasing opportunities for

contribution from these respected members of our community by supporting

and encouraging a healthy social environment that enables seniors to

continue their productive lives if they wish, that affirms and

encourages their ability to achieve financial security, and that works

to preserve their dignity, safety, and independence.

(g) Public programs should promote personal security for seniors,

encourage personal responsibility of their families and intimates, and

recognize and build on the interdependence of all generations and the

diversity of our population.

(h) Public investment in programs providing health care and other

social help for seniors should be provided at a level which supports

public mandates with respect to these programs.

(i) No declaratory relief, injunctive remedy or monetary liability

against the state of New York or any political subdivision thereof, or

any public or private entity, domiciled or doing business in the state

of New York, or any employee or officer thereof, shall be created or

granted based upon the principles set forth in this subdivision, or upon

the enunciation of said principles to be made by the office pursuant

thereto. No claim for contribution or indemnification shall be created

based upon this subdivision. No assignment of claim shall be prosecuted

based upon this subdivision.

(j) Existing powers of the office for the aging shall not be changed

by this subdivision.

* 5. Every state department, bureau, or agency or office shall

cooperate to the fullest extent possible in providing such data as the

office may need to assemble such reports, including recommendations by

the director to the governor and legislature.

* NB Amended Ch. 640/2004 §1, language juxtaposed per Ch. 642/2004 §12

Community services for the elderly. 1. Definitions. As used in

this section, the following words shall have the following meanings:

(a) "Designated agency" shall mean an agency which is designated by

the chief executive officer of the county if there be one, or otherwise

the governing board of such county, or the chief executive officer of

the city of New York, or the governing board of an Indian tribal

council; which is either a unit of county government or the city of New

York or an Indian tribal organization or a private non-profit agency,

and which is the area agency on aging created pursuant to the federal

older Americans act of 1965.

(b) "Elderly person" shall mean a person sixty years of age or older.

(c) "County" shall mean a county, as defined in section three of the

county law, except that the city of New York shall be considered one

county.

(d) "Base year expenditures" and "base year services" shall mean the

level of expenditures and services in the year prior to the first year

for which a county plan is submitted or in such county's two thousand

five fiscal year, whichever is greater.

(e) "Community services" shall mean services for elderly persons which

are provided by a public or governmental agency or non-profit agency,

and which are provided in the home of an elderly person or in community

settings such as senior citizens centers, housing projects, or agency

offices. Such services shall not include any services provided pursuant

to the public health law other than home care services.

(f) "Community service projects" shall mean community services

financed pursuant to paragraph (b) of subdivision four of this section.

(g) "County plan" shall mean a plan for community services prepared by

a county pursuant to this section.

(h) "Non-profit agency" shall mean a corporation organized or existing

pursuant to the not-for-profit corporation law.

(i) "Program year" shall mean the period from April first through

March thirty-first of the following calendar year.

(j) "First program year" for a county shall mean the initial year for

which the county has received approval for its county plan.

2. County plans for improving the availability of community services

to the elderly. (a) Counties with a designated agency are required to

submit a county plan for a two-, three-, or four-year period determined

by the director, with an annual update containing a budget request for

the forthcoming program year and such other information as shall be

required by the director, for improving the delivery of community

services for elderly persons in the format prescribed by the director.

The plan for the city of New York shall specifically address the needs

of each county within such city. Such plan shall be a comprehensive

description of the manner in which the county intends to address the

needs of elderly persons living in the county through improved

coordination of existing community services and by the development of

any new or expanded community service projects which will improve the

delivery of services to the elderly. Such plan shall contain:

(1) a statement of goals and objectives for addressing the needs of

elderly persons in the county, an assessment of the needs of elderly

persons residing in the county, a description of public and private

resources that currently provide community services to elderly persons

within the county, a description of intended actions to consolidate and

coordinate existing community services administered by county

government, a description of the intended actions to coordinate

congregate services programs for the elderly operated within the county

pursuant to section two hundred seventeen of this title with other

community services for the elderly, a description of the means to

coordinate other community services for elderly persons in the county

with those administered by county government, and a statement of the

priorities for the provision of community services during the program

period covered by such plan;

(2) an identification of community service projects to be developed to

improve the delivery of services, a budget request for approval for the

forthcoming year which individually identifies each community service

project to be funded pursuant to paragraph (b) of subdivision four of

this section, letters of comment from the appropriate local agencies on

the relationship and expected impact of the proposed community service

projects, assurances that community service projects will provide

services to those most in need, an indication of fee schedules by which

elderly persons participating in community service projects may

contribute to the costs of such projects, and an indication of how the

effectiveness of such community service projects will be evaluated;

(3) an identification of planning, coordination, and administrative

activities necessary to achieve the goals and objectives of the plan,

together with a budget request for such activities for approval for the

forthcoming year to be funded pursuant to paragraph (a) of subdivision

four of this section, and assurances by the county that it will comply

with the requirements of state and federal law; and

(4) such other components as may be required pursuant to regulations

promulgated by the director.

(b) Such county plan for community services or annual update shall be

prepared by the designated agency and approved by the chief executive

officer of the county, if there be one, or otherwise the governing board

of the county, or the chief executive of the city of New York and

submitted to the director no later than ninety days prior to the

beginning of the program period covered by such plan or annual update.

Prior to a submission of a county plan or annual update to the director

for approval, the designated agency shall conduct such public hearings

as may be required by regulations of the director, provided that there

shall be at least one such hearing, and one in each county contained

within the city of New York.

(c) The director shall review such county plan and may approve or

disapprove such plan, or any part, program, or project within such plan,

and shall propose such modifications and conditions as are deemed

appropriate and necessary. Compliance with paragraphs (a) and (b) of

this subdivision shall be the basis for approval of a county plan. The

director shall establish by regulation the dates for notifying the

designated agency of approval or disapproval of a county plan. In the

event the director shall disapprove the proposed county plan, the county

submitting such application shall be afforded an opportunity for an

adjudicatory hearing, as prescribed by article three of the state

administrative procedure act.

(d) Notwithstanding any provision of this section, nothing contained

in this section shall give the director or a designated agency any

administrative, fiscal, supervisory, or other authority whatsoever over

any plans, programs or expenditures authorized pursuant to titles

eighteen, nineteen and twenty of the federal social security act, or

over any unit of state or local government.

(e) Counties with a designated agency may submit to the director a

letter of intent, in the form and by the date prescribed by the director

with the approval of the director of the budget, evidencing the

commitment of the county to develop a county home care plan for

functionally impaired elderly.

(f) Within the amounts appropriated therefor, counties submitting an

approved letter of intent pursuant to paragraph (e) of this subdivision

shall be eligible for reimbursement of one hundred percent of the

approved expenditures for preparing a county home care plan for

functionally impaired elderly. Such a grant-in-aid shall be available to

a county only once and shall be limited to one-half the amount available

to such county pursuant to subparagraph one of paragraph (a) of

subdivision four of this section; provided however that in either of the

two years immediately following its first submission of a home care plan

for functionally impaired elderly, a county which does not receive state

aid during such year for expanded non-medical in-home services,

non-institutional respite services, case management services, and

ancillary services pursuant to paragraph (j) of subdivision four of this

section, may apply for reimbursement of one hundred percent of the

approved expenditures for revising such home care plan, limited to

one-quarter the amount available to such county pursuant to subparagraph

one of paragraph (a) of subdivision four of this section.

(g) County home care plans for functionally impaired elderly prepared

pursuant to this subdivision shall include a comprehensive description

of all aspects of home care, non-institutional respite, case management,

and ancillary services available to elderly persons in the county; a

description of intended actions to coordinate such home care,

non-institutional respite, case management, and ancillary services to

functionally impaired elderly persons in their county provided under

this section with other services to elderly persons; a proposal for

expanded non-medical in-home services, non-institutional respite

services, case management services, and ancillary services for

functionally impaired elderly persons with unmet needs to support such

persons' continued residence in their homes; and such other components

as may be required pursuant to regulations promulgated by the director,

including how the proposed expanded non-medical in-home services,

non-institutional respite services, case management services, and

ancillary services will be delivered to unserved or underserved

populations.

(h) Such county home care plan for functionally impaired elderly shall

be prepared by the designated agency after consultation with the social

services district and the local public health agency, and shall be

approved by the chief executive officer of the county, if there be one,

or otherwise the governing board of the county, or the chief executive

of the city of New York, and submitted to the director for approval by

such date as may be specified by regulation. The director shall not

approve such county home care plan for functionally impaired elderly

unless it complies with the standards and regulations issued pursuant to

this section.

3. Community service projects. (a) The director may authorize a county

which has an approved county plan pursuant to this section to provide

one or more community service projects included in such approved plan

which are designed to make community services and entitlement programs

more available and accessible to older persons through the improved

coordination and delivery of services for the elderly. As necessary to

meet project goals and objectives, such projects may provide new

services not previously provided within the county, expand services

provided during the base year, and establish new mechanisms to

coordinate all existing and new services.

(b) Counties having an approved plan which includes one or more

community service projects shall be eligible for state aid, as provided

in subdivision four of this section, for the provision of such projects

identified in such plan.

(c) Each community service project included in a county plan shall

clearly specify the intended goals and objectives of such project, shall

describe the elderly population the project intends to serve, shall

specify a timetable not to exceed three years to achieve and evaluate

such goals and objectives, and shall specify proposed methods to

evaluate the effectiveness of such project.

(d) The director, with the advice of the advisory committee for the

aging, shall promulgate regulations and issue guidelines for evaluating

the effectiveness and achievements of such community service projects,

shall require periodic evaluations of each project, and shall make

available such evaluations to appropriate agencies, the governor and the

legislature.

(e) No project funded pursuant to this section shall continue beyond

three years, unless approved by the director after the director is

satisfied that the project effectively improves the delivery of services

to the elderly based upon periodic evaluations of the project.

4. State aid. (a) County plans for improving the availability of

community services to the elderly:

(1) within the amounts appropriated therefor, counties with an

approved county plan shall be eligible for reimbursement of one hundred

percent of the annual approved expenditures for the preparation and

revision of such county plan, evaluation of projects contained within

such county plan, execution of interagency agreements necessary to carry

out the plan, actions to consolidate, combine or collocate services

within the county, and such other costs of the designated agency

necessary to implement such county plan, provided that the total annual

amount payable to a county pursuant to this subparagraph shall not

exceed the sum of one dollar for each elderly person residing in the

county, or seventy-five thousand dollars, whichever is less, and further

provided that for the city of New York such amount shall not exceed one

dollar for each elderly person residing in the city or three hundred

seventy-five thousand dollars, whichever is less. Notwithstanding the

foregoing limitations, counties with a population of less than twenty

thousand elderly persons shall be eligible for reimbursement of one

hundred percent of such annual approved expenditures provided that the

total annual amount of such reimbursement per county shall not exceed

twenty thousand dollars.

(2) within the amounts appropriated therefor, a county may receive a

grant-in-aid of up to twenty-five per centum of the total annual amount

that such county is eligible to receive pursuant to subparagraph one of

this paragraph for the cost of preparing an initial county plan in

accordance with this section. Such a grant-in-aid shall be available to

a county only once and shall be in addition to the reimbursement

received by the county pursuant to subparagraph one of this paragraph

for the first program year. A request for such a grant-in-aid shall be

accompanied by a letter of intent in the form prescribed by the director

evidencing the commitment of the county to develop a county plan for

community services and shall be submitted to the director at least six

months prior to the beginning of the first program year.

(b) Community service projects:

(1) within the amounts appropriated therefor, counties having an

approved county plan shall be eligible for reimbursement by the state

for expenditures for approved community service projects pursuant to

this section. Such state reimbursement shall not exceed thirty-three

thousand six hundred dollars or four dollars twenty cents for each

elderly person residing in the county, whichever is greater. The annual

state reimbursement eligibility shall be at a rate of seventy-five

percent of the total annual expenditures for such approved programs.

(2) the director shall provide by regulation that certain non-county

moneys and in-kind equivalents may be used to comprise the county share

of such total annual approved expenditures, provided that such county

share shall not include cost-sharing received from elderly persons

receiving expanded non-medical in-home services, non-institutional

respite services, case management services, and ancillary services

pursuant to paragraph (k) of this subdivision or moneys received from

the federal government for services for the elderly allocated to the

states or local governments according to population or other such

non-competitive basis.

(3) the director shall provide by regulation the requirements for any

participant contributions and fee schedules used for community service

projects and the manner for the accounting and use of any such revenue.

(c) Reimbursement pursuant to this section shall not be available for

expenditures for base year services otherwise provided without cost, or

to replace base year expenditures made by the county or any other

service provider irrespective of the source of funds for such services.

(d) Reimbursement shall not be available to community services

projects funded pursuant to paragraph (b) of this subdivision or to

expanded non-medical in-home services, non-institutional respite

services, case management services, and ancillary services funded

pursuant to paragraph (j) of this subdivision for services provided to

elderly persons who are eligible for or are receiving services to meet

their needs pursuant to titles eighteen, nineteen or twenty of the

federal social security act or any other governmental programs or for

services provided to residents in adult residential care facilities

which had previously been provided by the facility or which are required

by law to be provided by such facility.

(e) For the purpose of determining the amount of state reimbursement

for which a county is eligible pursuant to this section, the last

preceding federal census or other census data approved by the

comptroller shall be used. Funds appropriated by the state for the

purpose of reimbursement for community services pursuant to this section

shall be apportioned among the counties pursuant to the formula set

forth in paragraph (b) of this subdivision by the director. Funds

appropriated by the state for the purpose of reimbursement for expanded

non-medical in-home services, non-institutional respite services, case

management services, and ancillary services pursuant to this section

shall be apportioned among the counties by the director pursuant to the

formula set forth in paragraph (j) of this subdivision.

(f) The comptroller may withhold the payment of state aid to any

county in the event that such county alters or discontinues the

operations approved by the director pursuant to this section or

otherwise fails to comply with the regulations or requirements of the

director.

(g) Counties shall submit claims for reimbursement after the end of

each month or each quarter as required by and in accordance with

procedures prescribed by the director. Reimbursement shall be available

for approved expenditures incurred in accordance with an approved county

plan for community services.

(h) Reimbursement pursuant to subparagraph one of paragraph (b) or

paragraph (j) of this subdivision shall not be available for

expenditures for community or expanded non-medical in-home services,

non-institutional respite services, case management services, and

ancillary services to elderly persons in the city of New York unless

expenditures for such services are apportioned for services in each of

the counties contained within such city in a manner which the director

has determined by regulation substantially reflects the proportion that

the number of elderly persons in that county bears to the total number

of elderly persons in the city as a whole. In determining whether

reimbursement shall be available under paragraph (g) of this

subdivision, the director shall ensure that expenditures were

apportioned in accordance with the provisions of this paragraph.

(i) The director, within the amounts appropriated therefor and with

the approval of the director of the budget, may authorize a county which

has an approved home care plan for functionally impaired elderly to

provide expanded non-medical in-home services, non-institutional respite

services, case management services, and ancillary services pursuant to

such plan. Such services shall be limited to those services necessary to

meet otherwise unmet needs and which support such elderly persons'

continued residence in their homes. Needs will be determined pursuant to

a standardized evaluation of functional impairment, available resources

and such other relevant factors specified pursuant to regulations

promulgated by the director. No expanded non-medical in-home services,

non-institutional respite services, or ancillary services shall be

provided to any individual pursuant to this section unless such expanded

non-medical in-home services, non-institutional respite services, or

ancillary services are accompanied by ongoing case management services

in accordance with regulations promulgated by the director.

(j) Within the amounts appropriated therefor, counties authorized to

provide expanded non-medical in-home services, non-institutional respite

services, case management services, and ancillary services pursuant to

paragraph (i) of this subdivision shall be eligible for reimbursement by

the state of up to seventy-five percent of allowable expenditures for

approved services pursuant to this section up to the level authorized by

the director. The director shall not authorize a level of state

reimbursement pursuant to this paragraph which exceeds the sum of

ninety-one thousand two hundred fifty dollars or seven dollars thirty

cents for each elderly person residing in the county, whichever is

greater, and shall proportionately reduce such sum for each county in

any years for which appropriations are not sufficient to fully fund

approved expanded non-medical in-home services, non-institutional

respite services, case management services, and ancillary services for

functionally impaired elderly in all counties with approved home care

plans; provided however that in state fiscal years beginning on or after

the first day of April, two thousand five, the director, with the

approval of the director of the budget, may authorize state

reimbursement in excess of these levels to the extent appropriations are

available therefor.

(k) The director, with the approval of the director of the budget,

shall provide by regulation the extent of cost-sharing to be required of

elderly persons receiving expanded non-medical in-home services,

non-institutional respite services, case management services, and

ancillary services pursuant to this section, which shall reflect such

recipients' means to pay for such services and which will not affect

their ability to remain in their homes; provided however that the

director shall not authorize or direct the withholding of state aid

pursuant to paragraph (f) of this subdivision prior to the first day of

April, two thousand five, based on any county's failure or inability to

comply with regulations promulgated pursuant to this paragraph. The full

amount of cost-sharing actually received by any county from elderly

persons receiving expanded non-medical in-home services,

non-institutional respite services, case management services, and

ancillary services shall be used by such county to expand either such

county's program of community services or such county's program of

expanded non-medical in-home services, non-institutional respite

services, case management services, and ancillary services pursuant to

this section.

