New York Consolidated Laws, Public Health Law - PBH § 4015. Pilot program for all-inclusive care for children

1. The commissioner is hereby authorized to establish a pilot program for all-inclusive care for children.  Such program, subject to the rules and regulations of the commissioner, shall consist of comprehensive hospice and palliative care services for children with life-limiting illnesses that addresses the medical, psychosocial and spiritual aspects of care and allows such children to be cared for at home rather than in an institutional setting.  Such services shall be provided by a licensed, certified hospice working jointly with a certified home health agency, or a certified home health agency working jointly with a licensed, certified hospice to assure the provision of services which are an enhancement of either the certified home health agency or hospice alone, and shall include hospice services as well as related expressive therapies such as art, play or music therapy in addition to services of a child life specialist, and opportunities for respite care.

2. “A child with a life threatening illness” shall mean a child eligible for medical assistance under article five of the social services law, who under the age of eighteen is diagnosed with an illness that places the child at substantial risk of dying before the age of twenty-one where the child can, with appropriate services be cared for at an alternative to institutional care.

3. Qualified agencies providing services under this section to a child shall be reimbursed under medical assistance under article five of the social services law, at a per diem rate for each day the child is enrolled in a program.  To ensure the alienability of needed services to these children, reimbursement shall be provided only to those agencies having satisfied conditions of the department including satisfactory training in pediatric palliative care.

4. Certified hospice programs shall be allowed to waive the admission criteria requiring certification of “a terminal illness with prognosis of six months or less” as well as the requirement for families to forgo curative treatment for children qualifying for this program receiving care from an approved site.

5. All home care and other medical assistance under article five of the social services law otherwise authorized for the child, shall continue without interruption.  The pilot program for all-inclusive care for children is not intended to supersede any program already in place.

6. The locations of the providers under the pilot program for all-inclusive care shall be geographically disbursed throughout the state and approved by the commissioner.

7. The commissioner shall require each provider under the pilot program for all-inclusive care for children to submit an annual report, which shall include data analyzing the cost and efficiency of care provided under such program.  On or before December thirty-first, two thousand eight, the commissioner shall submit a report to the governor, the temporary president of the senate and the speaker of the assembly analyzing the cost and efficiency of the pilot program.