hereby authorized to and within thirty days shall allocate from the general fund such funds as are necessary to meet the obligations, but not to exceed the amount reallocated, to be distributed in accordance with this subparagraph. Further, that the amount reallocated, less any funds repayed due to insufficient funds in the programs, shall be encumbered by the state comptroller before the end of each fiscal year, and for any fiscal year commencing on or after April first, nineteen hundred ninetyone but ending with the fiscal year beginning on April first, nineteen hundred ninety-three where the governor fails to submit a budget bill containing an appropriation to provide for the programs or the legislature fails to appropriate such amount in the budget bill submitted by the governor for such fiscal year, the amount reallocated and encumbered shall be payable forthwith to such programs on the fifteenth day of May of such year, in the manner described by law, except that for the fiscal year beginning April first, nineteen hundred ninety-three such reallocation shall be encumbered by the comptroller and repayed from the general fund no later than December thirty-first, nineteen hundred ninetythree. ]

§ 60. The opening paragraph of subdivision 2 of section 365-a of the social services law, as amended by chapter 110 of the laws of 1971, is amended to read as follows:

"Medical assistance" shall mean payment of part or all of the cost of medically necessary medical, dental and remedial care, services and supplies, as authorized in this title or the regulations of the department, which are necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with [his] such person's capacity for normal activity, or threaten some significant handicap and which are furnished an eligible person [is] in accordance with this title[,] and the regulations of the department. Such care, services and supplies shall include, but need not be limited to] the following medical care, services and supplies, together with such medical care, services and supplies provided for in subdivisions three, four and five of this section, and such medical care, services and supplies as are authorized in the regulations of the department:

61. Notwithstanding subdivision 2 of section 365-a of the social services law, "medical assistance" shall include court-ordered care, services or supplies, other than medical care, services or supplies heretofore ordered by a court to be provided to a recipient of medical

assistance.

§ 62. Paragraphs (a) and (1) of subdivision 2 of section 365-a of the social services law, as amended by chapter 165 of the laws of 1991, amended and a new subdivision 8 is added to read as follows:

are

to

(a) services of qualified physicians, dentists [to the extent authorized by paragraph (e) herein], nurses except that private duty nursing shall be provided subject to section three hundred sixty-seven-1 of this chapter, and private duty nursing services shall be further subject the provisions of section three hundred sixty-seven-o of this chapter, optometrists, [podiatrists] and other related professional personnel; (1) care and services of podiatrists which care and services shall only be provided upon referral by a physician, nurse practitioner or certified nurse midwife in accordance with the program of early and periodic screening and diagnosis established pursuant to subdivision three of this section or to persons eligible for benefits under title XVIII of the federal social security act as qualified medicare beneficiaries in accordance with federal requirements therefor and private duty nurses which care and services shall only be provided in accordance with regulations of the department of health and subject to the provisions of section three hundred sixty-seven-1 of this title.

(eS2)

8. (a) Any person twenty-one years of age or older eligible for benefits under this title pursuant to section three hundred sixty-six of this article only as a result of being eligible for or in receipt of home relief shall receive the services specified in subdivision two of this section, provided that: such person shall receive the services listed in paragraphs (d), (e), (h), (j) and (1) of subdivision two of this section, optometric services as described in paragraph (a) of subdivision two of this section, audiology as described in paragraph (n) of subdivision two of this section, clinical psychologists, orthotics, sick room supplies and inpaEXPLANATION-Matter in italics is new; matter in brackets [ ] is old law to be omitted.

tient services in a nursing home as described in paragraph (b) of subdivision two of this section, but only if such person is enrolled in one of the following programs, or if there is no provider affiliated with any such program who is sufficiently accessible to the recipient as to reasonably provide services to the recipient, in accordance with departmental regulations:

(A) a health maintenance organization or other entity which provides comprehensive health services;

(B) a managed care program or other primary provider program, as specified by the department; or

(C) a voluntary medical care coordinator program. For the purposes of this subdivision, a voluntary medical care coordinator program shall mean a program established in accordance with departmental regulations to enroll medical assistance recipients with primary physicians, diagnostic and treatment centers and hospital outpatient departments and primary pharmacies which shall provide or refer the recipient to medically necessary services pursuant to this section and shall further coordinate the utilization of those services to assure the appropriate and cost-effective delivery of medical assistance.