(l) Reimbursement pursuant to paragraph (j) of this subdivision shall

not be available for expenditures for base year services otherwise

provided without cost, or to replace base year expenditures made by the

county or any other service provider irrespective of the source of

funds, or to replace community services expenditures pursuant to

paragraph (b) of this subdivision.

(m) Counties shall submit claims for reimbursement for expanded

in-home services, non-institutional respite services, case management

services, and ancillary services to functionally impaired elderly as

required by and in accordance with procedures prescribed by the

director. Reimbursement shall be available for approved expenditures

incurred in accordance with an approved county home care plan for

functionally impaired elderly to the extent the director has authorized

state aid for such services pursuant to paragraph (i) of this

subdivision.

(n) The director shall provide by regulation that certain non-county

moneys and in-kind equivalents may be used in part to compose the county

share of total allowable expenditures pursuant to paragraph (j) of this

subdivision, provided that such county share shall not include

cost-sharing received from elderly persons receiving expanded

non-medical in-home services, non-institutional respite services, case

management services, and ancillary services pursuant to paragraph (k) of

this subdivision or moneys received from the federal government for

services for the elderly allocated to the states or local governments

according to population or other such non-competitive basis.

5. Contracts for services. (a) For the purposes of this section,

counties are authorized to contract with public agencies,

municipalities, non-profit agencies, or such other entities as the

director may authorize. Contracts for nursing services, home health aide

services, nutritional services (other than the delivery of meals),

physical, speech, and occupational therapy, and medical social services

provided pursuant to this section shall only be with certified home

health agencies as defined in article thirty-six of the public health

law.

(b) Community services provided pursuant to this section shall not be

provided directly by the designated agency unless approval is granted by

the director. Such approval may not be given by the director unless the

designated agency directly provided the service prior to approval of the

annual county plan by the director, or unless it can be shown that the

direct provision of a community service by the designated agency is

necessary due to the absence of an existing suitable provider to assure

an adequate supply of such service, or to ensure the quality of the

service provided.

(c) Pursuant to an agreement, two or more counties may join together

for the purposes of this section. Such agreements shall make provision

for the proportionate cost to be borne by each county, the employment of

personnel, the receipt and disbursement of funds, and any other matters

deemed necessary by the director. Claims for reimbursement pursuant to

subdivision four of this section shall be paid to each county and shall

be limited to the amount to which each county would be entitled pursuant

to such subdivision.

6. Implementation of home care plans. Within the amounts appropriated

therefor, counties authorized to provide expanded non-medical in-home

services, non-institutional respite services, case management services,

and ancillary services pursuant to paragraph (i) of subdivision four of

this section shall be eligible for reimbursement by the state of one

hundred percent of allowable expenditures for implementing the approved

county home care plan for functionally impaired elderly, limited to a

sum equivalent to the amount available to such county pursuant to

subparagraph one of paragraph (a) of subdivision four of this section.

7. For the purposes of obtaining state aid within the amounts

appropriated therefor under this section, a designated agency of an

Indian tribal organization shall qualify as though it were a designated

agency for a county.

Social model adult day services programs. 1. Definitions. As

used in this section:

(a) "Advisory committee for the aging" shall mean the advisory

committee for the aging established pursuant to section two hundred ten

of this title.

(b) "Social adult day services" shall mean a program providing a

variety of long term care services to functionally impaired individuals,

whether due to physical or cognitive impairments, in a congregate,

community, or home setting and pursuant to a person-centered service

plan.

(c) "Designated agency" shall mean any agency which is either a unit

of county government, the city of New York, or the governing body or

council of an Indian tribal reservation, or a private not-for-profit

agency organized or existing pursuant to the not-for-profit corporation

law, which has been designated as an area agency on aging by the state

office for the aging pursuant to the federal older Americans act of

1965, as amended.

(d) "Functionally impaired" shall mean a person who needs the

assistance of another person in at least one of the following activities

of daily living: toileting, mobility, transferring, or eating; or who

needs supervision due to cognitive and/or psycho-social impairment.

(e) "Social adult day care" shall mean a program providing a variety

of comprehensive services to functionally impaired elderly persons as

defined in regulations established by the director.

2. Duties of the director. (a) The director is authorized and directed

to promulgate rules and regulations, establishing standards and

requirements with regard to the operation of all social adult day care

programs receiving funding pursuant to this article. Such standards and

requirements shall include, but not be limited to:

(1) services to be provided;

(2) admission criteria;

(3) participant cost-sharing;

(4) assessment and enrollment;

(5) staffing;

(6) monitoring and evaluation of programs; and

(7) any other standards or requirements which the director determines

to be appropriate.

(b) Rules and regulations promulgated by the director pursuant to this

subdivision shall also direct how social adult day care will be included

in the planning currently required of designated agencies.

(c) The director shall develop materials for employees and volunteers

of programs providing social adult day services or social adult day care

on the signs and symptoms of elder abuse, which shall include identity

theft. Such materials shall include, but not be limited to, ways to

discuss suspected elder abuse with seniors where abuse is suspected and

resources to which seniors may be referred for counseling, shelter, or

other assistance.

3. Funding for social adult day care programs.

(a) Beginning with amounts appropriated in the two thousand five

fiscal year, the director shall, within amounts appropriated therefor,

make grants available on a competitive basis to not-for-profit or local

government operated social adult day care programs for functionally

impaired elderly persons, with consideration of regional needs and a

broad array of models. Such grants shall equal seventy-five percent of

allowable expenditures for approved services pursuant to this section;

provided however that the director may accept certain in-kind

equivalents to comprise the required twenty-five percent match; and

provided further, in the case of providers which can demonstrate

financial need, the director may make grants of up to one hundred

percent of allowable expenditures pursuant to this section.

(b) Beginning with the first year that the annual increase in amounts

appropriated for the purposes of this section shall equal at least five

million dollars, for that increase and all increases thereafter, the

director shall distribute such increases to designated agencies for the

provision of social adult day care programs for functionally impaired

elderly persons based on a formula developed by the office which shall

consider at least the following: the number of elderly persons in the

area; and the number of functionally impaired elderly persons in the

area as determined by the office. Base funding established under

paragraph (a) of this subdivision shall continue to be distributed as

provided in paragraph (a) of this subdivision. Within the amounts

appropriated therefor, designated agencies authorized to provide social

adult day care under this section shall be eligible for reimbursement

from the state for seventy-five percent of allowable expenditures for

approved social adult day care services pursuant to this section up to a

level authorized by the director; provided however, that certain in-kind

equivalents may comprise the twenty-five percent match.

(c) The office may use up to three percent of the total of any funding

appropriated pursuant to this section for administration.

(d) The designated agency may use up to three percent of the total of

any funds provided to the designated agency pursuant to this section for

administration.

4. Funding eligibility. Funding pursuant to this section shall not be

available to social adult day care programs for services provided to

elderly persons who are eligible for or receiving comparable services to

those defined in this section pursuant to title eighteen, nineteen or

twenty of the federal social security act, or any other government

program. In addition, funding pursuant to this section shall not

supplant any existing public or private funding for social adult day

care programs.

5. Report of director. The director, after consultation with his or

her advisory committee, affected state agencies, any affected municipal

agencies and persons involved in providing social adult day care

services, shall make a report, on or before December thirty-first, two

thousand five, to the governor, the temporary president of the senate,

the speaker of the assembly, the chair of the senate standing committee

on aging and the chair of the assembly standing committee on aging on

the projected costs and benefits of establishing uniform standards and

requirements with regard to operation of social adult day care services

in the state. The report shall include the director's findings,

recommendations and estimate of the fiscal implications of regulating

social adult day care services in the state.

Senior vision services program. 1. Definitions. As used in

this section:

(a) "Senior vision services" shall mean the provision of

non-vocational services to elderly persons who have a functional visual

impairment. These services may include, but not be limited to, client

assessment, information and referral, client and family counseling,

referrals for opthalmological, optometric or other health care services,

technical assistance and training for human services personnel to serve

persons who are blind or visually impaired, and low vision screening.

(b) "Functional visual impairment" shall mean an impairment of sight

that substantially interferes with an elderly person's ability to

perform specific daily living skills and tasks. Persons who are not

regarded as legally blind, pursuant to this section, but who experience

such an impairment of sight, shall be deemed eligible for senior vision

services pursuant to this section.

(c) "Elderly" shall mean an individual over sixty years of age.

(d) "Director" shall mean the director of the office for the aging.

2. The director, in consultation with the New York state commission

for the blind, is hereby authorized and directed, subject to the

availability of appropriations, to establish a program of senior vision

services grants to assist in the provision of vision services to elderly

persons with functional visual impairments.

3. The director, in consultation with the New York state commission

for the blind, shall award senior vision services grants to

not-for-profit corporations which demonstrate:

(a) the ability to provide senior vision services;

(b) a commitment to provide such services to visually impaired persons

or specialized training in providing such services to persons who are

blind or visually impaired; and

(c) other such factors as may be determined by the director in

consultation with the state commission for the blind.

4. Grant awards shall take into consideration the lack of

non-traditional and non-vocational services for elderly persons in need

of senior vision services and the ability of such senior vision services

grants to establish or to expand existing blind or visually impaired

services currently provided or available in the county or region served

by the not-for-profit corporation or through another source.

5. The director shall ensure that in awarding the grants pursuant to

this section that due consideration is given to the geographic and

existing service demands for senior vision services within a county or

region of the state.

6. The director shall promulgate any rules and regulations necessary

to carry out the provisions of this section. Additionally, the director

shall submit a report to the governor, the temporary president of the

senate and the speaker of the assembly, prior to, but in no event later

than, December thirty-first, in the year following enactment of this

section, and annually thereafter, which shall include, but not be

limited to:

(a) financial reports of the grant project operations established

pursuant to this section;

(b) an analysis of the grant project's ability to provide such senior

vision services to elderly persons with functional visual impairments;

(c) recommendations on the continuation of such grants and the need

for program expansion, if appropriate;

(d) a profile of the grant recipient; and

(e) other information deemed necessary by the director.

* § 215-b. Enriched social adult day services. 1. Legislative intent.

Social adult day services programs are resources that can help

communities maintain the independence of functionally impaired adults.

The level of services needed by some functionally impaired adults

exceeds the level of assistance currently available through social model

adult day services programs but is not at the level of support provided

in an adult day health care program. Social adult day services programs

cannot enroll new participants whose needs exceed the services that can

be provided in the current social adult day services programs.

Additionally, these programs must discharge current participants when

their needs cannot be met. Therefore, an enriched social adult day

services project shall be established as a demonstration project for the

purposes of maintaining functionally impaired adults in the community by

deterring or delaying institutionalization.

2. Definitions. For purposes of this section, the following terms

shall have the following meanings:

(a) "Eligible participant" shall mean individuals who are functionally

impaired, as defined in section two hundred fifteen of this title, and

in need of services that exceed the level of assistance currently

available through social adult day services programs but not at the

level of support provided by adult day health care programs.

(b) "Eligible entity" shall mean any not-for-profit or government

entity, including the governing body or council of an Indian tribal

reservation, who currently provides all of the services required for

social adult day services programs pursuant to section two hundred

fifteen of this title; including total assistance with toileting,

mobility, transferring, and eating where appropriate; and has an

existing contract with the state office for the aging.

(c) "Enriched services" shall include the dispensing of medications by

a registered nurse; health education; counseling; case management;

restorative therapies lasting less than six months and maintenance

therapies. Restorative and maintenance therapies shall be provided by an

appropriately licensed health care provider.

(d) "Optional services" shall mean other non-medical services approved

by the director designed to improve the quality of life of eligible

participants by extending their independence, avoiding unnecessary

hospital and nursing home stays, and sustaining their informal supports.

3. Duties of the director. (a) The director, in conjunction with the

commissioner of health, shall develop an application process whereby

eligible entities may apply for approval to offer enriched services,

optional services, or both. Such application shall include, but not be

limited to:

(1) an estimate of the number of eligible participants to whom the

eligible entity could effectively provide the services for which they

are applying to offer pursuant to this section; and

(2) a plan under which the eligible entity would safely offer the

services for which they are applying pursuant to this section, either

directly or through a contract with a licensed health care practitioner

or licensed home care provider as defined in section thirty-six hundred

five of the public health law.

(b) In considering applications made pursuant to paragraph (a) of this

subdivision, the director, in conjunction with the commissioner of

health, may consider:

(1) eligible entities that can effectively serve eligible participants

residing in rural, urban, or suburban settings;

(2) eligible entities that effectively serve culturally diverse

populations;

(3) eligible entities that demonstrate innovative use of technology,

coordination, partnerships, transportation or other services to enable

eligible participants to be effectively served; and

(4) any other criteria determined to be appropriate.

4. Evaluation. On or before January thirtieth, two thousand seventeen,

the director shall provide the governor, the speaker of the assembly,

the temporary president of the senate, and the chairpersons of the

assembly and senate aging and health committees with a written

evaluation of the program. The evaluation shall examine the

effectiveness of the project in forestalling institutional placement,

the costs of providing enriched services in a day care setting,

participant satisfaction and program quality, and identification of the

program design elements necessary for successful replication.

5. Grants. (a) The director may, within amounts appropriated therefor,

make grants, available on a competitive basis, to eligible entities

under this section. Such grants shall be for one hundred percent of the

allowable expenditures for approved services and expenses under this

section.

(b) In making grants, the director, in conjunction with the

commissioner of health, may consider the criteria established under

subdivision three of this section.

(c) Funds made available under this subdivision shall supplement and

not supplant any federal, state, or local funds expended by any entity,

including a unit of general purpose local government or not-for-profit,

to provide services under this section. Funds under this subdivision

cannot pay for individuals who are eligible under title nineteen of the

federal social security act.

* NB Repealed March 31, 2029

Senior center council. 1. Definition. For the purposes of this

section, the term "council" shall mean the senior center council

convened by the director pursuant to this section.

2. Membership. The senior center council shall consist of ten members

appointed by the director who shall serve as the chair. These members

shall have experience with the operation of senior centers and the

provision of services therein. Members shall also be broadly

representative of older adult groups and all geographic areas of the

state. At least two of these members shall be over the age of sixty-two.

3. Compensation. Members of the council, other than the director,

shall receive no compensation for their services, but shall be allowed

their actual and necessary expenses incurred in the performance of their

duties pursuant to this section.

4. Purpose. The purpose of the council shall be to (a) provide a forum

for discussion of challenges facing senior centers across the state and

developing solutions;

(b) support sharing of information regarding efficient and effective

operation of senior centers in different areas around the state;

(c) encourage the spread of methods and programs with proven

effectiveness;

(d) create an environment for peer-to-peer support for senior centers

across the state; and

(e) offer recommendations for how the state can support senior centers

and lower barriers to effective service delivery.

Congregate services initiative for the elderly. 1. Definitions.

As used in this section, the following words shall have the following

meanings:

(a) "Designated agency" shall mean an agency which is designated by

the chief executive officer of the county if there be one, or otherwise

the governing board of such county, or the chief executive officer of

the city of New York, or the governing board of an Indian tribal

council; which is either a unit of county government or the city of New

York or an Indian tribal organization or a private non-profit agency,

and which is the area agency on aging created pursuant to the federal

older Americans act of 1965.

(b) "Elderly person" shall mean a person sixty years of age or older.

(c) "County" shall mean a county, as defined in section three of the

county law, except that the city of New York shall be considered one

county.

(d) "Congregate services" shall mean services for elderly persons

which are provided by a public or a government agency or non-profit

agency which are provided in community settings at which elderly people

come together for services and activities that respond to their diverse

needs and interests, enhance their dignity, support their independence,

and encourage their involvement in and with the community and which seek

to prevent the well elderly from requiring more intensive services such

as those provided under expanded non-medical in-home services and

non-institution respite service. Such services include but are not

limited to:

(1) Information and referral;

(2) Transportation;

(3) Nutrition-related services that deal with hunger among the

elderly;

(4) Socialization/companionship;

(5) Educational and cultural opportunities;

(6) Counseling;

(7) Support services for families/caregivers;

(8) Volunteer opportunities;

(9) Employment services information;

(10) Health promotion and disease prevention services;

(11) Financial literacy education; and

(12) Elder abuse, including identity theft, education and outreach.

(e) "Non-profit agency" shall mean a corporation organized or existing

pursuant to the not-for-profit corporation law.

2. Notwithstanding any provision of this section, nothing contained

herein shall give the director or a designated agency any

administrative, fiscal, supervisory, or other authority whatsoever over

any plans, programs or expenditures authorized pursuant to titles

eighteen, nineteen and twenty of the federal social security act, or

over any unit of state or local government.

3. Funding. (a) The director shall, within the amounts appropriated

therefor, make funds available to designated agencies for the provision

of congregate services for elderly persons.

(b) The director shall distribute such funds based on a formula

developed by the office which shall take into account the geographic

distribution of elderly persons within the state and any other factors

deemed appropriate by the director.

4. (a) Except as otherwise provided in paragraph (b) of this

subdivision, the designated agency shall subcontract with public

agencies, not-for-profit agencies, or other entities to provide

congregate services.

(b) The designated agency may directly operate, with the approval of

the director, congregate services.

(c) The designated agency may use up to five percent of the total of

any funds provided to the designated agency pursuant to this section for

administration.

5. Designated agencies qualifying for funds under this section must

include in the current county plan, required under section two hundred

fourteen of this title, a description of the planning, coordination,

administrative and local funding priorities and activities necessary to

achieve the goals and objectives of this section.

