§ 2808-E — Residential health care for children with medical fragility in transition to young adults and young adults with medical fragility demonst...

* § 2808-e. Residential health care for children with medical\nfragility in transition to young adults and young adults with medical\nfragility demonstration program. 1. Notwithstanding any law, rule, or\nregulation to the contrary, the commissioner shall, within amounts\nappropriated and subject to the availability of federal financial\nparticipation, establish a demonstration program for two eligible\npediatric residential health care facilities, as defined in paragraph\n(d) of subdivision two of this section, to construct a new facility or\nrepurpose part of an existing facility to operate as a young adult\nresidential health care facility for the purpose of improving the\nquality of care for young adults with medical fragility.\n 2. For purposes of this section:\n (a) "children with medical fragility" shall mean children up to\ntwenty-one years of age who have a chronic debilitating condition or\nconditions, are at risk of hospitalization, are technology-dependent for\nlife or health sustaining functions, require complex medication regimens\nor medical interventions to maintain or to improve their health status,\nand/or are in need of ongoing assessment or intervention to prevent\nserious deterioration of their health status or medical complications\nthat place their life, health or development at risk.\n (b) "young adults with medical fragility" shall mean individuals who\nmeet the definition of children with medical fragility, but for the fact\nsuch individuals are aged between eighteen and thirty-five years old.\n (c) "pediatric residential health care facility" shall mean a\nresidential health care facility or discrete unit of a residential\nhealth care facility providing services to children under the age of\ntwenty-one.\n (d) "eligible pediatric residential health care facilities" shall mean\npediatric health care facilities that meet the following eligibility\ncriteria for the demonstration program set forth in subdivision one of\nthis section: (i) has over one hundred and sixty licensed pediatric\nbeds; or (ii) is currently licensed for pediatric beds pursuant to this\narticle, is co-operated by a system of hospitals licensed pursuant to\nthis article, and such hospitals qualify for funds pursuant to a vital\naccess provider assurance program or a value based payment incentive\nprogram, as administered by the department in accordance with all\nrequirements set forth in the state's federal 1115 Medicaid waiver\nstandard terms and conditions.\n 3. Notwithstanding any law, rule, or regulation to the contrary, any\nchild with medical fragility who has resided for at least thirty\nconsecutive days in an eligible pediatric residential health care\nfacility and who has reached the age of twenty-one while a resident, may\ncontinue residing at such eligible pediatric residential health care\nfacility and receiving such services from the facility, provided that\nsuch young adult with medical fragility remains eligible for nursing\nhome care, and provided further that the eligible pediatric residential\nhealth care facility has prepared, applied for, and submitted to the\ncommissioner, a proposal for a new residential health care facility for\nthe provision of extensive nursing, medical, psychological and\ncounseling support services to young adults with medical fragility in\naccordance with subdivision four of this section. A young adult with\nmedical fragility may remain in such eligible pediatric residential\nhealth care facility until such time that the young adult with medical\nfragility attains the age of thirty-five years or the young adult\nresidential health care facility is constructed and becomes operational,\nwhichever is sooner.\n 4. Upon receipt of a certificate of need application from an eligible\npediatric residential health care facility selected by the commissioner\nfor the demonstration program authorized under this section, the\ncommissioner is authorized to approve, with the written approval of the\npublic health and health planning council pursuant to section\ntwenty-eight hundred two of this article, the construction of a new\nresidential health care facility to be constructed and operated on a\nparcel of land within the same county as that of eligible pediatric\nresidential health care facility that is proposing such new facility and\nover which it will have site control, or the repurposing of a portion of\na residential health care facility that is currently serving geriatric\nresidents or those with similar needs for the provision of nursing,\nmedical, psychological and counseling support services appropriate to\nthe needs of nursing home-eligible young adults with medical fragility,\nreferred to herein below as a young adult facility, provided that the\nestablished operator of such eligible pediatric residential health care\nfacility proposing the young adult facility is in good standing and\npossesses at least thirty years' prior experience operating as a\npediatric residential health care facility in the state or more than\nthirty years' experience serving medically fragile pediatric patients,\nand provided further that such facility qualifies for the demonstration\nprogram set forth in subdivision one of this section.\n 5. A young adult facility established pursuant to subdivision four of\nthis section may admit, from the community-at-large or upon referral\nfrom an unrelated facility, young adults with medical fragility who\nprior to reaching age twenty-one were children with medical fragility,\nand who are eligible for nursing home care and in need of extensive\nnursing, medical, psychological and counseling support services,\nprovided that the young adult facility, to promote continuity of care,\nundertakes to provide priority admission to young adults with medical\nfragility transitioning from the pediatric residential health care\nfacility or unit operated by the entity that proposed the young adult\nfacility and ensure sufficient capacity to admit such young adults as\nthey approach or attain twenty-one years of age.\n 6. (a) For inpatient services provided to any young adults with\nmedical fragility eligible for medical assistance pursuant to title\neleven of article five of the social services law residing at any\neligible pediatric residential health care facility as authorized in\nsubdivision three of this section, the commissioner shall establish the\noperating component of rates of reimbursement appropriate for young\nadults with medical fragility residing at a pediatric residential health\ncare facility, to apply to such young adults twenty-one years of age or\nolder. Such methodology shall take into account the methodology used to\nestablish the operating component of the rates pursuant to section\ntwenty eight hundred eight of this article for pediatric residential\nhealth care facilities with an increase or decrease adjustment as\nappropriate to account for any discrete expenses associated with caring\nfor young adults with medical fragility, including addressing their\ndistinct needs as young adults for psychological and counseling support\nservices.\n (b) For inpatient services provided to any young adults with medical\nfragility eligible for medical assistance pursuant to title eleven of\narticle five of the social services law at any young adult facility as\nauthorized in subdivision four of this section, the commissioner shall\nestablish the operating component of rates of reimbursement appropriate\nfor young adults with medical fragility. Such methodology shall take\ninto account the methodology used to establish the operating component\nof the rates pursuant to section twenty eight hundred eight of this\narticle for pediatric residential health care facilities with an\nincrease or decrease adjustment as appropriate to account for any\ndiscrete expenses associated with caring for young adults with medical\nfragility, including addressing their distinct needs as young adults for\npsychological and counseling support services.\n 7. The commissioner shall have authority to waive any rule or\nregulation to effectuate the demonstration program authorized pursuant\nto subdivision one of this section.\n * NB Repealed August 17, 2027\n * NB There are 2 § 2808-e's\n