§ 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\ncontracts or continuing care at home contracts. 1. The commissioner may\napprove an application for a certificate of authority and may issue a\ncertificate of authority for the establishment and operation of a\ncontinuing care retirement community under an arrangement which\notherwise complies with the requirements of this article except that the\ncosts of nursing facility or home health care services are paid for in\nwhole or in part by (a) long term care insurance obtained and paid for\nby the resident or by medical assistance payments in accordance with the\npartnership for long term care program pursuant to section three hundred\nsixty-seven-f of the social services law and section three thousand two\nhundred twenty-nine of the insurance law or (b) other group or\nindividual long term care insurance approved by the superintendent and\nthe council in connection with the application. The council, in\nconsultation with the superintendent, shall provide for adequate\ndisclosure to residents of their options, rights and obligations under\nsuch an arrangement, and shall establish standards for the remittance\nand collection of premiums and monthly care fees.\n 2. With regard to nursing facility or home health care services which\nare part of the continuing care retirement contract or continuing care\nat home contract, any elimination or waiting periods and any\ndeductibles, copayments, or other amounts not paid for by such long term\ncare insurance or medical assistance payments shall be the\nresponsibility of the continuing care retirement community. The resident\nshall not be liable to pay any such amounts.\n 3. The continuing care retirement community operator shall not require\nthat long term care insurance be purchased from a specified insurer or\ngroup of insurers and the operator shall not, without the approval of\nthe council and the approval of the superintendent, specify a minimum\nacceptable benefit level different from that established under the\npartnership for long term care program.\n 4. Entrance fees and monthly care fees shall reflect that the cost of\na resident's nursing facility and home health care services are or will\nbe paid for in whole or in part in accordance with (a) the partnership\nfor long term care program or (b) other group or individual long term\ncare insurance approved by the superintendent and the council in\nconnection with the application.\n 5. a. If a resident fails to maintain minimum long term care insurance\ncoverage in accordance with this section, the continuing care retirement\ncommunity operator shall purchase, if possible, such coverage on behalf\nof and at the expense of the resident and may require an appropriate\nadjustment in payments by the resident to the operator.\n b. If the continuing care retirement community operator cannot\npurchase long term care insurance coverage under paragraph a of this\nsubdivision, the operator may require an adjustment in the resident's\nmonthly fees, subject to the approval of the superintendent, to fund the\nadditional risk to the facility.\n c. If the resident fails to maintain long term care insurance coverage\nin accordance with this section and the community operator has not\npurchased such coverage, the operator shall be responsible for any\nexpenses which would have been covered under the long term care\ninsurance policy which the resident failed to maintain. The operator may\nadd the amount of such expenses to the resident's monthly fees.\n