6. Within the amounts appropriated therefor, counties authorized to

provide congregate services pursuant to this section shall be eligible

for reimbursement by the state of up to seventy-five percent of

allowable expenditures for approved services pursuant to this section.

7. The comptroller may withhold the payment of state aid to any county

in the event that such county alters or discontinues the operations

approved by the director pursuant to this section or otherwise fails to

comply with the regulations or requirements of the director.

8. Contracts for services. (a) For the purposes of this section,

counties are authorized to contract with public agencies,

municipalities, non-profit agencies, or such other entities as the

director may authorize.

(b) Congregate services provided pursuant to this section shall not be

provided directly by the designated agency unless approval is granted by

the director. Such approval may not be given by the director unless the

designated agency directly provided the service prior to approval of the

annual county plan by the director, or unless it can be shown that the

direct provision of a congregate service by the designated agency is

necessary due to the absence of an existing suitable provider to assure

an adequate supply of such service, or to ensure the quality of the

service provided.

(c) Pursuant to an agreement, two or more counties may join together

for the purposes of this section. Such agreements shall make provision

for the proportionate cost to be borne by each county, the employment of

personnel, the receipt and disbursement of funds, and any other matters

deemed necessary by the director.

9. For the purposes of obtaining state aid within the amounts

appropriated therefor under this section, a designated agency of an

Indian tribal organization shall qualify as though it were a designated

agency for a county.

10. On or before February first, two thousand five the office shall

submit a report to the chairs of the assembly ways and means committee,

the senate finance committee, and the director of the division of the

budget which evaluates and makes recommendations on the congregate

services initiative program. The report should include but not be

limited to the following information:

(a) A description of grant recipients and amount of funds received

through area offices on aging for the congregate services initiative.

The description of grant recipients should include: the types of

services offered at each site, the number of individuals served, and, to

the extent practicable, a profile of the individuals served. The office

should include a specific recommendation on whether a minimal set of

services should be required of each program or if flexible service

requirements should be maintained.

(b) A description of the benefits of the program, including any survey

information obtainable from participants in the program, family members,

or caregivers for whom the program may serve as respite. The description

of benefits should also address the extent to which availability of the

program helps to avoid unnecessary institutionalization of participants.

(c) A description of oversight and planning mechanisms built into the

program and an assessment of the extent to which reconfiguration of the

recreation program to the congregate services initiative has improved

the delivery and/or oversight of services.

(d) A description of how providers of congregate services initiative

services have coordinated with other agencies, providers, or counties,

who offer similar services.

(e) A description of any known factors which have either contributed

to successful service delivery or have hindered the congregate services

initiative program.

(f) An assessment of the need for and/or demand for congregate

initiative services and the extent to which the congregate services

initiative or any other available services, are currently addressing

those needs.

(g) Any other information the office for the aging deems relevant.

11. The executive department is authorized to collect any information

necessary from grant recipients or area offices on aging necessary to

complete this report.

12. With regard to direct grants to community based non-profit

organizations for the provision of congregate services to persons sixty

years of age or older to promote their health, independence and

involvement in the community, congregate services shall be provided at

community settings where eligible persons come together for services and

activities and shall include, but are not limited to: information and

referral; transportation; nutrition-related services; socialization;

educational and cultural opportunities; counseling; support services for

caregivers and families; volunteer opportunities; employment services

information; and health promotion and disease prevention services.

* § 217-a. Long term care insurance education and outreach program. 1.

For the purposes of this section, the term "long term care insurance

resource center" shall mean a project within an area agency on aging

funded pursuant to this section that provides direct assistance to the

general public in choosing and obtaining long term care insurance.

2. The commissioner of health, in consultation with the director of

the office for the aging and the superintendent of financial services,

is hereby authorized and directed, within amounts allocated therefor

pursuant to paragraph (qq) of subdivision one of section twenty-eight

hundred seven-v of the public health law, to establish a long term care

insurance education and outreach program within the department of health

for the purpose of informing and educating the general public about long

term care insurance, including those policies that are available through

the partnership for long term care program.

3. The commissioner of health, the superintendent of financial

services and the director of the office for the aging shall appoint a

state program coordinator to implement, administer and supervise the

long term care insurance education and outreach program, and coordinate

the development of the educational and informational materials. The

state program coordinator shall be an employee of the office for the

aging who shall be selected from among individuals with expertise and

experience in the fields of long term care insurance, and with other

qualifications determined by the commissioner of health, the

superintendent of financial services and the director of the office for

the aging to be appropriate for the position. The state program

coordinator shall, within amounts available, personally or through

authorized representatives, be responsible for training staff persons of

the program, including staff persons of the long term care insurance

resource centers, and shall provide for the collection and dissemination

of timely and accurate long term care insurance information to said

staff persons.

4. The long term care insurance education and outreach program shall,

within amounts available, consist of the following elements which shall

be provided by the office for the aging:

(a) educational and informational materials in print, audio, visual,

electronic or other media;

(b) public service announcements, advertisements, media campaigns,

workshops, mass mailings, conferences or presentations;

(c) establishment of a toll-free telephone hotline and electronic

services to provide information; and

(d) establishment of long term care insurance resource centers within

each area agency on aging.

5. Long term care insurance resource centers shall, within amounts

available, provide the general public with the following items or

services:

(a) educational and informational materials in print, audio, visual,

electronic or other media;

(b) public service announcements, advertisements, media campaigns,

workshops, mass mailings, conferences or presentations; and

(c) counseling, information, referral services, and direct assistance

in choosing and obtaining long term care insurance. Direct assistance

shall, within amounts available, include but not be limited to

assistance with the following:

(i) planning for the financing of long term care;

(ii) understanding policy options, benefits and appeal rights;

(iii) obtaining the coverage needed and the appropriate benefits; and

(iv) avoiding or reporting illegal billing, fraudulent practices or

scams.

Each long term care insurance resource center shall be responsible,

within amounts available, for providing a sufficient number of staff

positions (including volunteers) necessary to provide and carry out the

services of the long term care insurance education and outreach program,

provided that at least one position shall be filled by an individual who

is employed full time and paid by the area agency on aging. The long

term care insurance resource center shall be responsible for ensuring

that its staff persons have no conflict of interest in providing the

services described in subdivision four of this section.

6. Annually, in order to receive funding, each area agency on aging

shall submit a service plan and proposed budget for the operation of a

long term care insurance resource center to the state program

coordinator for approval. An area agency on aging shall be eligible to

receive funds in an amount of up to fifty thousand dollars, except that

an area agency on aging located within a city of one million or more

shall be eligible to receive funds in an amount of up to one hundred

thousand dollars.

7. The department of health shall produce, post on its website, make

available to others for reproduction, or contract with others to develop

such materials required by this section. The material produced pursuant

to this section shall be culturally and linguistically appropriate for

the communities served by the long term care insurance resource centers.

These materials shall be made available to the public free of charge.

8. In exercising any of their powers under this section, the

commissioner of health and/or the director of the office for the aging

may consult with appropriate agencies, organizations, and consumers and

providers of long term care insurance or organizations representing

them.

9. In addition to state funds allocated for programs under this

section, the commissioner of health and/or the director of the office

for the aging may accept funding from public sources for these programs,

and may undertake joint or cooperative programs with other public

entities or a private not-for-profit corporation which is neither a

provider or regulator of long term care insurance, or an affiliate or

unit of such agency or corporation.

10. The commissioner of health, the director of the office for the

aging and the superintendent of financial services shall issue an annual

report to the governor, the speaker of the assembly, and the temporary

president of the senate. Such report shall contain, at a minimum, the

following information: the number of individuals who have received

counseling and assistance by the long term care insurance education and

outreach program, their ages and their occupations; whether these

individuals have purchased a long term care insurance policy, and if so,

the policy that was purchased; a description of all of the services,

including counseling, education and outreach services, being provided by

the long term care education and outreach program, broken down by

county; the activities used to promote the partnership for long term

care program; and a description of the long term care education and

outreach program's funding sources and whether they are adequate. The

report shall also contain recommendations for targeting specific age

groups to buy long term care insurance, creating new methods of

promoting the purchase of long term care insurance, and improving long

term care insurance products.

11. An area agency on aging may use up to five percent of the total of

any funds provided to an area agency on aging pursuant to this section

for administration.

* NB Added Ch. 58/2004 Part B §23, language juxtaposed per Ch.

642/2004 §12

* NB Section number supplied by the Legislative Bill Drafting

Commission

Long-term care ombudsman. 1. Definitions. For the purposes of

this section, the following terms shall have the following meanings:

(a) "Administrative action" shall mean any action or decision by an

owner, employee, or agent of a long-term care facility, or by a

government agency, which affects the provision of service to residents

of or applicants for admission to long-term care facilities.

(b) "Immediate family" pertaining to conflicts of interest, shall mean

a member of the household or a relative with whom there is a close

personal or significant financial relationship.

(c) "Local ombudsman entity" shall mean any entity designated to

operate a local long-term care ombudsman program.

* (d) "Long-term care facilities" shall mean residential health care

facilities as defined in subdivision three of section twenty-eight

hundred one of the public health law; adult care facilities as defined

in subdivision twenty-one of section two of the social services law,

including those adult homes and enriched housing programs licensed as

assisted living residences, pursuant to article forty-six-B of the

public health law; or any facilities which hold themselves out or

advertise themselves as providing assisted living services and which are

required to be licensed or certified under the social services law or

the public health law. Within the amounts appropriated therefor,

"long-term care facilities" shall also mean managed long-term care plans

and approved managed long-term care or operating demonstrations as

defined in section forty-four hundred three-f of the public health law

and the term "resident", "residents", "patient" and "patients" shall

also include enrollees of such plans.

* NB Effective until December 31, 2027

* (d) "Long-term care facilities" shall mean residential health care

facilities as defined in subdivision three of section twenty-eight

hundred one of the public health law, adult care facilities as defined

in subdivision twenty-one of section two of the social services law, and

assisted living residences, as defined in article forty-six-B of the

public health law, or any facilities which hold themselves out or

advertise themselves as providing assisted living services and which are

required to be licensed or certified under the social services law or

the public health law.

* NB Effective December 31, 2027

(e) "Long-term care ombudsman" or "ombudsman" shall mean a person who:

(1) is an employee or volunteer of the state office for the aging or

of a designated local ombudsman entity and represents the state

long-term care ombudsman program;

(2) has been verified as having successfully completing a

certification training program developed by the state ombudsman; and

(3) has a current designation as a long-term care ombudsman by the

state long-term care ombudsman.

(f) "Resident representative" shall mean either of the following:

(1) an individual chosen by the resident to act on behalf of the

resident in order to support the resident in decision-making; access

medical, social, or other personal information of the resident; manage

financial matters; or receive notifications;

(2) a person authorized by state or federal law (including but not

limited to agents under power of attorney, representative payees, and

other fiduciaries) to act on behalf of the resident in order to support

the resident in decision-making; access medical, social, or other

personal information of the resident; manage financial matters; or

receive notifications;

(3) a legal representative, as used in section 712 of the older

Americans act of 1965, as amended; or

(4) the court-appointed guardian or conservator of the resident.

(5) Nothing in this section is intended to expand the scope of

authority of any resident representative beyond that authority

specifically authorized by the resident, state or federal law, or a

court of competent jurisdiction.

(g) "State long-term care ombudsman" or "state ombudsman" shall mean

the individual who heads the office of the state long-term care

ombudsman and is responsible to personally, or through representatives

of the office of the state long-term care ombudsman, fulfill the

functions, responsibilities and duties of the office of the state

long-term care ombudsman.

(h) "Willful interference" shall mean actions or inactions taken by an

individual in an attempt to intentionally prevent, interfere with, or

attempt to impede an ombudsman from performing any of the functions or

responsibilities of the office of the state long-term care ombudsman.

2. Office of the state long-term care ombudsman established. (a) There

is hereby established within the state office for the aging an office of

the state long-term care ombudsman which shall be headed by the state

long-term care ombudsman, who shall carry out, directly and/or through

local ombudsman entities, the duties set forth in this section.

(b) The office of the state long-term care ombudsman is a distinct

entity, separately identifiable, and located within the state office for

the aging.

(c) The state office for the aging shall provide the long-term care

ombudsman program with legal counsel that is adequate, available, has

competencies relevant to the legal needs of the program, and is without

conflict of interest as determined by the state office for the aging in

consultation with the state long-term care ombudsman.

(d) The state office for the aging shall not establish personnel

policies or practices which prohibit the ombudsman from performing the

functions and responsibilities of the ombudsman, as set forth in this

section.

(e) Nothing in this section shall prohibit the state office for the

aging from requiring that the state ombudsman, or other employees of the

office of the state long-term care ombudsman, adhere to the personnel

policies and procedures of the state office for the aging.

3. State long-term care ombudsman. (a) The director of the state

office for the aging shall appoint a full-time state long-term care

ombudsman to administer and supervise the office of the state long-term

care ombudsman.

(b) The state ombudsman shall be selected from among individuals with

expertise and experience in long-term care and advocacy, long-term

services and supports or other direct services for older persons or

individuals with disabilities, consumer-oriented public policy advocacy,

leadership and program management skills, negotiation and problem

resolution skills, and with other qualifications determined by the

director of the state office for the aging to be appropriate for the

position.

(c) Any actual and potential conflicts of interest shall be identified

and addressed in accordance with subdivision ten of this section.

(d) The state ombudsman, personally or through authorized

representatives shall:

(1) identify, investigate and resolve complaints that are made by, or

on behalf of, long-term care residents in this state and that relate to

actions, inactions or decisions that may adversely affect the health,

safety and welfare or rights of such residents; the state ombudsman may

refer to the appropriate investigatory agency information obtained

during the investigation of a complaint which suggests the possible

occurrence of physical abuse, mistreatment or neglect or Medicaid fraud,

in accordance with the older Americans act of 1965, as amended and the

regulations promulgated thereunder as well as rules and regulations

promulgated by the state office for the aging; provided, however, that

upon consent of the resident, the ombudsman or state ombudsman shall

immediately make such referral. Nothing in this section shall be

construed as authorizing the state ombudsman to impose a resolution

unacceptable to either party involved in a complaint or to assume powers

delegated to the commissioner of health or the department of health

pursuant to article twenty-eight of the public health law or to the

commissioner of the office of children and family services or the office

of children and family services pursuant to the social services law; nor

does it authorize the state ombudsman to investigate final

administrative determinations made pursuant to law by such commissioners

if such decisions become the subject of complaints to the state

ombudsman;

(2) provide services to assist residents in protecting their health,

safety, welfare and rights, including but not limited to representing

the interests of residents before governmental agencies and seeking

appropriate administrative, legal and other remedies to protect their

welfare, safety, health and rights;

(3) inform the residents about means of obtaining services provided by

the long-term care ombudsman program and other public agencies;

(4) analyze, comment on, and monitor the development and

implementation of federal, state and local laws, regulations, policies

and actions that pertain to the health, safety, welfare, and rights of

the residents of long-term care facilities and services in the state;

(5) ensure that residents have regular and timely access to the

services provided through the long-term care ombudsman program and that

residents and complainants receive timely responses to requests for

information and complaints;

(6) recommend changes in federal, state and local laws, regulations,

policies, and actions pertaining to the health, safety, welfare, and

rights of residents;

(7) develop a certification training program and continuing education

for ombudsmen which at a minimum shall specify the minimum hours of

training, the annual number of hours of in-service training, and the

content of the training, including, but not limited to, training

relating to cultural competency and diversity, federal, state, and local

laws, regulations, and policies with respect to long-term care

facilities in the state, investigative and resolution techniques, and

such other training-related matters as the state ombudsman determines to

be appropriate;

(8) provide administrative and technical assistance to long-term care

ombudsmen and local ombudsman entities;

(9) make determinations and establish positions of the office of the

state long-term care ombudsman, without necessarily representing the

determinations or positions of the state office for the aging;

(10) recommend to the director of the state office for the aging

policies and procedures for the state long-term care ombudsman program;

(11) coordinate with and promote the development of citizen

organizations consistent with the interests of residents;

(12) promote, provide technical support for the development of, and

provide ongoing support as requested by resident and family councils to

protect the well-being and rights of residents;

(13) provide leadership to statewide systems advocacy efforts of the

office of the state long-term care ombudsman on behalf of long-term care

facility residents, including coordination of systems advocacy efforts

carried out by representatives of the office of the state long-term care

ombudsman;

(14) in accordance with applicable state contracting procedures,

coordinate with the state office for the aging in the review and

approval of plans or contracts governing local ombudsman entity

operations;

(15) carry out such other activities as the director of the state

office for the aging determines to be appropriate pursuant to the

federal older Americans act of 1965 and other applicable federal and

state laws and related regulations as may, from time to time, be

amended; and

(16) in accordance with the regulations promulgated under this section

provide the director of the state office for the aging with notice prior

to performing the activities identified in paragraphs four, six and nine

of this subdivision. Such notice shall not give the director of the

state office for the aging or any other state official the right to

pre-approve the position or communications of the state ombudsman.

(e) The state ombudsman, with the approval of the director of the

state office for the aging, may appoint one or more assistant state

long-term care ombudsmen to assist the state ombudsman in the

performance of his or her duties under this section. Such assistant

state ombudsmen must be verified as having completed a certification

training program developed by the state ombudsman within six (6) months

of their appointment as assistant state ombudsmen.

(f)(1) The state ombudsman shall only appoint as ombudsmen individuals

who have been verified as completing the certification training program

developed by the state ombudsman. In addition, the state long-term care

ombudsman may refuse, suspend, or remove such appointments of ombudsmen.

