N.Y. Public Health Law 4623 – Long term care insurance and continuing care retirement contracts or continuing care at home contracts
§ 4623. Long term care insurance and continuing care retirement contracts or continuing care at home contracts. 1. The council may approve an application for a certificate of authority and the commissioner may issue a certificate of authority for the establishment and operation of a continuing care retirement community under an arrangement which otherwise complies with the requirements of this article except that the costs of nursing facility or home health care services are paid for in whole or in part by (a) long term care insurance obtained and paid for by the resident or by medical assistance payments in accordance with the partnership for long term care program pursuant to § 367-f of the social services law and § 3229 of the insurance law or (b) other group or individual long term care insurance approved by the superintendent and the council in connection with the application. The council, in consultation with the superintendent, shall provide for adequate disclosure to residents of their options, rights and obligations under such an arrangement, and shall establish standards for the remittance and collection of premiums and monthly care fees.
Terms Used In N.Y. Public Health Law 4623
- certificate of authority: shall mean an authorization in writing, approved by the council and issued by the commissioner, for an operator to operate a continuing care retirement community and to enter into continuing care retirement contracts and continuing care at home contracts pertaining to such community. See N.Y. Public Health Law 4601
- Commissioner: shall mean the commissioner of health. See N.Y. Public Health Law 4601
- community: shall mean a facility or facilities established to provide a comprehensive, cohesive living arrangement for the elderly, oriented to the enhancement of the quality of life and which, pursuant to a contract, at a minimum:
a. See N.Y. Public Health Law 4601 - continuing care at home contract: shall mean a single contract to provide a person the services provided by a continuing care retirement community. See N.Y. Public Health Law 4601
- Contract: A legal written agreement that becomes binding when signed.
- Council: shall mean the continuing care retirement community council, established pursuant to section forty-six hundred two of this article. See N.Y. Public Health Law 4601
- Facility: shall mean any place in which an operator undertakes to provide a resident with the services of a continuing care retirement community, pursuant to a contract, whether such place is constructed, owned, leased, rented, or otherwise contracted for by the operator. See N.Y. Public Health Law 4601
- Operator: shall mean a legal entity operating a continuing care retirement community pursuant to a certificate of authority. See N.Y. Public Health Law 4601
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- Resident: shall mean any person who, pursuant to a continuing care retirement contract or continuing care at home contract, is entitled to reside in and/or receive services from a continuing care retirement community. See N.Y. Public Health Law 4601
- Social services: shall mean those services which may include, but not be limited to counseling, case management, and information and referral. See N.Y. Public Health Law 4601
- Superintendent: shall mean the superintendent of financial services. See N.Y. Public Health Law 4601
2. With regard to nursing facility or home health care services which are part of the continuing care retirement contract or continuing care at home contract, any elimination or waiting periods and any deductibles, copayments, or other amounts not paid for by such long term care insurance or medical assistance payments shall be the responsibility of the continuing care retirement community. The resident shall not be liable to pay any such amounts.
3. The continuing care retirement community operator shall not require that long term care insurance be purchased from a specified insurer or group of insurers and the operator shall not, without the approval of the council and the approval of the superintendent, specify a minimum acceptable benefit level different from that established under the partnership for long term care program.
4. Entrance fees and monthly care fees shall reflect that the cost of a resident's nursing facility and home health care services are or will be paid for in whole or in part in accordance with (a) the partnership for long term care program or (b) other group or individual long term care insurance approved by the superintendent and the council in connection with the application.
5. a. If a resident fails to maintain minimum long term care insurance coverage in accordance with this section, the continuing care retirement community operator shall purchase, if possible, such coverage on behalf of and at the expense of the resident and may require an appropriate adjustment in payments by the resident to the operator.
b. If the continuing care retirement community operator cannot purchase long term care insurance coverage under paragraph a of this subdivision, the operator may require an adjustment in the resident's monthly fees, subject to the approval of the superintendent, to fund the additional risk to the facility.
c. If the resident fails to maintain long term care insurance coverage in accordance with this section and the community operator has not purchased such coverage, the operator shall be responsible for any expenses which would have been covered under the long term care insurance policy which the resident failed to maintain. The operator may add the amount of such expenses to the resident's monthly fees.