as

(ii) in no case shall payment be made for more than thirty-two days of in-patient services, excepting in-patient services in a nursing home such term is defined in section twenty-eight hundred one of the public health law, in any twelve month consecutive period unless such services are part of a full capitation program, and provided, further, that in no event shall an in-patient facility providing in-patient services described in paragraph (b) of subdivision two of this section discharge such person solely as a result of his or her having received the maximum number of his or her in-patient service days for which payment is

available pursuant to this title.

§ 63. Paragraph (d) of subdivision 2 of section 365-a of the social services law, as amended by chapter 165 of the laws of 1991, is amended to read as follows:

(d) home health services provided in a recipient's home and prescribed by a physician subject to the provisions of section three hundred sixtyseven-j of this title including[: (i)] services of a nurse provided on a part-time or intermittent basis rendered by an approved home health agency or if no such agency is available, by a registered nurse, licensed to practice in this state, acting under the written orders of a physician; (ii)] and home health aide service provided by an approved home health agency;

§ 64. The opening paragraph of paragraph (a) of subdivision 2 of section 366 of the social services law, as amended by chapter 77 of the laws of 1977, is amended and a new subdivision 8 is added to read as follows:

The following income and resources shall be exempt and shall [neither] not be taken into consideration [nor required to be applied toward the payment or part payment of the cost of] in determining a person's eligibility for medical care [and], services and supplies available under this title:

8. Notwithstanding any inconsistent provision of this chapter or any other law to the contrary, income and resources which are otherwise exempt from consideration in determining a person's eligibility for medical care, services and supplies available under this title, shall be considered available for the payment or part payment of the costs of such medical care, services and supplies as required by federal law and regulations.

65. Subparagraph 4 of paragraph (a) of subdivision 2 of section 366 of the social services law, as separately amended by chapters 32 and 588 of the laws of 1968, is amended to read as follows:

(4) savings in amounts equal to at least one-half of the [appropriate income exemptions allowed] income amount permitted under subparagraph seven of this paragraph, provided, however, that the amounts for one and two person households shall not be less than the amounts permitted to be retained by households of the same size in order to qualify for benefits under the federal supplemental security income program;

§ 66. Subdivisions 4 and 5 of section 365-g of the social services law, subdivision 4 as added by chapter 938 of the laws of 1990 and subdivision 5 as amended by chapter 165 of the laws of 1991, are amended to read as follows:

4. Utilization thresholds established pursuant to this section shall not apply to the following services: (a) clinic and other outpatient services, as follows:

(i) mental health services provided pursuant to paragraph (c) of subdivision two of section three hundred sixty-five-a of this chapter, alcoholism services, substance abuse services, mental retardation [services] and developmental disabilities services provided in clinics certified under article twenty-eight of the public health law, or article twenty-three or article thirty-one of the mental hygiene law provided to persons eligible for medical assistance by reason other than their being eligible for home relief and continuing treatment and continuing day treatment certified under article thirty-one of the mental hygiene law provided to persons eligible for medical assistance solely by reason their being eligible for home relief; and

of

(ii) alcoholism services, substance abuse services, mental retardation services and developmental disabilities services provided in clinics certified under article twenty-eight of the public health law, or article twenty-three or article thirty-one of the mental hygiene law provided to persons eligible for medical assistance by reason of their being eligible for home relief; and

(iii) services performed by an article twenty-eight hospital or diagnostic and treatment center on an ambulatory basis upon the order of qualified practitioner to test, diagnose or treat the recipient.

as follows:

a

(B) Physician servicvices provided to persons eligible for medical as

sistance by reason other than their being eligible for home relief; and (ii) anesthesiology services.