(2) The state ombudsman shall develop a grievance process to offer an

opportunity for reconsideration of any decision to refuse, suspend, or

remove appointment of any ombudsman. Notwithstanding the grievance

process, the state ombudsman shall make the final determination to

designate or to refuse, suspend, or remove appointment of an ombudsman.

(g) Any actual and potential conflicts of interest shall be identified

and addressed in accordance with subdivision ten of this section.

* (h) Within the amounts appropriated therefor, the state long-term

care ombudsman program shall include services specifically designed to

serve persons enrolled in managed long-term care plans or approved

managed long-term care or operating demonstrations authorized under

section forty-four hundred three-f of the public health law, and shall

also review and respond to complaints relating to marketing practices by

such plans and demonstrations.

* NB Repealed December 31, 2025

4. Local long-term care ombudsman program. (a) The state ombudsman, in

accordance with applicable state contracting procedures, may designate

an entity to operate a local long-term care ombudsman program for one or

more counties, and shall monitor the performance of such entity. If the

state office for the aging is aware or becomes aware of any evidence

that the designation of an entity to operate a long-term care ombudsman

program by the state long-term care ombudsman would result in legal

concerns or liability for the state office for the aging or office of

the state long-term care ombudsman, the state ombudsman will comply with

the state office for the aging's determination that such designation

should not be made.

(b) The designated entity shall be an area agency on aging, a public

agency or a private not-for-profit corporation which is free from any

conflict of interest that cannot be remedied. Any actual and potential

conflicts of interest shall be identified and addressed in accordance

with subdivision ten of this section.

(c)(1) Each local long-term care ombudsman program shall be directed

by a qualified individual who is employed and paid by the local entity

and who shall have the duties and responsibilities as provided in

regulations, consistent with the provisions of this section and of Title

VII of the federal older Americans act of 1965, as amended. In addition,

upon designation, the entity is responsible for providing for adequate

and qualified staff, which may include trained volunteers to perform the

functions of the local long-term care ombudsman program.

(2) No local program staff, including the supervisor and any

volunteers, shall perform or carry out the activities on behalf of the

state long-term care ombudsman program unless such staff has been

verified as completing the training program developed by the state

ombudsman and has been approved by the state ombudsman as qualified to

carry out the activities on behalf of the local program.

(d) When the state ombudsman determines that a local long-term care

ombudsman program does not meet the standards set forth in this section

and in any related regulations, the state ombudsman, in coordination

with the state office for the aging, may refuse, suspend, or remove the

designation of the local ombudsmen entity. Prior to taking such action,

the state ombudsman shall send to the affected local program a notice of

the state ombudsman's intentions to refuse, suspend, or remove the

designation; provided, however, if the state office for the aging is

aware or becomes aware of evidence that the designation or continued

designation of an entity to operate a long-term care ombudsman program

would result in legal concerns or liability for the state office for the

aging or the office of the state long-term care ombudsman, the state

ombudsman will comply with the state office for the aging's

determination that such designation should not be made or that such

designation be refused, suspended, or removed.

(e) The state ombudsman shall develop a grievance process to offer an

opportunity for reconsideration of any decision to refuse, suspend, or

remove the designation of a local ombudsman entity. Notwithstanding the

grievance process, the state ombudsman shall make the final

determination to designate or to refuse, suspend, or remove the

designation of a local ombudsman entity; provided, however, if the state

office for the aging is aware or becomes aware of any evidence that the

designation of an entity to operate a long-term care ombudsman program

by the state long-term care ombudsman or that the failure of the state

ombudsman to refuse, suspend, or remove the designation of a local

ombudsman entity would result in legal concerns or liability for the

state office for the aging or the office of the state long-term care

ombudsman, the state ombudsman will comply with the state office for the

aging's determination that such designation should not be made or that

such designation be refused, suspended, or removed.

5. Review of complaint. Upon receipt of a complaint, the ombudsman or

state ombudsman shall determine whether there are reasonable grounds for

an investigation. Such investigation shall be conducted in a manner

prescribed in regulations. The ombudsman or state ombudsman may

immediately refer to the appropriate investigatory agency information

obtained during the investigation of a complaint which suggests the

possible occurrence of physical abuse, mistreatment or neglect or

Medicaid fraud, in accordance with and subject to any limitations

identified in the older Americans act of 1965, as amended and the

regulations promulgated thereunder as well as rules and regulations

promulgated by the state office for the aging; provided, however, that

upon consent of the resident, the ombudsman or state ombudsman shall

immediately make such referral.

6. Record access. (a) An ombudsman and state ombudsman shall have

access to:

(1) medical, social and other records relating to a resident, if:

(A) the resident or resident representative communicates informed

consent to the access and the consent is given in writing or through the

use of auxiliary aids and services, provided that a guardian appointed

pursuant to article seventeen-A of the surrogate's court procedure act

or article eighty-one of the mental hygiene law who has the authority

pursuant to court order to give such consent shall supersede any other

resident representatives;

(B) the resident or resident representative communicates informed

consent orally, visually, or through the use of auxiliary aids and

services, and such consent is documented contemporaneously by an

ombudsman in accordance with procedures established by the state

ombudsman, provided that a guardian appointed pursuant to article

seventeen-A of the surrogate's court procedure act or article eighty-one

of the mental hygiene law who has the authority pursuant to court order

to give such consent shall supersede any other resident representatives;

and

(C) access is necessary in order to investigate a complaint, the

resident representative refuses to consent to the access, an ombudsman

has reasonable cause to believe that the resident representative is not

acting in the best interests of the resident, and the ombudsman obtains

the approval of the state ombudsman;

(2) administrative records, policies, and documents, to which the

residents have or the general public has access, of long-term care

facilities;

(3) all licensing and certification records maintained by the state

with respect to long-term care facilities and copies thereof upon

request; and

(4) a list of resident names and room numbers.

(b) No ombudsman or state ombudsman shall disclose files, records, or

information about a complaint, including identifying information of any

resident or complainant unless:

(1) the complainant or resident or his or her resident representative

communicates informed consent to the ombudsman in writing, provided that

a guardian appointed pursuant to article seventeen-A of the surrogate's

court procedure act or article eighty-one of the mental hygiene law who

has the authority pursuant to court order to give such consent shall

supersede any other resident representatives.

(2) the complainant or resident or his or her resident representative

communicates informed consent orally or visually, including through the

use of auxiliary aids and services, and such consent is documented

contemporaneously by an ombudsman or state ombudsman in accordance with

the procedures of the office of the state long-term care ombudsman,

provided that a guardian appointed pursuant to article seventeen-A of

the surrogate's court procedure act or article eighty-one of the mental

hygiene law who has the authority pursuant to court order to give such

consent shall supersede any other resident representatives;

(3) the disclosure is required pursuant to a court order; or

(4) the resident is unable to communicate informed consent and does

not have a resident representative, or the state long-term care

ombudsman determines that the resident representative has taken an

action, inaction or made a decision that may adversely affect the

health, safety, welfare, or rights of the resident. In such cases,

disclosures may be made in accordance with criteria to be developed by

the state ombudsman.

(c) all files, records, and other information of the long-term care

ombudsman program, including information maintained by local ombudsman

entities pertaining to the cases and activities of the program are the

property of the office of the state long-term care ombudsman. Such

files, records, and information may be disclosed only at the discretion

of the state ombudsman or designee of the state ombudsman for such

purpose and in accordance with the criteria developed by the state

ombudsman.

(d) No ombudsman or state ombudsman shall disclose to any person

outside of the long-term care ombudsman program any information obtained

from a resident's record without the approval of the state ombudsman or

his or her designee, in accordance with procedures for disclosure

established by the state ombudsman.

(e) No ombudsman or state ombudsman who directly or indirectly obtains

access to a resident's medical or personal records pursuant to section

twenty-eight hundred three-c of the public health law shall disclose to

such resident or to any other person outside of the long-term care

ombudsman program the content of any such records to which such resident

or other person had not previously had the right of access, provided

that this restriction shall not prevent such ombudsman from advising

such resident of the status or progress of an investigation or complaint

process initiated at the request of such resident or from referring such

complaint, together with the relevant records, to appropriate

investigatory agencies. Any person who intentionally violates the

provisions of this subdivision shall be guilty of a misdemeanor. Nothing

contained in this section shall be construed to limit or abridge any

right of access to records, including financial records, otherwise

available to ombudsmen, residents, or any other person.

(f) Notwithstanding any law to the contrary, any individual, when

acting in his or her official capacity as an ombudsman, shall be exempt

from the mandatory reporting of abuse, neglect, exploitation, or

maltreatment. However, an ombudsman may report abuse, neglect,

exploitation, or maltreatment in accordance with the older Americans act

of 1965, as amended and the regulations promulgated thereunder as well

as rules and regulations promulgated by the state office for the aging;

provided, however, that upon consent of the resident, the ombudsman or

state ombudsman shall immediately make such referral.

(g) Nothing in this section shall prohibit the disclosure by an

ombudsman, state ombudsman, or local ombudsman entity of non-identifying

aggregate data for monitoring or reporting purposes to the state office

for the aging or agency in which a local ombudsman entity is

organizationally located.

(h) Any information accessed pursuant to this subdivision by a

long-term care ombudsman or local ombudsman entity shall only be used

for the purposes of the long-term care ombudsman program. Any use of

such information other than for the purposes of the long-term care

ombudsman program or purposes authorized under this section may

constitute grounds for the designation of such ombudsman or local

ombudsman entity to be removed.

7. Access to long-term care facilities. An ombudsman or state

ombudsman shall have authority to enter all long-term care facilities at

any time during a facility's regular business hours or regular visiting

hours, and at any other time when access may be required by the

circumstances to be investigated and shall have access to all residents

and/or the resident representative to perform all functions and duties

enumerated herein.

8. Noninterference. No long-term care facility shall:

(a) refuse to permit an ombudsman or state ombudsman entry into such

facility or, interfere with, or refuse to cooperate with an ombudsman or

state ombudsman carrying out their mandated duties and responsibilities

set forth in this section and any regulations promulgated pursuant

thereto;

(b) retaliate against an ombudsman or state ombudsman for carrying out

his or her mandated duties and responsibilities set forth in this

section and any regulations promulgated pursuant thereto;

(c) refuse to permit residents or staff to communicate freely and

privately with an ombudsman; or

(d) retaliate or discriminate against any resident, resident

representative, complainant, or staff member for filing a complaint

with, providing information to, or otherwise cooperating with any

ombudsman or state ombudsman. Any resident who has reason to believe

that he or she may have been discriminated or retaliated against in

violation of subdivision eight of this section may file a complaint with

the commissioner of health pursuant to subdivision ten of section

twenty-eight hundred one-d of the public health law.

9. Failure to cooperate. Any such facility that violates the

provisions of subdivision eight of this section shall be subject to the

appropriate sanctions pursuant to section twenty-eight hundred three-c

of the public health law, and accompanying regulations, if such facility

is a residential healthcare facility or section four hundred sixty-d of

the social services law, and accompanying regulations, if such facility

is an adult care facility.

10. Conflict of interest. The state office for the aging and the state

ombudsman shall consider both the organizational and individual

conflicts of interest that may impact the effectiveness and credibility

of the work of the office of the state long-term care ombudsman. In so

doing, both the state office for the aging and the state ombudsman shall

be responsible to identify actual and potential conflicts and, where a

conflict has been identified, to remove or remedy such conflict as set

forth in paragraphs (b) and (d) of this subdivision.

(a) Identifying conflicts of interest. In identifying conflicts of

interest, the state office for the aging and the state ombudsman shall

consider the organizational conflicts that may impact the effectiveness

and credibility of the work of the office of the state long-term care

ombudsman. Organizational conflicts of interest include, but are not

limited to, placement of the office of the state long-term care

ombudsman, or requiring that a state ombudsman or long-term care

ombudsman perform conflicting activities, in an organization that:

(1) is responsible for licensing, surveying, or certifying long-term

care facilities;

(2) is responsible for licensing, surveying, or certifying long-term

care services;

(3) is an association (or an affiliate of such an association) of

long-term care facilities, or of any other residential facilities for

older individuals or individuals with disabilities;

(4) has any ownership or investment interest (represented by equity,

debt, or other financial relationship) in, or receives grants or

donations from, a long-term care facility;

(5) has governing board members with any ownership, investment, or

employment interest in long-term care facilities;

(6) provides long-term care to residents of long-term care facilities,

including the provision of personnel for long-term care facilities or

the operation of programs which control access to or services for

long-term care facilities;

(7) provides long-term care services, including programs carried out

under a Medicaid waiver approved under section 1115 of the Social

Security Act (42 U.S.C. 1315) or under subsection (b) or (c) of section

1915 of the Social Security Act (42 U.S.C. 1396n), subsection (i), (j),

or (k) of section 1915 of the Social Security Act (42 U.S.C. 1396n);

(8) provides long-term care case management;

(9) provides long-term care coordination or case management for

residents of long-term care facilities;

(10) sets reimbursement rates for long-term care facilities;

(11) sets reimbursement rates for long-term care services;

(12) provides adult protective services;

(13) is responsible for eligibility determinations regarding Medicaid

or other public benefits for residents of long-term care facilities;

(14) conducts preadmission screening for long-term care facility

placements;

(15) makes decisions regarding admission or discharge of individuals

to or from long-term care facilities; or

(16) provides guardianship, conservatorship, or other fiduciary or

surrogate decision-making services for residents of long-term care

facilities.

(b) Removing or remedying organizational conflicts. The state office

for the aging and the state ombudsman shall identify and take steps to

remove or remedy conflicts of interest between the office of the state

long-term care ombudsman and the state office for the aging or other

agency carrying out the state long-term care ombudsman program.

(1) The state ombudsman shall identify organizational conflicts of

interest in the state long-term care ombudsman program and describe

steps taken to remove or remedy conflicts within the annual report

submitted to the assistant secretary through the national ombudsman

reporting system.

(2) Where the office of the state long-term care ombudsman is located

within or otherwise organizationally attached to the state office for

the aging, the office for the aging shall:

(A) take reasonable steps to avoid internal conflicts of interest;

(B) establish a process for review and identification of internal

conflicts;

(C) take steps to remove or remedy conflicts;

(D) ensure that no individual, or member of the immediate family of an

individual, involved in the designating, appointing, otherwise selecting

or terminating the state ombudsman is subject to a conflict of interest;

and

(E) assure that the state ombudsman has disclosed such conflicts and

described steps taken to remove or remedy conflicts within the annual

report submitted to the assistant secretary through the national

ombudsman reporting system.

(3) Where the state office for the aging is unable to adequately

remove or remedy a conflict, it shall carry out the state long-term care

ombudsman program by contract or other arrangement with a public agency

or nonprofit private organization. The state office for the aging may

not enter into a contract or other arrangement to carry out the state

long-term care ombudsman program if the other entity, and may not

operate the office of the state long-term care ombudsman directly if it:

(A) is responsible for licensing, surveying, or certifying long-term

care facilities;

(B) is an association (or an affiliate of such an association) of

long-term care facilities, or of any other residential facilities for

older individuals or individuals with disabilities; or

(C) has any ownership, operational, or investment interest

(represented by equity, debt, or other financial relationship) in a

long-term care facility.

(4) Where the state office for the aging carries out the state

long-term care ombudsman program by contract or other arrangement with a

public agency or nonprofit private organization, the state office for

the aging shall:

(A) prior to contracting or making another arrangement, take

reasonable steps to avoid conflicts of interest in such agency or

organization which is to carry out the state long-term care ombudsman

program and to avoid conflicts of interest in the state office for the

aging oversight of the contract or arrangement;

(B) establish a process for periodic review and identification of

conflicts;

(C) establish criteria for approval of steps taken by the agency or

organization to remedy or remove conflicts;

(D) require that such agency or organization have a process in place

to:

(i) take reasonable steps to avoid conflicts of interest, and

(ii) disclose identified conflicts and steps taken to remove or remedy

conflicts to the state office for the aging for review and approval.

(5) Where an agency or organization carrying out the state long-term

care ombudsman program by contract or other arrangement develops a

conflict and is unable to adequately remove or remedy a conflict, the

state office for the aging shall either operate the state long-term care

ombudsman program directly or by contract or other arrangement with

another public agency or nonprofit private organization. The state

office for the aging shall not enter into such contract or other

arrangement with an agency or organization which is responsible for

licensing or certifying long-term care facilities in the state or is an

association (or affiliate of such an association) of long-term care

facilities.

(6) Where local ombudsman entities provide ombudsman services, the

state ombudsman shall:

(A) prior to designating or renewing designation, take reasonable

steps to avoid conflicts of interest in any agency which may host a

local ombudsman entity,

(B) establish a process for periodic review and identification of

conflicts of interest with the local ombudsman entity in any agencies

hosting a local ombudsman entity,

(C) require that such agencies disclose identified conflicts of

interest with the local ombudsman entity and steps taken to remove or

remedy conflicts within such agency to the state ombudsman,

(D) establish criteria for approval of steps taken to remedy or remove

conflicts in such agencies, and

(E) establish a process for review of and criteria for approval of

plans to remove or remedy conflicts with the local ombudsman entity in

such agencies.

(7) Failure of an agency hosting a local ombudsman entity to disclose

a conflict to the office of the state long-term care ombudsman or

inability to adequately remove or remedy a conflict shall constitute

grounds for refusal, suspension, or removal of designation of the local

ombudsman entity by the state ombudsman.

