New York Laws
Title 11 - Medical Assistance for Needy Persons
367-C - Payment for Long Term Home Health Care Programs.

(b) As used in this subdivision, the term "person with special needs"
shall mean a person for whom a plan of care has been developed pursuant

to subdivision two or three of this section who (1) needs care including
but not limited to respiratory therapy, tube feeding, decubitus care or
insulin therapy which cannot be appropriately provided by a personal
care aide as defined in regulations issued by the commissioner, or (2)
has one or more of the following conditions: mental disability as
defined in section 1.03 of the mental hygiene law, acquired immune
deficiency syndrome, or dementias, including Alzheimer's disease.
(c) The number of persons with special needs for whom a local social
services official may authorize payment for services pursuant to
paragraph (a) of this subdivision shall be limited to twenty-five
percent of the total number of persons, all long term home health care
programs, within a social services district are authorized to serve;
provided, however, in any district containing a city having a population
of one million or more, such limit shall be fifteen percent.
(d) In the event that a district reaches the limitation specified in
paragraph (c) of this subdivision, the local social services official
may, upon the approval of the commissioner, authorize payment for
services, pursuant to paragraph (a) of this subdivision, for additional
persons with special needs.
4. Notwithstanding any inconsistent provision of this section, if two
members of this same household, eligible to receive services under this
title, require care and services in either a nursing home or an
intermediate care facility, and assessments conducted pursuant to the
provisions of this section indicate that such persons can receive the
appropriate level of care at home, then such care may be provided at
home where total monthly expenditures made under this title for such
persons shall not exceed a maximum of seventy-five percent, or such
lesser percentage as may be determined by the commissioner, of the
monthly rates which would be payable under this title for both members
of the household for nursing home and/or intermediate care facility
services within the social services district. If assessments of such
persons' needs demonstrate that they require services the payment for
which would exceed such monthly maximum, but it can be reasonably
anticipated that total expenditures for required services for such
persons will not exceed the maximum calculated over a one year period, a
social services official may authorize payment for such services.
5. If a person eligible to receive services under the provisions of
this title who is medically eligible for care, treatment, maintenance,
nursing or other services in a nursing home or is medically eligible for
health related care and services in an intermediate care facility
desires to and is deemed by his or her physician able to remain in an
adult care facility, other than a shelter for adults, which is able and
willing to retain such person if the necessary services are provided,
such person or his or her representatives shall so inform the local
social services official. If a long term home health care program is
provided in a social services district, an official of such district
shall authorize an assessment under the provisions of section three
thousand six hundred sixteen of the public health law. If the results of
the assessment indicate that the person can receive the appropriate
level of care at such location, and meets the appropriate standards for
continued stay for such facility as are established by law and
regulation, such official shall prepare for that person a plan for the
provision of services. In developing such plan, the official shall
consult with those persons performing the assessment and with the
operator of the adult care facility. The services shall be provided by a
long term home health care program authorized pursuant to article
thirty-six of the public health law, provided, however that
notwithstanding the provisions of section three thousand six hundred

sixteen of such law, services shall not be provided prior to the
completion of the assessment. At the time of the initial assessment and
at the time of each subsequent assessment performed under the provisions
of section three thousand six hundred sixteen of the public health law,
or more often if the person's needs require, the official shall
establish a monthly budget in accordance with which he shall authorize
payment for the services provided under that plan, provided, however
that no services shall be authorized in the plan which the operator of
the facility is required by law and regulation to provide. The long term
home health care program providing services authorized in such plan
shall be solely responsible for managing and providing or arranging for
such authorized services. The operator of the adult care facility shall
be solely responsible for managing and providing those services which
the facility is required by law or regulation to provide. However, the
two entities shall collaborate to assure coordination. Total monthly
expenditures made under this title for such person shall not exceed a
maximum of fifty percent, or such lesser percentage as may be determined
by the commissioner, of the average of the monthly rates paid under this
title for the provision of nursing home services or health related care
and services in intermediate care facilities, whichever is appropriate,
within the social services district for which the official has
authority. However, if a continuing assessment of the person's needs
demonstrates that he or she requires increased services, the social
services official may authorize the expenditure of any amount accrued
under this section during the past twelve months as a result of the
expenditures for that person not exceeding such maximum. If an
assessment of the person's needs demonstrates that he or she requires
services the payment for which would exceed such monthly maximum, but it
can be reasonably anticipated that total expenditures for required
services for such person will not exceed such maximum calculated over a
one year period, the social services official may authorize payment for
such services. The provisions of this subdivision shall not be deemed to
alter standards for admission to an adult care facility nor shall the
admission of a person into such facility be contingent on such person's
enrollment in a long term home health care program.
6. Notwithstanding any inconsistent provision of law but subject to
expenditure limitations of this section, the commissioner, subject to
the approval of the state director of the budget, may authorize the
utilization of medical assistance funds to pay for services provided by
specified long term home health care programs in addition to those
services included in the medical assistance program under section three
hundred sixty-five-a of this chapter, so long as federal financial
participation is available for such services. Expenditures made under
this subdivision shall be deemed payments for medical assistance for
needy persons and shall be subject to reimbursement by the state in
accordance with the provisions of section three hundred sixty-eight-a of
this chapter.
7. No social services district shall make payments pursuant to title
XIX of the federal Social Security Act for benefits available under
title XVIII of such act without documentation that title XVIII claims
have been filed and denied.
8. No social services district shall make payment for a person
receiving a long term home health care program while payments are being
made for that person for inpatient care in a residential health care
facility or hospital.
9. The commissioner, together with the commissioner of health, shall
submit a report to the governor, president pro tem of the senate and
speaker of the assembly by the first day of February, nineteen hundred

eighty, on the implementation of this section. Such report shall include
a statement of the scope and status of long term home health care
programs, the extent to which such programs have affected
institutionalization, the costs associated with such programs, any
recommendations for legislative action, and such other matters as may be
pertinent.
10. This section shall be effective if, and as long as, federal aid is
available therefor.

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