Title: Section 900.11 - Long term care security program for long term care model

Effective Date

07/27/1994

900.11 Long term care security program for long term care model.

(a) The Life Care Community Council may approve an application for a certificate of authority and the Commissioner may issue a certificate of authority for the establishment and operation of a life care community under an arrangement which otherwise complies with the requirements of Article 46 except that the costs of each resident's nursing facility or home health care services are paid for in whole or in part by long term care insurance obtained and paid for by the resident or by medical assistance payments in accordance with the Long Term Care Security Program for Long Term Care pursuant to Section 367(f) of the Social Services Law and Section 3229 of the Insurance Law.

(b) With regard to nursing home or home health care services provided as part of the life care contract, any elimination or waiting periods and any deductibles, co-payments, or other amounts not paid for by such long term care insurance or medical assistance payments shall be the responsibility of the life care community. The resident shall not be liable to pay any such amounts.

(c) The life care community operator shall not require that long term care insurance be purchased from a specified insurer or group of insurers and the life care community operator shall not specify a minimum acceptable benefit level in excess of that established under the Long Term Care Security Program for Long Term Care.

(d) Entrance fees and monthly care fees shall reflect that the cost of resident's nursing home and home health care services are or will be paid for in whole or in part through a long term care insurance policy and medical assistance payments.

(e) If a resident fails to maintain minimum long term care insurance coverage in accordance with the Long Term Care Security Program for Long Term Care, the life care community operator shall purchase, if possible, such coverage on behalf of and at the expense of the resident and may require an appropriate adjustment in the monthly fees paid by the resident to the life care community operator.

(1) If the life care community operator cannot purchase such long term care insurance coverage, the operator may require an adjustment in the resident's monthly fees, subject to the approval of the Superintendent, to fund the additional risk to the facility.

(2) If the resident fails to maintain such long term care insurance coverage and the life care community operator has not purchased such coverage, the operator shall be responsible for any expenses which would have been covered under the long term care insurance policy which the resident failed to maintain. The operator may add the amount of such expenses to the resident's monthly fees.
 

Volume

VOLUME E (Title 10)

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