2013 New York Consolidated Laws
PBH - Public Health
Article 46 - (4600 - 4624) CONTINUING CARE RETIREMENT COMMUNITIES
4623 - Long term care insurance for continuing care retirement contracts.

 
    §  4623.  Long  term  care  insurance  for  continuing care retirement
  contracts.  1. The 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  continuing  care  retirement
  community  under  an  arrangement  which  otherwise  complies  with  the
  requirements of this article except that the costs of  nursing  facility
  or  home  health  care  services are paid for in whole or in part by (a)
  long term care insurance obtained and paid for by  the  resident  or  by
  medical  assistance payments in accordance with the partnership for long
  term care program pursuant to section three hundred sixty-seven-f of the
  social services law and section three thousand two  hundred  twenty-nine
  of  the  insurance  law  or (b) other group or individual long term care
  insurance approved by the superintendent and the council  in  connection
  with   the   application.   The   council,   in  consultation  with  the
  superintendent, shall provide for adequate disclosure  to  residents  of
  their  options,  rights  and  obligations under such an arrangement, and
  shall establish standards for the remittance and collection of  premiums
  and monthly care fees.
    2.  With regard to nursing facility or home health care services which
  are part of the continuing care retirement contract, any elimination  or
  waiting  periods  and  any deductibles, copayments, or other amounts not
  paid for by such long term care insurance or medical assistance payments
  shall be the responsibility of the continuing care retirement community.
  The resident shall not be liable to pay any such amounts.
    3. The continuing care retirement community operator shall not require
  that long term care insurance be purchased from a specified  insurer  or
  group  of  insurers  and the operator shall not, without the approval of
  the council and the approval of the superintendent,  specify  a  minimum
  acceptable  benefit  level  different  from  that  established under the
  partnership for long term care program.
    4. Entrance fees and monthly care fees shall reflect that the cost  of
  a  resident's nursing facility and home health care services are or will
  be paid for in whole or in part in accordance with (a)  the  partnership
  for  long  term  care program or (b) other group or individual long term
  care insurance  approved  by  the  superintendent  and  the  council  in
  connection with the application.
    5. a. If a resident fails to maintain minimum long term care insurance
  coverage in accordance with this section, the continuing care retirement
  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 payments by the resident to the operator.
    b.  If  the  continuing  care  retirement  community  operator  cannot
  purchase long term care insurance coverage under  paragraph  a  of  this
  subdivision,  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.
    c. If the resident fails to maintain long term care insurance coverage
  in accordance with this section  and  the  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.