CCRC Care at Home Contracts

Review and Discussion

Michael Heeran
CCRC Program Director

March 16, 2018

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Intent of the Care at

Home contract
model
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What is Care at Home

Care at Home allows seniors to take advantage of CCRC
Communities without leaving their home until such time as their
care needs require admission to a CCRC’s Assisted Living or
Skilled Nursing Facility, if necessary.

Care at Home contracts are intended to allow seniors to access

the amenities of a CCRC campus while living at home and
receive a predefined package of services from a CCRC such
as care coordination, home care, transportation, meals, and
wellness programs.
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What is Care at Home (cont.)

Care at Home contracts target seniors who desire to remain in
their home but have want to access the services and security
offered to traditional CCRC residents.

Care at Home contracts are intended to have an initial entrance

fee plus a monthly care fee to cover the cost of services
provided under the contract.
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What is Care at Home (cont.)

The entrance fee and monthly care fee could be offered at
generally less expensive pricing than traditional CCRC
Residency Agreements for Independent Living Units.

Care at Home services are provided by the CCRC or provider

under contract with the CCRC.

Care at Home contract holders are expected to live within a

reasonable geographic vicinity of the CCRC to allow access to
CCRC services and amenities.
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Perceived Benefits of Care at Home

Can provide seniors access to support and health services that
allow them to remain in the home instead of requiring
institutional placement.

May make CCRC services attractive to a younger senior

population.

Offers seniors an alternative to traditional long term care

insurance.
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Perceived Benefits of Care at Home (cont.)

Provides an opportunity for seniors living at home to interact
with peers at the CCRC.

Expands the CCRC “community” into the greater senior

community in the geographic area. “CCRC without walls”

May be able to convert a Care at Home contract to a traditional

CCRC Residency Agreement if one chooses.
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Basic Requirements
for Care at Home in
NYS
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Under Public Health Law, Care at Home….

Can only be offered by an Article 46 CCRC through an
amendment to the Certificate of Authority. The amendment
must be approved by the CCRC Council. PHL § 4605-a.
Can only be offered by communities that also offer continuing
care retirement contracts (Type A or B) and maintain CCRC
facilities that operate in support of continuing care retirement
Type A or B contracts. PHL § 4601(2-b)(f).

Cannot be offered by a separate corporation/operator even if

they are affiliated with the CCRC operator.
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Under Public Health Law, Care at Home….

Will have services provided by CCRC employees or contractors
that are duly licensed or certified pursuant to law, including any
licensure requirements for the provision of home care services.
PHL § 4608-a(1)

Operating expenses are included in the calculation of reserve

requirements required by the Department of Financial Services.
PHL § 4608-a(2)
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Under Public Health Law, Care at Home….

Financial reporting will include all operating activities for
continuing care at home contracts in the total operation of the
community as required by DOH and DFS. PHL § 4608-a(3)
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Under Public Health Law, the number of

Care at Home will be limited to:
the number of approved ILUs on the community's premises,
except that the council may approve additional contracts upon
a request meeting the requirements of PHL § 4605-a. PHL §
4605-b(1)

the demonstrated number of continuing care at home contract

holders that can be supported in the existing or approved future
capacity of the adult care facility and skilled nursing facility
servicing the continuing care retirement contracts.
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Under Public Health Law, the number of

Care at Home will be limited to:
Conditions set forth by the New York State Department of
Financial Services, based upon the superintendent's
assessment of the following:
(a) the overall financial impact on the community; and
(b) the submitted materials in the Care at Home application.
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Care at Home
Application
Requirements
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Public Health Law § 4605-a requires

applicants to submit:
A business plan that includes:
• Services to be provided, market to be served, and fees to be
charged
• A copy of the Care at Home contracts to be used
• An actuarial study that includes the Care at Home contracts
demonstrating the impact they will have on the community
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Public Health Law § 4605-a requires

applicants to submit:
A market feasibility study demonstrating to the commissioner
and superintendent sufficient consumer interest in continuing
care at home contracts and further demonstrating that the
addition of continuing care at home contracts will not have an
adverse impact on the provision of services to continuing care
retirement contract holders.
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Public Health Law § 4605-a requires

applicants to submit:
A copy of the notification sent to continuing care retirement
contract holders describing the anticipated impact of the
addition of continuing care at home contracts on continuing
care retirement community resources and proof that such
notification has been distributed to all continuing care
retirement contract holders.

Materials that meet all requirements established by the New

York State Department of Financial Services.
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Care at Home
Contract
Requirements
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Public Health Law § 4601(8-b) states:

"Continuing care at home contract" shall mean a single contract
to provide a person with long term care services and supports
based upon the person's needs and coordinated by a case
manager, which shall include services provided to the person in
his or her residence and services of the community's nursing
facility and adult care facility, or affiliated facilities.
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Public Health Law § 4608(20) states:

Continuing care at home contracts shall include the following:
• a statement describing the circumstances under which a contract
holder may move into a campus independent living unit, adult
care facility or nursing home;
• a statement as to whether and under what circumstances
transportation will be provided to continuing care at home
contract holders;
• a statement describing the mechanism for monitoring continuing
care at home contract holders;
  
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Public Health Law § 4608(20) states:

Continuing care at home contracts shall include the following:
• a statement describing the method by which the community will
determine priority for access to available ILUs between a
continuing care at home contract holder who wishes to convert
the contract to a continuing care retirement contract and a
continuing care retirement contract holder;
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Public Health Law § 4608(20) states:

Continuing care at home contracts shall include the following:
• a statement describing any applicable geographical limits of the
continuing care at home services, and the policy that will be
followed in the event that a continuing care at home contract
holder relocates to a different residence outside the geographical
limits covered by the continuing care at home contract; and
• a statement describing any applicable policy that would entitle a
continuing care at home contract holder to select adult care
facility or skilled nursing facility placement in a facility that is not
part of the continuing care retirement community.
  
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Care at Home
Next Steps
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Steps required to process applications:

Pursuant to 4602(2)(j) the CCRC Council shall have the power and
duty to develop guidelines for applications for certificates of
authority.

Feedback of the CCRC Council is required to assist DOH and DFS in

developing an application process which would provide the Council
with the necessary materials to approve Care at Home COA
applications.
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Steps required to process applications:

Questions have arisen from potential applicants regarding they type
of Care at Home model that would be acceptable to the Council and
allowed under Article 46 of Public Health Law.

Examples are:
• How to handle refundable entrance fee contracts and refunds
• Portability of services
• Limits on geographic area of service
• Required services
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Steps required to implement Care at Home :

New regulations would be required to support the Care at Home
contract type.

• The CCRC Council would provide input to DOH to help develop

proposed regulations for the Care at Home contract model.
• DOH would propose new regulations for the Care at Home
contracts.
• The CCRC Council would be required to adopt new regulations for
Care at Home contracts.
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Recommended next steps:

For the June 14, 2018 CCRC Council meeting:
• Presentation from a CCRC interested in implementing Care at
Home contracts.
• Discuss and recommend materials to be required in the
submission of a Care at Home application.
• Identify potential areas of discussion and clarification related to
Care at Home contracts.
For the October 18, 2018 CCRC Council meeting:
• Resolve remaining issues with Care at Home applications.
• Identify implementation issues to be resolved.
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Questions?