2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4623 - Long Term Care Insurance and Continuing Care Retirement Contracts or Continuing Care at Home Contracts.

§  4623.  Long  term  care  insurance  and  continuing care retirement
  contracts or continuing care at  home  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 or  continuing  care
  at   home   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.