Section 425.1 - Definitions

425.1 Definitions. As used in this Part:

(a) Adult day health care is defined as the health care services and activities provided to a group of registrants with functional impairments to maintain their health status and enable them to remain in the community.

(b) Registrant is defined as a person:

(1) who is not a resident of a residential health care facility, is functionally impaired and not homebound, and requires supervision, monitoring, preventive, diagnostic, therapeutic, rehabilitative or palliative care or services but does not require continuous 24-hour-a-day inpatient care and services, except that where reference is made to the requirements of Part 415 of this Subchapter, the term resident as used in Part 415 shall mean registrant;

(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 orderor a referral from a managed long term care plan or care coordination model and a comprehensive assessment conducted by the adult day health care program or by the managed long term care plan or care coordination model.

(c) Program is defined as an approved adult day health care program located at a licensed residential health care facility or an approved extension site.

(d) Operating hours for an adult day health care program are defined as 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 long term care plan 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.

(e) Visit is defined as 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/her care plan. A registrant's individual visit may be fewer than five hours or longer than five hours depending on the assessed needs of the registrant.

Registrants referred by a managed long term care plan 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.

(f) Registrant capacity is defined as the total number of registrants approved by the Department for each session in a 24 hour day.

(g) Operator of an adult day health care program is defined as the operator of a residential health care facility that is approved by the Department to be responsible for all aspects of the adult day health care program.

(h) Practitioner is defined as a physician, nurse practitioner or a physician’s assistant with physician oversight.

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

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

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

(l) Comprehensive assessment means an interdisciplinary comprehensive assessment of a registrant completed in accordance with Section 425.6 of this Part by the adult day health care program, or an interdisciplinary comprehensive assessment, approved by the Department, completed by the managed long term care plan or care coordination model that referred the registrant to the adult day health care program.

(m) Care plan means the care plan developed in accordance with section 425.7 of this Part by the adult day health care program.

(n) 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 long term care plan or care coordination model based on the registrant’s comprehensive assessment. The full range of adult day health care services as described in Part 425 will be available to all registrants enrolled in the adult day health care program.

Effective Date: 
Wednesday, September 10, 2014
Doc Status: 
Complete