N.Y. Comp. Codes R. & Regs. tit. 18 § 494.4

Current through Register Vol. 46, No. 43, October 23, 2024

Section 494.4 - Admission and retention standards

(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.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 494.4

Amended New York State Register May 15, 2019/Volume XLI, Issue 20, eff. 5/15/2019