5. Utilization thresholds established pursuant to this section shall not apply to services, even though such services might otherwise be subject to utilization thresholds, when provided as follows:

(a) through a managed care program;

(b) subject to prior approval or prior authorization;

(c) as family planning services;

(d) [under the recipient restriction program;

(e) as methadone maintenance services;

[(f)] (e) on a fee-for-services basis to in-patients in general hospitals certified under article twenty-eight of the public health law or article thirty-one of the mental hygiene law and residential health care facilities, with the exception of podiatrists' services;

[8]

(f) for hemodialysis; or

(8) through or by referral

from a preferred primary care provider designated pursuant to subdivision twelve of section twentyeight hundred seven of the public health law.

67. Section 367-a of the social services law is amended by adding a new subdivision 12 to read as follows:

12. Notwithstanding any inconsistent provision of law or regulation to the contrary, the commissioner shall reduce payments for in-patient services for patients that exceed the limitations on covered days of such services pursuant to paragraph (b) of subdivision eight of section three hundred sixty-five-a of this title: (a) to exclude, for per diem unit of service based payments, payments for days of care provided to a patient that exceed such limitations; and (b) to exclude, for case based unit of service payments, a percentage of the case based payment amount based upon the ratio of the number of days of care covered by the case based rate of payment actually provided to a patient that exceed such limitations to the total number of days of care covered by the case based rate of payment actually provided to such patient, expressed as a percentage.

§ 68. Subparagraph (iv) of paragraph (e) of subdivision 1 of section 367-j of the social services law, aš added by chapter 165 of the laws 1991, is amended to read as follows:

(iv) home health services are appropriate for the recipient's functional needs and [the recipient's living and working arrangements, can maintain the recipient in the home, and can be reasonably provided or, based on] that institutionalization is contraindicated, based on a review by the certified home health agency of the recipient's medical case history, [that] including a certified statement from the recipient's physician on a form required by the department and the department of health describing the potential impact of institutionalization which has been reviewed by a residential health care facility to determine if institutionalization would result in a diminishing of the recipient's ability to perform the activities of daily living;

EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law to be omitted.

§ 69. Subparagraph (v) of paragraph (e) of subdivision 1 of section 367-j of the social services law is repealed and subparagraph (vi) of such paragraph is relettered subparagraph (v) and amended to read as follows:

(v) the local social services district] certified home health agency determines in the event the recipient lives with someone who would require services in the recipient's absence, that the cost for services for both persons, if either or both are institutionalized, would equal or exceed the cost for continued home health services for the recipient and for services to such other person.

§ 70. Subdivision 2 of section 367-j of the social services law, as added by chapter 165 of the laws of 1991, is amended to read as follows: 2. (a) Certified home health agencies shall assess all recipients, to determine, the following:

(i) [eligibility for hospice services, and unless medically contraindicated by a recipient's physician, notify recipients of such services if available in the district and assisting the social services district with referrals to hospice if a recipient so chooses;

(ii)] that the provision of home health services are provided according to the plan of care and can maintain the recipient's health and safety in the home as defined by the department of health in regulation; [(iii)] (ii) whether the functional needs and living and working arrangements, of recipients receiving home health services solely for purposes of monitoring such recipients, can be appropriately and more cost-effectively monitored through the provision of personal emergency response system services available in the district;

the

(iv)(iii) whether the functional needs and living and working arrangements, of home health services recipients can be appropriately and more cost-effectively maintained through the provision of shared aides; [(y)] (iv) whether home health services recipients requiring only personal care, or an appropriate substitute, and that do not require, part of a routine plan of care, part-time or intermittent nursing or other therapeutic services, can be appropriately and more costeffectively served through the provision of personal care services, unless such services are otherwise available in the district;

as

[(vi)] (v) whether home health services can be appropriately and more cost-effectively provided to the recipient by the agency in cooperation with an adult day health program or a clinic rather than on a fee for service basis, provided however, that such program or clinic is geographically accessible to the recipient;

【(vii)] ́(vi) whether home health services recipients can be appropriately and more cost-effectively served through other long-term care services, including but not limited to the long-term home health care program, assisted living program and enriched housing program; and

(vii) whether home health services can be appropriately and more costeffectively provided under a patient managed home care program consistent with section three hundred sixty-five-f of this title.