(c) Identifying individual conflicts of interest. (1) In identifying

conflicts of interest, the state office for the aging and the state

ombudsman shall consider individual conflicts that may impact the

effectiveness and credibility of the work of the office of the state

long-term care ombudsman or local long-term care ombudsman program.

(2) Individual conflicts of interest for the state ombudsman,

long-term care ombudsmen, and members of their immediate family include,

but are not limited to:

(A) direct involvement in the licensing or certification of a

long-term care facility or of a provider of a long-term care service;

(B) ownership, operational, or investment interest (represented by

equity, debt, or other financial relationship) in an existing or

proposed long-term care facility or a long-term care service;

(C) employment of an individual by, or participation in the management

of, a long-term care facility in the service area or by the owner or

operator of any long-term care facility in the service area;

(D) receipt of, or right to receive, directly or indirectly,

remuneration (in cash or in kind) under a compensation arrangement with

an owner or operator of a long-term care facility;

(E) accepting gifts or gratuities of significant value from a

long-term care facility or its management, a resident or a resident

representative of a long-term care facility in which the state ombudsman

or long-term care ombudsman provide services (except where there is a

personal relationship with a resident or resident representative which

is separate from the individual's role as state ombudsman or long-term

care ombudsman);

(F) accepting money or any other consideration from anyone other than

the office of the state long-term care ombudsman, or an entity approved

by the state ombudsman, for the performance of an act in the regular

course of the duties of the state ombudsman or long-term care ombudsman

without state ombudsman approval;

(G) serving as guardian, conservator, or in another fiduciary or

surrogate decision-making capacity for a resident of a long-term care

facility in which the state ombudsman or long-term care ombudsman

provides services; and

(H) serving residents of a facility in which an immediate family

member resides.

(d) Removing or remedying individual conflicts. (1) The state office

for the aging or state ombudsman shall develop and implement policies

and procedures to ensure that no state ombudsman or long-term care

ombudsman are required or permitted to hold positions or perform duties

that would constitute a conflict of interest as set forth in paragraph

(c) of this subdivision. This rule does not prohibit the state office

for the aging or state ombudsman from having policies or procedures that

exceed these requirements.

(2) When considering the employment, appointment, or designation of an

individual as the state ombudsman or as a long-term care ombudsman, the

state office for the aging or other employing or appointing entity

shall:

(A) take reasonable steps to avoid employing, appointing, or

designating an individual who has an unremedied conflict of interest or

who has a member of the immediate family with an unremedied conflict of

interest;

(B) take reasonable steps to avoid assigning an individual to perform

duties which would constitute an unremedied conflict of interest;

(C) establish a process for periodic review and identification of

conflicts of state ombudsman and long-term care ombudsmen; and

(D) take steps to remove or remedy conflicts.

(3) In no circumstance shall the entity which appoints, employs, or

designates the state ombudsman appoint, employ, or designate an

individual as the state ombudsman who:

(A) has direct involvement in the licensing or certification of a

long-term care facility;

(B) has an ownership or investment interest (represented by equity,

debt, or other financial relationship) in a long-term care facility.

Divestment within a reasonable period may be considered an adequate

remedy to this conflict;

(C) has been employed by or participating in the management of a

long-term care facility within the previous twelve months; or

(D) receives, or has the right to receive, directly or indirectly,

remuneration (in cash or in kind) under a compensation arrangement with

an owner or operator of a long-term care facility.

(4) In no circumstance shall the state office for the aging or an

agency hosting a local ombudsman entity appoint, employ, or designate an

individual, nor shall the state ombudsman designate an individual, as a

long-term care ombudsman who:

(A) has direct involvement in the licensing or certification of a

long-term care facility;

(B) has an ownership or investment interest (represented by equity,

debt, or other financial relationship) in a long-term care facility.

Divestment within a reasonable period may be considered an adequate

remedy to this conflict;

(C) receives, directly or indirectly, remuneration (in cash or in

kind) under a compensation arrangement with an owner or operator of a

long-term care facility; or

(D) is employed by, or participating in the management of, a long-term

care facility.

(i) An agency which appoints or employs long-term care ombudsmen shall

make efforts to avoid appointing, employing, or designating an

individual as a long-term care ombudsman who has been employed by or

participating in the management of a long-term care facility within the

previous twelve months.

(ii) Where such individual is appointed, employed, or designated, the

agency shall take steps to remedy the conflict.

11. Civil immunity. Notwithstanding any other provision of law,

ombudsmen designated under this section shall be included within the

definition of employee as set forth in section seventeen of the public

officers law and shall be defended and indemnified in accordance with

the provisions of article two of such law.

12. Grievance process. In addition to the provisions listed in this

section, the state ombudsman shall recommend policies and procedures for

the receipt and review of grievances regarding determinations or actions

of the state ombudsman or ombudsmen to the director of the state office

for the aging.

13. Regulations. The director of the state office for the aging, in

consultation with the state ombudsman, is authorized to promulgate

regulations to implement the provisions of this section.

14. Annual report. On or before March thirty-first, two thousand five,

and annually thereafter, the state ombudsman shall submit to the

governor, commissioner of the federal administration on aging, speaker

of the assembly, temporary president of the senate, director of the

state office for the aging, commissioner of the department of health,

and the commissioner of children and family services a report and make

such report available to the public:

(a) describing the activities carried out by the office of the state

long-term care ombudsman during the prior calendar year;

(b) containing and analyzing data relating to complaints and

conditions in long-term care facilities and to residents for the purpose

of identifying and resolving significant problems, including an

examination of any recurring complaints to determine if there are

systemic issues in such facilities;

(c) evaluating the problems experienced by, and the complaints made by

or on behalf of, residents;

(d) containing recommendations for appropriate state legislation,

rules and regulations and other action based on data collected pursuant

to this section, concerns raised by residents and families of residents,

and observations made when visiting long-term care facilities, to

improve the quality of the care and life of the residents, protecting

the health, safety and welfare and rights of the residents and resolving

resident complaints and identified problems or barriers;

(e) containing an analysis of the success of the long-term care

ombudsman program, including success in providing services to residents;

(f) describing barriers that prevent the optimal operation of the

ombudsman program;

(g) describing any organizational conflicts of interest in the

ombudsman program that have been identified and the steps taken to

remove or remedy such conflicts;

(h) containing all complaints received by the state ombudsman relating

to long-term care facilities including but not limited to complaints

that suggest the possible occurrence of physical abuse, mistreatment,

neglect or Medicaid fraud, listed by type of complaint, facility name

and by region;

(i) containing the number of visits to each long-term care facility,

listed by facility name and by region, and names of long-term care

facilities that did not receive any visits in the prior year; and

(j) any other matters as the state ombudsman, in consultation with the

director of the state office for the aging, determines to be

appropriate.

15. Outreach and awareness program. The state long-term care ombudsman

shall facilitate and coordinate the planning and implementation of an

outreach and awareness program to advertise and promote the long-term

care ombudsman program and to recruit additional ombudsmen. Such program

shall utilize educational and informational materials including, but not

limited to, media advertising, billboards, social media and the official

website of the long-term care ombudsman program.

Elderly abuse education and outreach program. 1. Definitions.

For the purposes of this section, the terms "designated agency" and

"elderly person" shall have the same meaning as ascribed to them in

section two hundred fourteen of this title.

2. The director, within the amounts appropriated therefor, shall, in

conjunction with the office of children and family services, establish

an elderly abuse education and outreach program for the purpose of

providing education and outreach to the general public, including

elderly persons and their families and caregivers, to identify and

prevent elderly abuse, neglect, exploitation, and identity theft.

3. (a) As part of the program, the director may award grants to

qualified designated agencies to establish local elderly abuse education

and outreach programs. Grants may also be awarded to expand or enhance

existing programs.

(b) In making such grants, the director shall consider:

(1) the need within the jurisdiction of the designated agency for such

education and outreach;

(2) the manner in which the designated agency proposes to provide such

education and outreach;

(3) the capacity of the designated agency to coordinate its services

with health, human service and law enforcement and public agencies which

provide services or assistance to the elderly, including the local

department of social services adult protective services unit; and

(4) any other criteria determined by the director to be appropriate.

4. (a) The office may use up to five percent of the total funds

appropriated pursuant to this section for administration.

(b) A designated agency which has been awarded a grant pursuant to

subdivision three of this section may use up to five percent of the

total of any funds provided to a designated agency pursuant to this

section for administration.

Resident advisor program. 1. Within amounts appropriated

therefor, the office may establish or administer as necessary a resident

advisor program in locales across the state and in such a manner that

insures a wide geographic representation.

2. The director of the office is directed to work in cooperation with

appropriate state and federal agencies to facilitate the successful

operation of local resident advisor program sites.

3. In administering the resident advisor program, the director is

directed to provide program sites with technical assistance to housing

and supportive service providers; training of an ongoing nature for

program sponsors; marketing materials and technical assistance aimed at

obtaining resident acceptance to resident advisors; and assistance in

developing necessary linkages between state, federal and local partners.

Senior citizen energy packaging pilot program. 1. (a) The

legislature finds and declares that a significant percentage of the

state's senior citizens live at or below the poverty level. In many

cases, energy costs reach or exceed thirty percent of household income.

These factors make energy conservation efforts on behalf of low income

elderly crucial. The legislature further finds that energy conservation

programs have been under-utilized by such citizens because of such

factors as reduced mobility, social and physical isolation, and the

complexity of the maze of services available.

(b) The legislature therefore declares that a pilot program to assist

such citizens to conserve energy should be implemented by the office in

conjunction with county offices for the aging. The legislature further

declares that such a program will further the energy conservation

objectives of the state and should be partially supported by petroleum

overcharge restitution funds.

2. Within the amounts appropriated therefor, the office shall

establish guidelines for and administer a senior citizen energy

packaging pilot program to be carried out by county offices for the

aging in the counties of Nassau, Suffolk, Broome, Erie, and Tompkins and

such other counties as funds may allow. Wherever possible, such program

shall be coordinated with appropriate existing programs of public

utilities, the state energy office, and the department of state.

3. These appropriations shall be used specifically for the training of

personnel within county offices for the aging to insure their thorough

familiarity with state and federal energy conservation programs and

benefits and their ability to facilitate receipt of such benefits by the

client population. These appropriations shall also be used to provide

salaries, appropriate benefits and expenses of such personnel in

carrying out the purposes of the pilot program. Depending on the size of

the client population to be served, no more than five of such personnel

shall be trained and utilized in any county.

4. The client population shall consist of those senior citizens living

at or below the poverty level. Whenever possible, priority shall be

given to serving first those in greatest need of assistance, including

but not limited to, home energy assistance program recipients.

Economically sustainable transportation demonstration program.

1. Definitions. As used in this section:

(a) "Economically sustainable transportation provider" shall mean a

non-profit provider of transportation services that submits to the

director and obtains approval of a plan demonstrating that the provider

is capable of providing economically sustainable transportation

services.

(b) "Economically sustainable transportation services" shall mean

demand-responsive transportation services that are provided:

(1) by automobile;

(2) to qualified individuals;

(3) twenty-four hours a day, seven days a week; and

(4) by volunteer or paid drivers.

(c) "Qualified individual" shall mean an individual who is:

(1) an older individual, as defined in section 102 of the Older

Americans Act of 1965 (42 U.S.C. 3002); or

(2) an individual who is blind, within the meaning of the

Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.), an individual who

has significant visual impairment described in section 751 of the

Rehabilitation Act of 1973 (29 U.S.C. 796j), or an individual who is

eligible for benefits under title II or XVI of the Social Security Act

(42 U.S.C. 401 et seq., 1381 et seq.) on the basis of blindness.

(d) "Qualified transportation account" shall mean an account

established for a qualified individual for the purpose of acquiring

transportation services from an economically sustainable transportation

provider.

(e) "Director" shall mean the director of the New York state office

for the aging.

(f) "Eligible entity" shall mean a private non-profit organization

with experience in establishing and replicating the independent

transportation network to provide economically sustainable

transportation services for qualified individuals.

2. The director shall establish the economically sustainable

transportation demonstration program for the purpose of enabling seniors

to remain independent and mobile in their community. The program would

provide an on demand transit service for seniors that would use

automobiles driven by volunteer and paid drivers to transport seniors to

where they need and want to go. After a period of five years, the

program would no longer be eligible for state funding and would be

completely self-sustaining, relying on consumer fares and voluntary

community support to remain operational.

3. Before carrying out the economically sustainable transportation

demonstration program, the director shall enter into a contract or a

cooperative agreement with an eligible entity to provide recommendations

and support to the director regarding the administration of such a

program.

(a) The eligible entity that enters into a contract or agreement under

subdivision three of this section shall:

(1) Provide initial and ongoing technical assistance and support to

the director for the administration of the sustainable transportation

demonstration program.

(2) Provide initial and ongoing technical assistance to economically

sustainable transportation providers.

(3) Provide recommendation to the director about the establishment of,

and requirements concerning locations where the economically sustainable

transportation services will be provided in the state.

(4) Provide recommendations to the director for the creation and use

of qualified transportation accounts for the transportation services,

including the provisions that such an account:

(i) may be funded with credits or funds equal to the value of a

vehicle traded to an economically sustainable transportation provider

by, or on behalf of, a qualified individual, or by other means;

(ii) shall be used only to provide transportation services to the

qualified individual;

(iii) shall have a designated beneficiary; and

(iv) shall be transferable to an individual other than the qualified

individual.

(5) Provide recommendations to the director regarding participation in

any federal grant program for an economically sustainable transportation

program.

4. After receiving the recommendations and support described in

subdivision three of this section, the director shall develop a request

for proposal to carry out the economically sustainable demonstration

program.

5. Copyrights and trademarks. Nothing in this section shall affect the

rights of the eligible entity under the copyright or trademark laws of

the United States. Nothing in this section shall require the disclosure

of information to which Federal law relating to trade secrets (including

section 552(b)(4) of title 5, United States Code) applies. In entering

into a contract or cooperative agreement under this section, the

director shall not establish any conditions that affect such rights or

require such disclosure.

6. Within amounts appropriated, the director shall make grants

available to qualified economically sustainable transportation providers

of no less than fifty-five thousand dollars per grantee in the first

year of the operation of the program. Such providers shall be eligible

to receive funding under this section annually for up to five years.

After such time, providers must be able to provide economically

sustainable transportation services without receiving further public

financial assistance for operating or capital expenses.

7. To be eligible to receive a grant under this section, an

economically sustainable transportation provider shall commit to raising

matching funds from non-state sources equal to fifty percent of the

state grant. Up to ten percent of the provider match may be provided

in-kind.

8. The office may use up to twelve percent of the total of any funding

appropriated pursuant to this section for administration.

Informal caregivers in the workplace program. 1. The office

shall, in conjunction with the department of labor, and in consultation

with community based organizations representing the interests of

informal caregivers around the state, develop and update on a yearly

basis a guide for businesses in the state that contains current best

practices for retaining employees who are also informal caregivers and

information for supporting such employees so they can achieve

effectiveness both in and out of the workplace.

2. Such guide shall be available on the websites of the office, the

department of labor and the department of state. Businesses that obtain

certification or licensure from the department of labor or department of

state shall be provided with a link to the guide provided for in

subdivision one of this section, or a paper copy upon request, when the

business applies for such certification or licensure. A nominal fee may

be charged for paper copies provided to individuals who are not business

owners.

Elder abuse enhanced multidisciplinary team program. 1. The

office is hereby authorized, subject to appropriation of funds for the

program, to establish an elder abuse enhanced multidisciplinary team

program consisting of teams at the regional or county level for complex

cases of elder abuse, including but not limited to financial

exploitation, physical abuse, psychological abuse, sexual abuse, and

neglect, involving a victim sixty years of age or older.

2. Such elder abuse enhanced multidisciplinary teams shall consist of

representation by professionals generally authorized to make decisions

on behalf of their agency from public, private, and voluntary agencies.

Represented professions may include, but are not limited to,

health/medical, mental health, aging, protective services, human

services, social work, banking/financial institutions, legal services,

district attorney's offices, law enforcement agencies, and forensic

accounting.

3. Teams will also consist of a coordinator who will provide case

consultation, triage cases, facilitate elder abuse enhanced

multidisciplinary team meetings, monitor progress, and facilitate

coordination and cooperative action in the provision of appropriate

services to an individual identified as being a victim of elder abuse,

as well as other duties associated with the role.

4. Notwithstanding any other provision of law to the contrary, members

of an elder abuse enhanced multidisciplinary team may share with other

team members client-identifiable information concerning victims of elder

abuse as appropriate to facilitate team activities.

Guide to actions when someone close dies. 1. The office shall

publish a "Guide to Actions When Someone Close Dies". Within one year of

the effective date of this section, this guide shall be made publicly

available on the official website of the office and the office may also

produce a paper format.

2. The guide shall provide information in at least the following

domains:

(a) Economic security, including but not limited to, pensions, social

security, life insurance, health insurance, and death benefits. This

information shall also refer to the resources provided by the department

of taxation and finance regarding estate taxes.

(b) Legal, including how to access death certificates, wills, trust

documents and other legal information needed to plan for the future.

(c) Mental health assistance, including information on the grieving

process, triggers and symptoms associated with grief, effective coping

strategies, the impact on family dynamics in relation to the loss of

someone close, and other mental health concerns correlated with grief.

(d) Disposition of remains including funeral and service arrangements

and burials. This information shall refer to the resources provided by

the department of health's bureau of funeral directing.

(e) Other information as determined by the office.

