The Disability Community has been fighting to create an alternative to institutional placement for nearly 24 years. Although we have not been able to end the institutional bias at the national level, we created a new state plan option called the Community First Choice (CFC) Option. CFC creates a new mechanism for states to provide community-based attendant services and supports for people with disabilities, regardless of age or disability. Once selected, this new option changes state Medicaid policy so every person who meets the level of care for institutional placement in a nursing facility, intermediate care facility, or institution for mental disease has the right to live and receive services and supports in the community.
CFC requires states to provide assistance with Activities of Daily Living (ADL's), Instrumental Activities of Daily Living (IADL's) and health related tasks (like medication administration, tube feeding, and vent care) to assure that people have the services and supports they need to live in the community.
Although New York State has a Nurse Practice Act (NPA) exemption for its consumer-directed program, it needs to amend the NPA to allow attendants under a more traditional agency model to provide assistance with health related tasks with training and supervision from a nurse.
Sounds pretty simple, right? But now the politics enters into it...
Governor Cuomo included language in his budget bills to authorize implementing of CFC, amending the Nurse Practice Act, and creating a workgroup of all interested parties to develop the specific operational decisions. When his administration became aware that the published language needed to be revised to implement CFC, they agreed to support a slightly modified proposal.
The NYS Senate incorporated the modified NPA amendment language in its budget resolution.
The NYS Assembly, however, failed to make the needed changes. Assemblywoman Deborah Glick - who chairs the Assembly Higher Education Committee which is responsible for - won't support the amending the NPA because the language doesn't define specifically which tasks attendants will be able to perform and what education, training and supervision will be required. She has not identified any alternative language which would allow the state to implement CFC and end the institutional bias.