Current through Register Vol. 46, No. 39, September 25, 2024
(a) An operator must admit, retain and care
for only those individuals who do not require services beyond those the
operator is permitted by law and regulation to provide.
(b) An operator shall not exclude an
individual on the sole basis that such individual is a person who primarily
uses a wheelchair for mobility, and shall make reasonable accommodations to the
extent necessary to admit such individuals, consistent with the Americans with
Disabilities Act of 1990, 42 U.S.C. 12101 et seq. and with the provisions of
this section.
(c) Appropriate
services must be provided to or arranged for an eligible individual only in
accordance with a plan of care which is based upon an initial assessment and
periodic reassessments conducted by an assisted living program, or if the
assisted living program itself is not an approved long-term home health care
program or certified home health agency, by an assisted living program and a
long-term home health care program or certified home health agency.
(d) An assisted living program may care only
for a person who:
(1) is medically eligible
for, and would otherwise require placement in, a residential health care
facility due to the lack of a home or a suitable home environment in which to
live and safely receive services;
(2) requires more care and services to meet
daily health or functional needs than can be provided directly by an adult care
facility;
(3) exhibits a stable
medical condition as categorized by the long-term care patient classification
system as defined in Title 10 NYCRR;
(4) is able, with direction, to take action
sufficient to assure self-preservation in an emergency; and
(5) voluntarily chooses to participate in an
assisted living program after being provided with sufficient information to
make an informed choice.
(e) An operator must not accept nor retain
any person who:
(1) requires continual
nursing or medical care;
(2) is
chronically bedfast and requires lifting equipment to transfer or the
assistance of two persons to transfer;
(3) is cognitively, physically or medically
impaired to a degree which endangers the safety of the resident or other
residents.
(f) Before an
operator admits an individual to an assisted living program, a determination
must be made that the assisted living program can support the physical,
supervisory and psycho-social needs of the resident.
(g) The determination referred to in
subdivision (e) of this section must be based on:
(1) a medical evaluation conducted within 30
days prior to the date of admission;
(2) an interview between the administrator or
a designee responsible for admission and retention decisions and the resident
and resident's representative(s), if any;
(3) a preassessment screening, a nursing
assessment and an assessment of the individual's social and functional needs
and an assessment of the ability of the program to meet those needs. These
assessments will be conducted by the operator and, if required, by a certified
home health agency or a long-term home health care program; and
(4) a mental health evaluation if a proposed
resident has a known history of chronic mental disability, or if the medical
evaluation or resident interview or any assessment suggests that such a
disability exists. This evaluation will be conducted by a psychiatrist,
physician, nurse, psychologist or social worker who has experience in the
assessment and treatment of mental illness.
(h) A reassessment of the resident must be
conducted no later than 45 days after the date of admission of the resident. In
addition, reassessments must be conducted as frequently as required to respond
to changes in the resident's condition and to ensure immediate access to
necessary and appropriate services by the resident, but in no event less
frequently than once every six months.
(i) Relationship to the medical assistance
program (MA).
(1) A contract must be executed
between the assisted living program as an authorized home care provider and the
social services district in which the assisted living program is operating. The
contract must provide that the assisted living program will assume all
responsibility for case management of all MA recipients in the assisted living
program and include the following:
(i) the
terms and conditions under which services will be provided;
(ii) the requirements for training and
licensing of employees;
(iii) the
maintenance of adequate records;
(iv) the observance of applicable
confidentiality standards with respect to information concerning MA
recipients;
(v) the conditions
under which the contract will be amended;
(vi) the procedures for notification of MA
applicants and recipients concerning their right to a fair hearing;
and
(vii) the conditions under
which the contract will be terminated, including the unavailability of
continued Federal or State funding.
(2) When a social services district receives
a request for an individual's participation in the assisted living program and
a completed application for MA, the district must determine the applicant's
eligibility for MA in accordance with Part 360 of this Title.
(3) A copy of the assessments for any MA
recipient who is determined appropriate to participate in the assisted living
program must be transmitted for review to the social services district which is
financially responsible for the MA recipient.
(4) A reassessment of the MA recipient must
be conducted in accordance with subdivision (c) of this section. Such
reassessment must be reviewed by the social services district which is
financially responsible for the MA recipient no later than 45 days after the
date of admission of the MA recipient and, at a minimum, every six months
thereafter.
(j) No
person will be admitted to or retained in an assisted living program unless the
assisted living program determines that the person can be safely and adequately
cared for if the services identified as necessary by an assessment or
reassessment are provided.
(k) For
a resident who cannot be retained in an assisted living program because the
resident does not meet the conditions set forth in subdivision (d) of this
section:
(1) the operator must make
persistent efforts to secure appropriate alternative placement and must
document such efforts;
(2)
persistent efforts are defined as:
(i)
assisting the resident or resident's representative to file five applications
for each such resident with appropriate facilities;
(ii) following up by telephone every two
weeks on the status of the applications;
(iii) if an application is rejected,
assisting the resident or resident's representative to file an application with
another facility within five working days of the date of rejection;
and
(iv) if the resident is not
placed, notifying the appropriate regional office of the department in writing,
every 90 days from the filing of the first application, of the name of the
resident and any pending and rejected applications.