3. The office may choose to seek consultation with and advice from

representatives from the following professions as well as any state

agency representatives, which may include:

(a) Funeral directors;

(b) Cemeteries;

(c) Mental health professionals with specific knowledge of grief

counseling;

(d) Attorneys specialized in estate planning, including the New York

state bar association;

(e) Tax professionals; and

(f) Clergy.

Short title. This title shall be known and may be cited as the

"program for elderly pharmaceutical insurance coverage".

Definitions. For purposes of this title, the terms:

1. "Covered drug" shall mean a drug dispensed subject to a legally

authorized prescription pursuant to section sixty-eight hundred ten of

the education law, and insulin, an insulin syringe, or an insulin

needle. Such term shall not include: (a) any drug determined by the

commissioner of the federal food and drug administration to be

ineffective or unsafe; (b) any drug dispensed in a package, or form of

dosage or administration, as to which the commissioner of health finally

determines in accordance with the provisions of section two hundred

fifty-two of this title that a less expensive package, or form of dosage

or administration, is available that is pharmaceutically equivalent and

equivalent in its therapeutic effect for the general health

characteristics of the eligible program participant population; (c) any

device for the aid or correction of vision, or any drug, including

vitamins, which is generally available without a physician's

prescription; and (d) drugs for the treatment of sexual or erectile

dysfunction, unless such drugs are used to treat a condition, other than

sexual or erectile dysfunction, for which the drugs have been approved

by the federal food and drug administration. For the purpose of this

title, except as otherwise provided in this section, a covered drug

shall be dispensed in quantities no greater than a thirty day supply or

one hundred units, whichever is greater. In the case of a drug dispensed

in a form of administration other than a tablet or capsule, the maximum

allowed quantity shall be a thirty day supply; the commissioner is

authorized to approve exceptions to these limits for specific products

following consideration of recommendations from pharmaceutical or

medical experts regarding commonly packaged quantities, unusual forms of

administration, length of treatment or cost effectiveness. In the case

of a drug prescribed pursuant to section thirty-three hundred thirty-two

of the public health law to treat one of the conditions that have been

enumerated by the commissioner of health pursuant to regulation as

warranting the prescribing of greater than a thirty day supply, such

drug shall be dispensed in quantities not to exceed a three month

supply.

2. "Provider pharmacy" shall mean a pharmacy registered in the state

of New York pursuant to section sixty-eight hundred eight of the

education law, a non-resident establishment registered pursuant to

section sixty-eight hundred eight-b of the education law, or a pharmacy

registered in a state bordering the state of New York when certified as

necessary by the executive director pursuant to section two hundred

fifty-three of this title, for which an agreement to provide pharmacy

services for purposes of this program pursuant to section two hundred

forty-nine of this title is in effect.

3. "Income" shall mean "household gross income" as defined in the real

property tax circuit breaker credit program, pursuant to subparagraph

(C) of paragraph one of subsection (e) of section six hundred six of the

tax law, but only shall include the income of program applicants and

spouses and shall exclude the income of other members of the household.

4. "Contractor" shall mean a private not-for-profit or proprietary

corporation which has entered into a contractual arrangement with the

state to carry out the provisions of section two hundred forty-three of

this title.

5. "Resident" shall mean an individual legally domiciled within the

state.

6. "Annual coverage period" shall mean the period of twelve

consecutive calendar months for which an eligible program participant

has met the application fee or deductible requirements, as the case may

be, of sections two hundred forty-seven and two hundred forty-eight of

this title.

7. "Program year" shall mean a year beginning on October first and

ending the following September thirtieth.

8. "Medicare part D excluded drug classes" shall mean any drugs or

classes of drugs, or their medical uses, which are described in section

1927(d)(2) or 1927(d)(3) of the federal social security act, with the

exception of smoking cessation agents.

Program eligibility. 1. Persons eligible for comprehensive

coverage under section two hundred forty-seven of this title shall

include:

(a) any unmarried resident who is at least sixty-five years of age and

whose income for the calendar year immediately preceding the effective

date of the annual coverage period beginning on or after January first,

two thousand five, is less than or equal to twenty thousand dollars.

After the initial determination of eligibility, each eligible individual

must be redetermined eligible at least every twenty-four months; and

(b) any married resident who is at least sixty-five years of age and

whose income for the calendar year immediately preceding the effective

date of the annual coverage period when combined with the income in the

same calendar year of such married person's spouse beginning on or after

January first, two thousand one, is less than or equal to twenty-six

thousand dollars. After the initial determination of eligibility, each

eligible individual must be redetermined eligible at least every

twenty-four months.

2. Persons eligible for catastrophic coverage under section two

hundred forty-eight of this title shall include:

(a) any unmarried resident who is at least sixty-five years of age and

whose income for the calendar year immediately preceding the effective

date of the annual coverage period beginning on or after January first,

two thousand one, is more than twenty thousand and less than or equal to

seventy-five thousand dollars. After the initial determination of

eligibility, each eligible individual must be redetermined eligible at

least every twenty-four months; and

(b) any married resident who is at least sixty-five years of age and

whose income for the calendar year immediately preceding the effective

date of the annual coverage period when combined with the income in the

same calendar year of such married person's spouse beginning on or after

January first, two thousand one, is more than twenty-six thousand

dollars and less than or equal to one hundred thousand dollars. After

the initial determination of eligibility, each eligible individual must

be redetermined eligible at least every twenty-four months.

3. (a) Eligibility for assistance under this title shall not be

granted to any person who at the time an application is made is

receiving medical assistance under section three hundred sixty-six of

the social services law, or to any person receiving equivalent or better

coverage from any other public or private third party payment source or

insurance plan than those benefits provided for under this title.

(b) An individual who is determined eligible for assistance under this

title whose prescription costs are covered in part by any public or

private plan may receive reduced assistance under this title. In such

cases, benefits provided through this title shall be considered payments

of last resort.

(c) The participant registration fee charged to eligible program

participants for comprehensive coverage pursuant to section two hundred

forty-seven of this title shall be waived for the portion of the annual

coverage period that the participant is also enrolled as a full subsidy

individual in a prescription drug or MA-PD plan under part D of title

XVIII of the federal social security act.

(e) As a condition of eligibility for benefits under this title, if a

program participant's income indicates that the participant could be

eligible for an income-related subsidy under section 1860D-14 of the

federal social security act by either applying for such subsidy or by

enrolling in a medicare savings program as a qualified medicare

beneficiary (QMB), a specified low-income medicare beneficiary (SLMB),

or a qualifying individual (QI), a program participant is required to

provide, and to authorize the elderly pharmaceutical insurance coverage

program to obtain, any information or documentation required to

establish the participant's eligibility for such subsidy, and to

authorize the elderly pharmaceutical insurance coverage program to apply

on behalf of the participant for the subsidy or the medicare savings

program. The elderly pharmaceutical insurance coverage program shall

make a reasonable effort to notify the program participant of his or her

need to provide any of the above required information. After a

reasonable effort has been made to contact the participant, a

participant shall be notified in writing that he or she has sixty days

to provide such required information. If such information is not

provided within the sixty day period, the participant's coverage may be

terminated.

(f) As a condition of eligibility for benefits under this title, a

program participant is required to be enrolled in Medicare part D and to

maintain such enrollment. For unmarried participants with individual

annual income less than or equal to twenty-three thousand dollars and

married participants with joint annual income less than or equal to

twenty-nine thousand dollars, the elderly pharmaceutical insurance

coverage program shall pay for the portion of the part D monthly premium

that is the responsibility of the participant. Such payment shall be

limited to the low-income benchmark premium amount established by the

federal centers for medicare and medicaid services and any other amount

which such agency establishes under its de minimus premium policy.

(h) The elderly pharmaceutical insurance coverage program is

authorized to represent program participants under this title with

respect to their Medicare part D coverage.

(i) An individual who is determined to be eligible for assistance

under this article shall not become ineligible based upon income solely

because of an increase in either a public or private pension or an

increase in social security benefits as provided under federal law where

such increase does not exceed the consumer price index (all items United

States city average) for such year. This provision shall be limited to

one subsequent calendar year.

4. As a condition of eligibility for benefits under this title,

participants must be enrolled in medicare part D and maintain such

enrollment. For persons who meet the eligibility requirements to

participate in the elderly pharmaceutical insurance coverage program,

the program will pay for a drug covered by the person's medicare part D

plan or a drug in a medicare part D excluded drug class, as defined in

subdivision eight of section two hundred forty-one of this title,

provided that such drug is a covered drug, as defined in subdivision one

of section two hundred forty-one of this title, and that the participant

complies with the point of sale co-payment requirements set forth in

sections two hundred forty-seven and two hundred forty-eight of this

title. No payment shall be made for medicare part D plan deductibles.

Pharmaceutical insurance contract. 1. The commissioner of

health shall, subject to the approval of the director of the budget,

enter into a contract with one or more contractors to assist in carrying

out the provisions of this title. Such contractual arrangements shall be

made subject to a competitive process pursuant to the state finance law

and shall ensure that state payments for the contractor's necessary and

legitimate expenses for the administration of this program are limited

to the amount specified in advance, and that such payments shall not

exceed the amount appropriated therefor in any fiscal year. The

commissioner shall review the contract pricing provisions to assure that

the level of contract payments are in the best interest of the state,

giving consideration to the total level of participant enrollment

achieved, the volume of claims processed, and such other factors as may

be relevant in order to contain state expenditures. In the event that

the commissioner determines that the contract payment provisions do not

protect the interest of the state, the commissioner shall initiate

contract negotiations for the purpose of modifying contract payments

and/or scope requirements.

2. The responsibilities of the contractor or contractors shall

include, but need not be limited to:

(a) providing for a method of determining, on an annual basis and upon

their application therefor, the eligibility of persons pursuant to

section two hundred forty-two of this title within a reasonable period

of time, including alternative methods for such determination of

eligibility, such as through the mail or home visits, where reasonable

and/or necessary, and for notifying applicants of such eligibility

determinations;

(b) notifying each eligible program participant in writing upon the

commencement of the annual coverage period of such participant's

cost-sharing responsibilities pursuant to section two hundred

forty-seven of this title. The contractor shall also notify each

eligible program participant of any adjustment of the co-payment

schedule by mail no less than thirty days prior to the effective date of

such adjustments and shall inform such eligible program participants of

the date such adjustments shall take effect;

(c) issuing an identification card to each eligible program

participant;

(d) processing of claims for reimbursement to participating provider

pharmacies pursuant to section two hundred fifty of this title;

(e) performing or causing to be performed utilization reviews for such

purposes as may be required by the commissioner of health;

(f) conducting audits and surveys of participating provider pharmacies

as specified pursuant to the terms and conditions of the contract; and

(g) coordinating coverage with insurance companies and other public

and private organizations offering such coverage for those eligible

program participants having partial coverage for covered drugs through

third-party sources, and providing for recoupment of any duplicate

reimbursement paid by the state on behalf of such eligible program

participants.

3. The contractor or contractors shall be required to provide such

reports as may be deemed necessary by the commissioner of health and

shall maintain files in a manner and format approved by the

commissioner.

4. The contractor or contractors may contract with private

not-for-profit or proprietary corporations, or with entities of local

government within the state of New York, to perform such obligations of

the contractor or contractors as the commissioner of health shall

permit.

Powers of the commissioner of health. The powers of the

commissioner of health in administering the elderly pharmaceutical

insurance coverage program shall include but not be limited to the

following:

1. subject to the approval of the director of the budget, promulgating

program regulations pursuant to section two hundred forty-six of this

title;

2. determining the annual schedule of cost-sharing responsibilities of

eligible program participants pursuant to section two hundred

forty-seven of this title;

3. entering into contracts pursuant to section two hundred forty-three

of this title;

4. implementing alternative program improvements for the efficient and

effective operation of the program in accordance with the provisions of

this title;

5. establishing or contracting for a therapeutic drug monitoring

program, for the purpose of monitoring therapeutic drug use by eligible

program participants in an effort to prevent the incorrect or

unnecessary consumption of such therapeutic drugs; and

6. monitor the provision of services pursuant to contractual

arrangements entered into pursuant to section two hundred forty-three of

this title and examine and review all documents and other information to

assure compliance with all provisions of this article whether such

documents or other information are under the control of a contractor or

a participating provider pharmacy.

Information regarding the home energy assistance program for

program participants. 1. For the purposes of this section, the following

terms shall have the following meanings:

(a) "OTDA" shall mean the state office of temporary and disability

assistance.

(b) "Home energy assistance program" or "HEAP" shall mean the

low-income home energy assistance program implemented pursuant to

section ninety-seven of the social services law.

2. The department of health shall notify program participants and

provide information regarding eligibility and how to apply for the home

energy assistance program. Such information shall be provided with each

elderly pharmaceutical insurance coverage paper application that is

distributed and also annually to all program participants.

3. The department of health shall consult with OTDA and the office on

the development of the notification to program participants referenced

in subdivision two of this section.

4. If a participant's household applies for and is enrolled in the

home energy assistance program, the applicable local social services

district shall provide written notification and information to the

participant's household in accordance with OTDA regulations.

5. OTDA and the department of health, in consultation with each other,

are authorized to promulgate any rules and regulations necessary to

carry out the provisions of this section.

Regulations. Program regulations shall:

1. Provide for a process of determining and redetermining eligibility

for participation in this program including provisions for submission of

proof of income, age, and residency and information on existing complete

or partial coverage of prescription drug expenses under a third party

assistance or insurance plan;

2. Provide for a fair hearing process pursuant to an agreement with

the department of health for individuals and participating provider

pharmacies to appeal determinations or actions of the contractors;

3. Establish procedures for the state to recover the value of benefits

or payments made under this title, if any, that were based on

applications or claims submitted in violation of any provision of this

title; and

4. Establish procedures to ensure that all information obtained on

persons pursuant to paragraph (a) of subdivision two of section two

hundred forty-three of this title shall remain confidential and shall

not be disclosed to persons or agencies other than those entitled to

such information because such disclosure is necessary for the proper

administration of the program established pursuant to this title.

Cost-sharing responsibilities of eligible program participants

for comprehensive coverage.

1. Registration fee. Eligible individuals meeting the registration fee

requirements of this section may purchase prescribed covered drugs for

an amount specified by subdivision three of this section, subject to the

limits on point of sale co-payments specified by subdivision four of

this section.

2. Registration fee schedule. Eligible individuals electing to meet

the requirements of this subdivision shall pay a quarterly registration

fee in a manner and form determined by the executive director; at the

option of the participant, the registration fee may be paid annually in

a lump sum upon the beginning of the annual coverage period. No eligible

individual electing to meet the requirements of this subdivision shall

have his participation in the program lapse by virtue of non-payment of

the applicable registration fee unless the contractor has provided

notification of the amount and due date thereof, and more than thirty

days have elapsed since the due date of the individual's registration

fee. The registration fee to be charged to eligible program participants

for comprehensive coverage under this option shall be in accordance with

the following schedule:

(a) Quarterly registration fees for unmarried individual program

participants:

individual income of $5,000 or less $2.00

individual income of $5,001 to $6,000 $2.00

individual income of $6,001 to $7,000 $4.00

individual income of $7,001 to $8,000 $5.50

individual income of $8,001 to $9,000 $7.00

individual income of $9,001 to $10,000 $9.00

individual income of $10,001 to $11,000 $10.00

individual income of $11,001 to $12,000 $11.50

individual income of $12,001 to $13,000 $13.50

individual income of $13,001 to $14,000 $15.00

individual income of $14,001 to $15,000 $20.00

individual income of $15,001 to $16,000 $27.50

individual income of $16,001 to $17,000 $35.00

individual income of $17,001 to $18,000 $42.50

individual income of $18,001 to $19,000 $50.00

individual income of $19,001 to $20,000 $57.50

(b) Quarterly registration fees for each married individual program

participant:

joint income of $5,000 or less $2.00

joint income of $5,001 to $6,000 $2.00

joint income of $6,001 to $7,000 $3.00

joint income of $7,001 to $8,000 $4.00

joint income of $8,001 to $9,000 $5.00

joint income of $9,001 to $10,000 $6.00

joint income of $10,001 to $11,000 $7.00

joint income of $11,001 to $12,000 $8.00

joint income of $12,001 to $13,000 $9.00

joint income of $13,001 to $14,000 $10.00

joint income of $14,001 to $15,000 $10.00

joint income of $15,001 to $16,000 $21.00

joint income of $16,001 to $17,000 $26.50

joint income of $17,001 to $18,000 $31.50

joint income of $18,001 to $19,000 $37.50

joint income of $19,001 to $20,000 $43.00

joint income of $20,001 to $21,000 $48.50

joint income of $21,001 to $22,000 $54.00

joint income of $22,001 to $23,000 $59.50

joint income of $23,001 to $24,000 $65.00

joint income of $24,001 to $25,000 $68.75

joint income of $25,001 to $26,000 $75.00

(c) In the event that the state expenditures per participant meeting

the registration fee requirements of this subdivision, exclusive of

expenditures for program administration, in the program year commencing

October first, nineteen hundred eighty-eight, and in each program year

thereafter, exceed such expenditures in the previous program year by a

minimum of ten percent, the annual registration fees set forth in this

subdivision may, unless otherwise provided by law, be increased,

pro-rata, for the subsequent program year, provided that such increase

shall not exceed seven and one-half percent of the prior year

registration fees as may have been adjusted in accordance with this

paragraph.

