Section 759.1 - Definitions

Section 759.1 Definitions. As used in this Part, unless the context otherwise requires:

(a) For purposes of this Part, AIDS shall mean acquired immune deficiency syndrome and other human immunodeficiency virus (HIV) related illnesses.

(b) Registrant means a person who either has AIDS or HIV-related illness or is otherwise considered to be part of a high-need population that, regardless of HIV status and in the discretion of the Commissioner, would benefit from receiving adult day health care services and:

(1) who is not a resident of a residential health care facility, is functionally impaired and not homebound, and requires certain preventive, diagnostic, therapeutic, rehabilitative or palliative care or services but does not require the continuous 24-hour-a-day inpatient care and services provided by a general hospital, or residential health care facility;

(2) whose assessed social and health care needs can satisfactorily be met, in whole or in part, by the delivery of appropriate services in the community setting; and

(3) who has been accepted by an adult day health care program based on an authorized practitioner's order or a referral from a managed care organization or care coordination model and a comprehensive assessment conducted by the adult day health care program or by the managed care organization or care coordination model.

(c) Adult day health care program or program, means an approved adult day health care program that is provided in a licensed diagnostic and treatment center, a residential health care facility or an approved extension site of either.

(d) Adult day health care services, or services, means care and services provided to a registrant under the medical direction of a physician by personnel of the adult day health care program.  Such care and services are required to be in accordance with a comprehensive assessment of care needs and individualized health care plan to maintain or improve a registrant’s health status and enable the registrant to remain in the community.

(e) Managed care organization means a managed care plan or a managed long-term care plan.

(f) Operating hours for an adult day health care program means the period of time that the program must be open, operational and providing services to registrants in accordance with the approval granted by the Department.  Each approved adult day health care session must operate for a minimum of five hours duration, not including time spent in transportation, and must provide, at a minimum, nutritional services in the form of at least one meal and necessary supplemental nourishment and planned activities. In addition, an ongoing assessment must be made of each registrant's health status by the adult day health care program or by the managed care organization or care coordination model that referred the registrant to the adult day health care program in order to provide coordinated care planning, case management and other health care services as determined by the registrant's needs.

(g) Visit means an individual episode of attendance by a registrant at an adult day health care program during which the registrant receives adult day health care services in accordance with his or her comprehensive care plan.  Registrants referred by a managed care organization or care coordination model will receive services as ordered by those entities in conformance with those entities’ comprehensive assessment after discussion and consultation with the adult day health care program.  

(h) Registrant capacity means the total number of registrants approved by the Department for each session in a 24-hour day.

(i) Operator of an adult day health care program, or operator, means the operator of a diagnostic and treatment center or a residential health care facility that is approved by the Department to be responsible for all aspects of the adult day health care program.

(j) Practitioner means a physician, nurse practitioner, or a physician’s assistant with physician oversight.

(k) Department means the New York State Department of Health.

(l) Commissioner means the Commissioner of the New York State Department of Health.

(m) Care coordination model means a program model that meets guidelines specified by the Commissioner that supports coordination and integration of services pursuant to section 4403-f of the Public Health Law.

(n) Comprehensive assessment means an interdisciplinary comprehensive assessment of a registrant completed in accordance with section 759.5 of this Part by the adult day health care program or an interdisciplinary comprehensive assessment, approved by the Department, completed by the managed care organization or care coordination model that referred the registrant to the adult day health care program.

(o) Care plan means the comprehensive care plan developed in accordance with section 759.6 of this Part by the adult day health care program.

(p) Unbundled Services/Payment Option means the ability of an adult day health care program to provide less than the full range of adult day health care services to a functionally impaired individual referred by a managed care organization or care coordination model based on the registrant’s comprehensive assessment.  The full range of adult day health care services as described in Part 759 shall be available to all registrants enrolled in the adult day health care program.

 

Effective Date: 
Wednesday, June 14, 2017
Doc Status: 
Complete