(b) If a certified home health agency determines that the recipient can be appropriately and more cost-effectively served through the provision of services or settings described in subparagraphs (ii), (iii), (iv), (v), (vi) and (vii) of paragraph (a) of this subdivision then the certified home health agency shall first consider the use of such services or settings in the development of a plan of care [for] and the recipient shall be required to use such services or settings in lieu of home health services for the maximum reduction in the need for home health services or other long-term care services.

(c) The certified home health agency must have a written agreement with any hospice which is available in the service area of the certified home health agency. Such agreement must specify the procedures for notifying recipients believed eligible, unless medically contraindicated by a recipient's physician, of the availability of hospice services and for referring recipients to such hospice, if a recipient so chooses. § 71. Subparagraph (iv) of paragraph (d) of subdivision 1 of section 367-k of the social services law, as added by chapter 165 of the laws of 1991, is amended to read as follows:

(iv) personal care services are [most] appropriate for the recipient's functional needs and [the recipient's living and working arrangements; the social services official reasonably expects that the services can maintain the recipient in the home; and the services can be reasonably provided or, based on] that institutionalization is contraindicated, based on a review by the social services district of the recipient's medical case history[, that] including a certified statement from the

recipient's physician on a form required by the department and the department of health describing the potential impact of institutionalization which has been reviewed by a residential health care facility to determine if institutionalization would result in a diminishing of the recipient's ability to perform the activities of daily living;

§ 72. Subparagraph (v) of paragraph (d) of subdivision of section 367-k of the social services law is repealed and subparagraph (vi) of such paragraph is relettered subparagraph (v).

§ 73. Subdivision 2 of section 367-k of the social services is amended to read as follows:

2. (a) Social services districts'* shall assess all recipients to determine the following:

(i) [eligibility for hospice services and, unless medically contraindicated by a recipient's physician, notify recipients of such services if available in the district and make referrals to hospice if a recipient so chooses;

(ii) that the provision of personal care services are provided according to the plan of care and can maintain the recipient's health and safety in the home as defined by the department of health in regulation; [(iii)] (ii) whether the functional needs and living and working arrangements, of recipients receiving personal care services solely for the purposes of monitoring such recipients, can be appropriately and more cost-effectively monitored through the provision of personal emergency response system services available in the district;

[(iv)] (iii) whether the functional needs and living and working arrangements, of personal care services recipients can be appropriately and more cost-effectively maintained through the provision of shared aides;

[(V] (iv) whether a personal care recipient requiring, as part of a route plan of care, part-time or intermittent nursing or other therapeutic service provided by a provider, except for the provision of services expected to be required on a short-term basis or nursing provided to a medically stable recipient, can be appropriately and more cost-effectively served through the provision of certified home health services; and

[(vi)] (v) whether personal care recipients can be appropriately and cost-effectively served through other long-term care services, including but not limited to, the long-term home health care program, assisted living program and enriched housing program; and

(vi) whether personal care services can be appropriately and more cost-effectively provided under a patient managed home care program consistent with section three hundred sixty-five-f of this title.

(b) If a social services district determines that the recipient can be appropriately and more cost-effectively served through the provision of services or settings described in subparagraphs (ii), (iii), (iv), (v) and (vi) of paragraph (a) of this subdivision then the social services district shall first consider the use of such services or settings in the development of a plan of care for the recipient shall be required to use such services or settings in lieu of personal care services or for maximum reduction in the need for home health services or other longterm care services.

(c) The social services district must have a written agreement with any hospice which is available in the district. Such agreement must specify the procedures for notifying recipients believed eligible, unless medically contraindicated by a recipient's physician, of the availability of hospice services and for referring recipients to such hospice, if a recipient so chooses.

§ 74. Subparagraph (iv) of paragraph (d) of subdivision 2 of section 367-1 of the social services law, as added by chapter 165 of the laws of 1991, is amended to read as follows:

(iv) the private duty nursing services are [most] appropriate for the recipient's functional needs and [the recipient's living and working arrangements, can maintain the recipient in the home and can be reasonably provided or, based on] that institutionalization is contraindicated, based on a review by the social services district of the recipient's medical case history, [that] including a certified statement from the recipient's physician on a form required by the department and the * So in original. ("districts'" should be "districts".)

EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

to be omitted.