(d) In the event that the state expenditures per such participant,

incurred pursuant to this subdivision, exclusive of expenditures for

program administration, in the program year commencing October first,

nineteen hundred eighty-eight, and in each program year thereafter, are

less than such expenditures in the previous program year by a minimum of

ten percent, the annual registration fees set forth in this subdivision

may, unless otherwise provided by law, be decreased, pro-rata, for the

subsequent program year, provided that such decrease shall not exceed

seven and one-half percent of the prior year registration fees as may

have been adjusted in accordance with this paragraph.

(e) The determination to adjust annual registration fees set forth in

this subdivision shall follow a review of such factors as the relative

financial capacity of the state and such eligible program participants

to support such adjustments and changes in the consumer price index. The

frequency of such adjustments shall not exceed once in any program year

and such adjustments shall not become effective for individual program

participants prior to the first day of the next annual coverage period

for each participant.

3. Point of sale co-payment. (a) Upon satisfaction of the registration

fee pursuant to this section an eligible program participant must pay a

point of sale co-payment as set forth in paragraph (b) of this

subdivision at the time of each purchase of a covered drug prescribed

for such individual. Such co-payment shall not be waived or reduced in

whole or in part subject to the limits provided by subdivision four of

this section.

(b) The point of sale co-payment amounts which are to be charged

eligible program participants shall be in accordance with the following

schedule:

For each prescription of covered drugs costing $15.00 or less.....$3.00

For each prescription of covered drugs costing $15.01 to $35.00...$7.00

For each prescription of covered drugs costing $35.01 to $55.00..$15.00

For each prescription of covered drugs costing $55.01 or more....$20.00

(c) For the purposes of the foregoing schedule of point of sale

co-payments, "costing" shall mean the amount of reimbursement which

shall be paid by the state to a participating provider pharmacy in

accordance with section two hundred fifty of this title plus the point

of sale co-payment, calculated as of the date of sale.

4. Limits on point of sale co-payments. During each annual coverage

period no point of sale co-payment as set forth in subdivision three of

this section shall be required to be made for the remainder of such

period by any eligible program participant who has already incurred

co-payments in excess of the limits set forth in the following schedule:

(a) Limits on co-payments by unmarried individual eligible program

participants:

individual income of $5,000 or less no more than $340

individual income of $5,001 to $6,000 no more than $408

individual income of $6,001 to $7,000 no more than $476

individual income of $7,001 to $8,000 no more than $544

individual income of $8,001 to $9,000 no more than $612

individual income of $9,001 to $10,000 no more than $700

individual income of $10,001 to $11,000 no more than $720

individual income of $11,001 to $12,000 no more than $827

individual income of $12,001 to $13,000 no more than $896

individual income of $13,001 to $14,000 no more than $964

individual income of $14,001 to $15,000 no more than $1,016

individual income of $15,001 to $16,000 no more than $1,034

individual income of $16,001 to $17,000 no more than $1,052

individual income of $17,001 to $18,000 no more than $1,070

individual income of $18,001 to $19,000 no more than $1,088

individual income of $19,001 to $20,000 no more than $1,160

(b) Limits on co-payments by each married individual eligible program

participant:

joint income of $5,000 or less no more than $291

joint income of $5,001 to $6,000 no more than $342

joint income of $6,001 to $7,000 no more than $399

joint income of $7,001 to $8,000 no more than $456

joint income of $8,001 to $9,000 no more than $513

joint income of $9,001 to $10,000 no more than $570

joint income of $10,001 to $11,000 no more than $622

joint income of $11,001 to $12,000 no more than $641

joint income of $12,001 to $13,000 no more than $660

joint income of $13,001 to $14,000 no more than $684

joint income of $14,001 to $15,000 no more than $710

joint income of $15,001 to $16,000 no more than $826

joint income of $16,001 to $17,000 no more than $877

joint income of $17,001 to $18,000 no more than $928

joint income of $18,001 to $19,000 no more than $980

joint income of $19,001 to $20,000 no more than $990

joint income of $20,001 to $21,000 no more than $1,008

joint income of $21,001 to $22,000 no more than $1,026

joint income of $22,001 to $23,000 no more than $1,044

joint income of $23,001 to $24,000 no more than $1,062

joint income of $24,001 to $25,000 no more than $1,080

joint income of $25,001 to $26,000 no more than $1,150

(c) Effective October first, nineteen hundred eighty-eight, the limits

on point of sale co-payments as set forth in this subdivision may be

adjusted by the panel on the anniversary date of each program

participant's annual coverage period, and such adjustment shall be in

effect for the duration of that annual coverage period. Any such annual

adjustment shall be made using a percentage adjustment factor which

shall not exceed one-half of the difference between the year-to-year

percentage increase in the consumer price index for all urban consumers,

as published by the United States Department of Labor, and, if larger,

the year-to-year percentage increase in the aggregate average cost of

covered drugs purchased under this title, which year-to-year percentage

increase in such cost shall be determined by comparison of such cost in

the same month of each of the appropriate successive years; provided,

however, that for any such adjustment based wholly on experience in the

program year commencing October first, nineteen hundred eighty-seven,

the year-to-year percentage increase in such cost shall be determined by

comparison of such cost in each of two months no less than five months

apart and within such program year, which comparison shall be

annualized. Such percentage adjustment factor shall be the same as that

used to determine any similar annual adjustment for the same annual

coverage periods pursuant to the provisions of subdivision four of

section two hundred forty-eight of this title.

(d) Such annual adjustments shall be calculated by multiplying the

percentage adjustment factor by (1) ten percent and applying the

resulting percentage to the upper income limitation of each income level

for unmarried individuals contained in this subdivision, and by (2)

seven and one-half percent and applying the resulting percentage to the

upper income limitation of each income level for married individuals

contained in this subdivision; each result of such calculations, minus

any applicable registration fee increases made pursuant to subdivision

two of this section and plus the result of applying the percentage

adjustment factor to the sum of any such annual adjustments applicable

thereto for any prior annual coverage period, shall be the amount by

which the limit on co-payments for each such income level may be

adjusted, and such amount shall be in addition to any such amount or

amounts applicable to prior annual coverage periods.

(e) The determination to adjust the limits on point of sale

co-payments set forth in this subdivision shall follow a review of such

factors as the relative financial capacity of the state and such

eligible program participants to support such adjustments.

Cost-sharing responsibilities of eligible program participants

for catastrophic coverage. 1. Deductible. Eligible individuals meeting

the deductible requirements of this section may purchase prescribed

covered drugs for an amount specified by subdivision three of this

section, subject to the limits on point of sale co-payments specified by

subdivision four of this section.

2. Deductible schedule. Eligible individuals electing to meet the

requirements of this subdivision shall incur an amount of personal

covered drug expenditures during any annual coverage period which are

not reimbursed by any other public or private third party payment source

or insurance plan, and shall be deemed to have met their deductible

requirements for the remainder of such annual coverage period. The

amount of personal covered drug expenditures to be incurred by eligible

program participants for catastrophic coverage under this option shall

be in accordance with the following schedule:

(a) Annual personal covered drug expenditures for unmarried individual

eligible program participants:

individual income of $20,001 to $21,000 $530

individual income of $21,001 to $22,000 $550

individual income of $22,001 to $23,000 $580

individual income of $23,001 to $24,000 $720

individual income of $24,001 to $25,000 $750

individual income of $25,001 to $26,000 $780

individual income of $26,001 to $27,000 $810

individual income of $27,001 to $28,000 $840

individual income of $28,001 to $29,000 $870

individual income of $29,001 to $30,000 $900

individual income of $30,001 to $31,000 $930

individual income of $31,001 to $32,000 $960

individual income of $32,001 to $33,000 $1,160

individual income of $33,001 to $34,000 $1,190

individual income of $34,001 to $35,000 $1,230

individual income of $35,001 to $36,000 $1,260

individual income of $36,001 to $37,000 $1,290

individual income of $37,001 to $38,000 $1,320

individual income of $38,001 to $39,000 $1,350

individual income of $39,001 to $40,000 $1,380

individual income of $40,001 to $41,000 $1,410

individual income of $41,001 to $42,000 $1,440

individual income of $42,001 to $43,000 $1,470

individual income of $43,001 to $44,000 $1,500

individual income of $44,001 to $45,000 $1,530

individual income of $45,001 to $46,000 $1,560

individual income of $46,001 to $47,000 $1,590

individual income of $47,001 to $48,000 $1,620

individual income of $48,001 to $49,000 $1,650

individual income of $49,001 to $50,000 $1,680

individual income of $50,001 to $51,000 $1,710

individual income of $51,001 to $52,000 $1,740

individual income of $52,001 to $53,000 $1,770

individual income of $53,001 to $54,000 $1,800

individual income of $54,001 to $55,000 $1,830

individual income of $55,001 to $56,000 $1,860

individual income of $56,001 to $57,000 $1,890

individual income of $57,001 to $58,000 $1,920

individual income of $58,001 to $59,000 $1,950

individual income of $59,001 to $60,000 $1,980

individual income of $60,001 to $61,000 $2,010

individual income of $61,001 to $62,000 $2,040

individual income of $62,001 to $63,000 $2,070

individual income of $63,001 to $64,000 $2,100

individual income of $64,001 to $65,000 $2,130

individual income of $65,001 to $66,000 $2,160

individual income of $66,001 to $67,000 $2,190

individual income of $67,001 to $68,000 $2,220

individual income of $68,001 to $69,000 $2,250

individual income of $69,001 to $70,000 $2,280

individual income of $70,001 to $71,000 $2,310

individual income of $71,001 to $72,000 $2,340

individual income of $72,001 to $73,000 $2,370

individual income of $73,001 to $74,000 $2,400

individual income of $74,001 to $75,000 $2,430

(b) Annual personal covered drug expenditures for each married

individual eligible program participant:

joint income of $26,001 to $27,000 $650

joint income of $27,001 to $28,000 $675

joint income of $28,001 to $29,000 $700

joint income of $29,001 to $30,000 $725

joint income of $30,001 to $31,000 $900

joint income of $31,001 to $32,000 $930

joint income of $32,001 to $33,000 $960

joint income of $33,001 to $34,000 $990

joint income of $34,001 to $35,000 $1,020

joint income of $35,001 to $36,000 $1,050

joint income of $36,001 to $37,000 $1,080

joint income of $37,001 to $38,000 $1,110

joint income of $38,001 to $39,000 $1,140

joint income of $39,001 to $40,000 $1,170

joint income of $40,001 to $41,000 $1,200

joint income of $41,001 to $42,000 $1,230

joint income of $42,001 to $43,000 $1,260

joint income of $43,001 to $44,000 $1,290

joint income of $44,001 to $45,000 $1,320

joint income of $45,001 to $46,000 $1,575

joint income of $46,001 to $47,000 $1,610

joint income of $47,001 to $48,000 $1,645

joint income of $48,001 to $49,000 $1,680

joint income of $49,001 to $50,000 $1,715

joint income of $50,001 to $51,000 $1,745

joint income of $51,001 to $52,000 $1,775

joint income of $52,001 to $53,000 $1,805

joint income of $53,001 to $54,000 $1,835

joint income of $54,001 to $55,000 $1,865

joint income of $55,001 to $56,000 $1,895

joint income of $56,001 to $57,000 $1,925

joint income of $57,001 to $58,000 $1,955

joint income of $58,001 to $59,000 $1,985

joint income of $59,001 to $60,000 $2,015

joint income of $60,001 to $61,000 $2,045

joint income of $61,001 to $62,000 $2,075

joint income of $62,001 to $63,000 $2,105

joint income of $63,001 to $64,000 $2,135

joint income of $64,001 to $65,000 $2,165

joint income of $65,001 to $66,000 $2,195

joint income of $66,001 to $67,000 $2,225

joint income of $67,001 to $68,000 $2,255

joint income of $68,001 to $69,000 $2,285

joint income of $69,001 to $70,000 $2,315

joint income of $70,001 to $71,000 $2,345

joint income of $71,001 to $72,000 $2,375

joint income of $72,001 to $73,000 $2,405

joint income of $73,001 to $74,000 $2,435

joint income of $74,001 to $75,000 $2,465

joint income of $75,001 to $76,000 $2,495

joint income of $76,001 to $77,000 $2,525

joint income of $77,001 to $78,000 $2,555

joint income of $78,001 to $79,000 $2,585

joint income of $79,001 to $80,000 $2,615

joint income of $80,001 to $81,000 $2,645

joint income of $81,001 to $82,000 $2,675

joint income of $82,001 to $83,000 $2,705

joint income of $83,001 to $84,000 $2,735

joint income of $84,001 to $85,000 $2,765

joint income of $85,001 to $86,000 $2,795

joint income of $86,001 to $87,000 $2,825

joint income of $87,001 to $88,000 $2,855

joint income of $88,001 to $89,000 $2,885

joint income of $89,001 to $90,000 $2,915

joint income of $90,001 to $91,000 $2,945

joint income of $91,001 to $92,000 $2,975

joint income of $92,001 to $93,000 $3,005

joint income of $93,001 to $94,000 $3,035

joint income of $94,001 to $95,000 $3,065

joint income of $95,001 to $96,000 $3,095

joint income of $96,001 to $97,000 $3,125

joint income of $97,001 to $98,000 $3,155

joint income of $98,001 to $99,000 $3,185

joint income of $99,001 to $100,000 $3,215

(c) In the event that the state expenditures per participant electing

to meet the deductible requirements of this subdivision, exclusive of

expenditures for program administration, in the program year commencing

October first, nineteen hundred eighty-eight, and in each program year

thereafter, exceed such expenditures in the previous program year by a

minimum of ten percent, the annual personal covered drug expenditures

set forth in this subdivision may, unless otherwise provided by law, be

increased, pro-rata, for the subsequent program year, provided that such

increase shall not exceed eight percent of the prior year personal

covered drug expenditures as may have been adjusted in accordance with

this paragraph.

(d) In the event that the state expenditures per such participant,

incurred pursuant to this subdivision, exclusive of expenditures for

program administration, in the program year commencing October first,

nineteen hundred eighty-eight, and in each program year thereafter, are

less than such expenditures in the previous program year by a minimum of

ten percent, the annual personal covered drug expenditures set forth in

this subdivision may, unless otherwise provided by law, be decreased,

pro-rata, for the subsequent program year, provided that such decrease

shall not exceed eight percent of the prior year personal covered drug

expenditures as may have been adjusted in accordance with this

paragraph.

(e) The determination to adjust annual personal covered drug

expenditures set forth in this subdivision, shall follow a review of

such factors as the relative financial capacity of the state and such

eligible program participants to support such adjustments and changes in

the consumer price index. The frequency of such adjustments shall not

exceed once in any twelve month period and such adjustments shall not

become effective for individual program participants prior to the first

day of the next annual coverage period for each participant.

3. Point of sale co-payment. (a) Upon satisfaction of the deductible

requirements pursuant to subdivision two of this section, an eligible

program participant shall pay a point of sale co-payment as set forth in

paragraph (b) of this subdivision at the time of each purchase of a

covered drug prescribed for such individual. Such co-payment shall not

be waived or reduced in whole or in part, subject to the limits provided

by subdivision four of this section.

(b) The point of sale co-payment amounts which are to be charged

eligible program participants shall be in accordance with the following

schedule:

For each prescription of covered

drugs costing $15.00 or less $3.00

For each prescription of covered

drugs costing $15.01 to $35.00 $7.00

For each prescription of covered

drugs costing $35.01 to $55.00 $15.00

For each prescription of covered

drugs costing $55.01 or more $20.00

(c) For the purposes of the foregoing schedule of point of sale

co-payments, "costing" shall mean the amount of reimbursement which

shall be paid by the state to a participating provider pharmacy in

accordance with section two hundred fifty of this title plus the point

of sale co-payment, calculated as of the date of sale.

4. Annual limits on point of sale co-payments. During each annual

coverage period, no point of sale co-payments as set forth in

subdivision three of this section shall be required to be made for the

remainder of such period by any eligible program participant meeting the

personal covered drug expenditure requirements of subdivision two of

this section in excess of the limits set forth in the following

schedule:

(a) Limits on co-payments by unmarried individual eligible program

participants:

individual income of $20,001 to $21,000 no more than $1,050

individual income of $21,001 to $22,000 no more than $1,100

individual income of $22,001 to $23,000 no more than $1,150

individual income of $23,001 to $24,000 no more than $1,200

individual income of $24,001 to $25,000 no more than $1,250

individual income of $25,001 to $26,000 no more than $1,300

individual income of $26,001 to $27,000 no more than $1,350

individual income of $27,001 to $28,000 no more than $1,400

individual income of $28,001 to $29,000 no more than $1,450

individual income of $29,001 to $30,000 no more than $1,500

individual income of $30,001 to $31,000 no more than $1,550

individual income of $31,001 to $32,000 no more than $1,600

individual income of $32,001 to $33,000 no more than $1,650

individual income of $33,001 to $34,000 no more than $1,700

individual income of $34,001 to $75,000 no more than $1,750

(b) Limits on co-payments by each married individual eligible program

participant:

joint income of $26,001 to $27,000 no more than $1,080

joint income of $27,001 to $28,000 no more than $1,120

joint income of $28,001 to $29,000 no more than $1,160

joint income of $29,001 to $30,000 no more than $1,200

joint income of $30,001 to $31,000 no more than $1,240

joint income of $31,001 to $32,000 no more than $1,280

joint income of $32,001 to $33,000 no more than $1,320

joint income of $33,001 to $34,000 no more than $1,360

joint income of $34,001 to $35,000 no more than $1,400

joint income of $35,001 to $36,000 no more than $1,440

joint income of $36,001 to $37,000 no more than $1,480

joint income of $37,001 to $38,000 no more than $1,520

joint income of $38,001 to $39,000 no more than $1,560

joint income of $39,001 to $40,000 no more than $1,600

joint income of $40,001 to $41,000 no more than $1,640

joint income of $41,001 to $42,000 no more than $1,680

joint income of $42,001 to $43,000 no more than $1,720

joint income of $43,001 to $44,000 no more than $1,760

joint income of $44,001 to $45,000 no more than $1,800

joint income of $45,001 to $46,000 no more than $1,840

joint income of $46,001 to $47,000 no more than $1,880

joint income of $47,001 to $48,000 no more than $1,920

joint income of $48,001 to $49,000 no more than $1,960

joint income of $49,001 to $100,000 no more than $2,000

(c) Effective October first, nineteen hundred eighty-eight, the limits

on point of sale co-payments as set forth in this subdivision may be

adjusted by the commissioner on the anniversary date of each program

participant's annual coverage period, and such adjustment shall be in

effect for the duration of that annual coverage period. Any such annual

adjustment shall be made using a percentage adjustment factor which

shall not exceed one-half of the difference between the year-to-year

percentage increase in the consumer price index for all urban consumers,

as published by the United States department of labor, and, if larger,

the year-to-year percentage increase in the aggregate average cost of

covered drugs purchased under this title, which year-to-year percentage

increase in such cost shall be determined by comparison of such cost in

the same month of each of the appropriate successive years; provided,

however, that for any such adjustment based wholly on experience in the

program year commencing October first, nineteen hundred eighty-seven,

the year-to-year percentage increase in such cost shall be determined by

comparison of such cost in each of two months no less than five months

apart and within such program year, which comparison shall be

annualized. Such percentage adjustment factor shall be the same as that

used to determine any similar annual adjustment for the same annual

coverage periods pursuant to the provisions of subdivision four of

section two hundred forty-seven of this title. Such annual adjustments

shall be calculated by multiplying the percentage adjustment factor by

(1) ten percent and applying the resulting percentage to the upper

income limitation of each income level for unmarried individuals

contained in this subdivision, and by (2) seven and one-half percent and

applying the resulting percentage to the upper income limitation of each

income level for married individuals contained in this subdivision; each

result of such calculations, minus any applicable deductible increases

made pursuant to subdivision two of this section and plus the result of

applying the percentage adjustment factor to the sum of any such annual

adjustments applicable thereto for any prior annual coverage period,

shall be the amount by which the limit on co-payments for each such

income level may be adjusted, and such amount shall be in addition to

any such amount or amounts applicable to prior annual coverage periods.

(d) The determination to adjust the limits on point of sale

co-payments set forth in this subdivision shall follow a review of such

factors as the relative financial capacity of the state and such

eligible program participant to support such adjustments.

Participating provider pharmacies. 1. The state shall offer an

opportunity to participate in this program to all provider pharmacies as

defined in section two hundred forty-one of this title, provided,

however, that the participation of pharmacies registered in the state

pursuant to section sixty-eight hundred eight-b of the education law

shall be limited to state assistance provided under this title for

prescription drugs covered by a program participant's medicare drug

plan.

2. To participate in this program, a pharmacy shall be required to

enter into a provider agreement and shall abide by such terms and

conditions as shall be prescribed in the agreement, including the

release of financial information for the purpose of program audits and

surveys.

Reimbursement to participating provider pharmacies. 1. The

amount of reimbursement which shall be paid by the state to a

participating provider pharmacy for any covered drug filled or refilled

for any eligible program participant shall be equal to the allowed

amount defined as follows, minus the point of sale co-payment as

required by sections two hundred forty-seven and two hundred forty-eight

of this title:

(a) Multiple source covered drugs. Except for brand name drugs that

are required by the prescriber to be dispensed as written, the allowed

amount for a multiple source covered drug shall equal the lower of:

(1) The pharmacy's usual and customary charge to the general public,

taking into consideration any quantity and promotional discounts to the

general public at the time of purchase, or

(2) The upper limit, if any, set by the centers for medicare and

medicaid services for such multiple source drug, or

(3) Average wholesale price discounted by twenty-five percent, or

(4) The maximum allowable cost, if any, established by the

commissioner of health pursuant to paragraph (e) of subdivision nine of

section three hundred sixty-seven-a of the social services law.

Plus a dispensing fee for drugs reimbursed pursuant to subparagraphs

two, three, and four of this paragraph, as defined in paragraph (c) of

this subdivision.

(b) Other covered drugs. The allowed amount for brand name drugs

required by the prescriber to be dispensed as written and for covered

drugs other than multiple source drugs shall be determined by applying

the lower of:

(1) Average wholesale price discounted by sixteen and twenty-five one

hundredths percent, plus a dispensing fee as defined in paragraph (c) of

this subdivision, or

(2) The pharmacy's usual and customary charge to the general public,

taking into consideration any quantity and promotional discounts to the

general public at the time of purchase.

(c) As required by paragraphs (a) and (b) of this subdivision, a

dispensing fee of four dollars fifty cents will apply to generic drugs

and a dispensing fee of three dollars fifty cents will apply to brand

name drugs.

2. For purposes of determining the amount of reimbursement which shall

be paid to a participating provider pharmacy, the commissioner of health

shall determine or cause to be determined, through a statistically valid

survey, the quantities of each covered drug that participating provider

pharmacies buy most frequently. Using the result of this survey, the

contractor shall update every thirty days the list of average wholesale

prices upon which such reimbursement is determined using nationally

recognized and most recently revised sources. Such price revisions shall

be made available to all participating provider pharmacies. The

pharmacist shall be reimbursed based on the price in effect at the time

the covered drug is dispensed.

3. (a) Notwithstanding any inconsistent provision of law, the program

for elderly pharmaceutical insurance coverage shall reimburse for

covered drugs which are dispensed under the program by a provider

pharmacy only pursuant to the terms of a rebate agreement between the

program and the manufacturer (as defined under section 1927 of the

federal social security act) of such covered drugs; provided, however,

that:

(1) any agreement between the program and a manufacturer entered into

before August first, nineteen hundred ninety-one, shall be deemed to

have been entered into on April first, nineteen hundred ninety-one; and

provided further, that if a manufacturer has not entered into an

agreement with the department before August first, nineteen hundred

ninety-one, such agreement shall not be effective until April first,

nineteen hundred ninety-two, unless such agreement provides that rebates

will be retroactively calculated as if the agreement had been in effect

on April first, nineteen hundred ninety-one; and

(2) the program may reimburse for any covered drugs pursuant to

subdivisions one and two of this section, for which a rebate agreement

does not exist and which are determined by the commissioner to be

essential to the health of persons participating in the program; and

likely to provide effective therapy or diagnosis for a disease not

adequately treated or diagnosed by any other covered drug.

(b) The rebate agreement between such manufacturer and the program for

elderly pharmaceutical insurance coverage shall utilize for covered

drugs the identical formula used to determine the rebate for federal

financial participation for drugs, pursuant to section 1927(c) of the

federal social security act, to determine the amount of the rebate

pursuant to this subdivision.

(c) The amount of rebate pursuant to paragraph (b) of this subdivision

shall be calculated by multiplying the required rebate formulas by the

total number of units of each dosage form and strength dispensed. The

rebate agreement shall also provide for periodic payment of the rebate,

provision of information to the program, audits, verification of data,

damages to the program for any delay or non-production of necessary data

by the manufacturer and for the confidentiality of information.

(d) The program in providing utilization data to a manufacturer (as

provided for under section 1927 (b) of the federal social security act)

shall provide such data by zip code, if requested, for the top three

hundred most commonly used drugs by volume covered under a rebate

agreement.

(e) Any funds collected pursuant to any rebate agreements entered into

with a manufacturer pursuant to this subdivision, shall be deposited

into the elderly pharmaceutical insurance coverage program premium

account.

4. Notwithstanding any other provision of law, entities which offer

insurance coverage for provision of and/or reimbursement for

pharmaceutical expenses, including but not limited to, entities

licensed/certified pursuant to article thirty-two, forty-two,

forty-three or forty-four of the insurance law (employees welfare funds)

or article forty-four of the public health law, shall participate in a

benefit recovery program with the elderly pharmaceutical insurance

coverage (EPIC) program which includes, but is not limited to, a

semi-annual match of EPIC's file of enrollees against the entity's file

of insured to identify individuals enrolled in both plans with claims

paid within the twenty-four months preceding the date the entity

receives the match request information from EPIC. Such entity shall

indicate if pharmaceutical coverage is available from the entity for the

insured persons, list the copayment or other payment obligations of the

insured persons applicable to the pharmaceutical coverage, and (after

receiving necessary claim information from EPIC) list the amounts which

the entity would have paid for the pharmaceutical claims for those

identified individuals and the entity shall reimburse EPIC for

pharmaceutical expenses paid by EPIC that are covered under the contract

between the entity and its insured in only those instances where the

entity has not already made payment of the claim. Reimbursement of the

net amount payable (after rebates and discounts) that would have been

paid under the coverage issued by the entity will be made by the entity

to EPIC within sixty days of receipt from EPIC of the standard data in

electronic format necessary for the entity to adjudicate the claim and

if the standard data is provided to the entity by EPIC in paper format

payment by the entity shall be made within one hundred eighty days.

After completing at least one match process with EPIC in electronic

format, an entity shall be entitled to elect a monthly or bi-monthly

match process rather than a semi-annual match process.

5. Notwithstanding any other provision of law, the commissioner of

health shall maximize the coordination of benefits for persons enrolled

under Title XVIII of the federal social security act (medicare) and

enrolled under this title in order to facilitate medicare payment of

claims. The commissioner of health may select an independent contractor,

through a request-for-proposal process, to implement a centralized

coordination of benefits system under this subdivision for individuals

qualified in both the elderly pharmaceutical insurance coverage (EPIC)

program and medicare programs who receive medications or other covered

products from a pharmacy provider currently enrolled in the elderly

pharmaceutical insurance coverage (EPIC) program.

6. The EPIC program shall be the payor of last resort for individuals

qualified in both the EPIC program and title XVIII of the federal social

security act (Medicare).

Penalties for fraud and abuse. 1. Any person who knowingly

makes a false statement or representation, or who by deliberate

concealment of any material fact, or by impersonation or other

fraudulent device, obtains or attempts to obtain or aids or abets any

person to obtain any benefit under this title to which he or she is not

entitled, shall be guilty of a class A misdemeanor.

2. Any person who, having made application to receive any benefit

under this title for the use and benefit of another and having received

it, knowingly and willfully converts such benefit or any part thereof to

a use other than for the use and benefit of such other person, shall be

guilty of a class A misdemeanor.

3. Any person who, with intent to defraud, presents for allowance or

payment any false or fraudulent claim for furnishing services or

merchandise, or knowingly submits false information for the purpose of

obtaining greater compensation than that to which he or she is legally

entitled for furnishing services or merchandise, or knowingly submits

false information for the purpose of obtaining authorization for

furnishing services or merchandise under this title, shall be guilty of

a class A misdemeanor.

Procedures for determinations relating to package, or form of

dosage or administration, of certain drugs. 1. If the department of

health makes an initial determination that a particular package, or form

of dosage or administration, of a drug shall be excluded in accordance

with the provisions of paragraph (b) of subdivision one of section two

hundred forty-one of this title, the executive department shall notify

the manufacturer of such drug product that the executive department

intends to seek the exclusion of such package, or form of dosage or

administration, from the program and shall provide such manufacturer

with the reasons therefor together with the facts which the department

relies upon to support its initial determination. The manufacturer shall

have fifteen days after receiving such exclusion notice to notify the

executive department of an intent to appeal the decision. If the

manufacturer fails to notify the executive department of an intent to

appeal within the time specified in this section, the commissioner of

health shall forthwith determine whether the package, or form of dosage

or administration, shall be excluded from the program. If the

manufacturer notifies the executive department of an intent to appeal,

the manufacturer shall submit to the executive department within

forty-five days of receiving such exclusion notice, the basis of the

manufacturer's appeal. Within fifteen days of receiving such submission

from the manufacturer, the executive department shall provide to the

manufacturer any additional facts concerning the drug product that the

department relies upon to support its initial determination. Within ten

days of receiving such facts, the manufacturer may submit additional

facts concerning the drug package, or form of dosage or administration.

Based on the facts submitted pursuant to this section, the commissioner

of health shall make a final determination, in accordance with the

standard set forth in paragraph (b) of subdivision one of section two

hundred forty-one of this title, as to whether the package, or form of

dosage or administration, of the drug product shall constitute a covered

drug for the purposes of this article. A determination to exclude the

drug package, or form of dosage or administration, shall be subject to

judicial review pursuant to article seventy-eight of the civil practice

law and rules.

2. The commissioner of health shall establish by regulation an

appropriate process allowing drug packages, or forms of dosage or

administration, finally determined under this section not to be covered

drugs for the purposes of this title to be dispensed to program

participants for whom such drug packages, or forms of dosage or

administration, are medically indicated as certified to by a physician

treating such participant. Any such drug package, or form of dosage or

administration, so certified as medically indicated for a specific

participant in accordance with such regulations shall be a covered drug

for the purpose of this title.

Utilization of out-of-state provider pharmacies; necessity and

convenience. 1. In counties having a population of seventy-five thousand

or less that are in proximity to the state boundary and which are

determined by the commissioner of health to be not adequately served by

provider pharmacies registered in New York, and in Fishers Island in the

town of Southold, Suffolk county, the commissioner may approve as

provider pharmacies, pharmacies located in New Jersey, Connecticut,

Vermont, Pennsylvania or Massachusetts. Such approvals shall be made

after (a) consideration of the convenience and necessity of New York

residents in the rural areas served by such pharmacies, (b)

consideration of the quality of service of such pharmacies and the

standing of such pharmacies with the governmental board or agency of the

state in which such pharmacy is located, (c) the commissioner shall give

all licensed pharmacies within the county notice of his or her intention

to approve such out-of-state provider pharmacies, and (d) the

commissioner has held a public hearing at which he or she has determined

factually that the licensed pharmacies within such county are not

adequately serving as provider pharmacies.

2. The commissioner of health shall investigate and determine whether

certification shall be granted within ninety days of the filing of an

application for certification by the governing body of any city, town or

village, within a county determined by the commissioner to be not

adequately served by provider pharmacies registered in New York pursuant

to subdivision one of this section, claiming to be lacking adequate

pharmaceutical service.

3. Every certification granted pursuant to this section shall expire

not more than five years after the date of issuance.

Cost of living adjustment. 1. Within amounts appropriated, the

commissioner of health shall adjust the program eligibility standards

set forth in subdivision two of section two hundred forty-two of this

title to account for increases in the cost of living.

2. The commissioner shall further adjust individual and joint income

categories set forth in subdivisions two and four of section two hundred

forty-eight of this title to conform to the adjustments made pursuant to

subdivision one of this section.

Guidelines for development of community-based programs. In

order to encourage the development of activities and programs that

support older adults within communities, the office shall develop

materials and guidelines for the development of community-based

programs. Such guidelines and materials shall be designed to assist

local area agencies on aging, non-profit entities, and community-based

organizations that wish to establish programs for seniors in their local

communities. In choosing what types of programs for which to develop

guidelines and materials, the office shall focus on programs that have

been successful in supporting older adults in the community and those

that provide innovative approaches to existing challenges. Areas of

concern, for which encouraging the spread of locally-based programs

would be most beneficial, shall include, but not be limited to: (a)

supporting the ability of older adults to stay in their homes, both

through services and assistance with chores and maintenance; (b) general

safety and prevention of abuse and exploitation; (c) socialization, both

with peers and with individuals of all ages; (d) opportunities for

involvement in the local community, including volunteerism; and (e)

encouraging older adults who wish to continue their career or embark on

a new career path.

Definitions. For purposes of this article:

1. "Abuse and maltreatment" shall mean actions as defined in

paragraphs (a), (b), (c), (d), (e) and (g) of subdivision six of section

four hundred seventy-three of the social services law.

2. "Self neglect" shall have the same meaning as defined in paragraph

(f) of subdivision six of section four hundred seventy-three of the

social services law.

3. "Older adult" shall mean an individual aged sixty years of age or

older.

4. "Director" shall mean the director of the office for the aging.

Guidelines for identifying and reporting suspected self

neglect, abuse and maltreatment. The director, in conjunction with the

commissioner of the department of health and the commissioner of the

office of children and family services, shall develop guidelines to

assist healthcare providers and others working in healthcare settings to

identify suspected self neglect, abuse and maltreatment of an older

adult. Such guidelines may be tailored to specific healthcare providers

or industries and shall include, but shall not be limited to:

1. Common signs and symptoms of self neglect, abuse and maltreatment;

2. Screening questions and tools that can be used during a visit to

help detect whether self neglect or abuse and maltreatment may be

occurring;

3. Training materials for distribution to healthcare providers and

others working in healthcare settings regarding appropriate

interventions and suggestions for discussing the possibility of self

neglect, abuse and maltreatment with older adults; and

4. Information regarding options for reporting suspected cases of self

neglect or abuse and maltreatment and available resources for older

adult victims.

Publishing and distribution of guidelines. The office for the

aging, the department of health, and the office of children and family

services shall make the guidelines and materials developed in accordance

with this article available on their respective websites and provide

such materials upon request to healthcare providers and facilities.