Budget Update: Medicaid Long-Term Care

It has been becoming increasingly difficult for Medicaid patients needing long-term care – especially home care for extended hours – to get the care they need.  In many areas, there is a shortage of home care aides because low reimbursement rates make recruitment and retention of workers difficult.  State payment rates to managed care plans discourage them from serving high-need patients properly.  The methodology for assessing patient need does not adequately account for cognitive deficiency and other factors.

The newly-enacted state budget legislation (A.3007-B) includes several important actions intended to begin to turn around this siutation.  In addition, the Department of Health (DOH) sent a side letter to the legislature committing to several further actions (indicated below as “Administrative action, side letter”).

  • Consumer Directed Personal Assistance Program (CDPAP) fiscal intermediary authorization: Requires fiscal intermediaries in the CDPAP program to register with DOH (“authorization”), and defines their scope of services.  In 2015, similar legislation was vetoed and this year’s legislation comes from negotiation among the Assembly and Senate Health Committees, DOH, and the fiscal intermediaries.
  • CDPAP wage parity: Adds workers in the CDPAP program to the Medicaid wage parity law that currently applies to other home care workers, primarily in the downstate metropolitan region.  It will phase in to reach full parity in three years. Medicaid payments to managed care plans will cover this, and managed care plans will attest to the wage pass-through in cost reports.
  • Uniform assessment system (UAS):  
  • Adds “cognitive” to the current evaluation of patient “medical, social and environmental needs” required for managed care enrollees. Because of a drafting error, this provision is found in the “revenue” budget bill (A.3009-C, Part GGG) rather than in the “health” budget bill (A.3007-B).
  • DOH will hold regular meetings with legislators, stakeholders, and the UAS program team in order to examine and formulate improvements to the UAS. (Administrative action, see side-letter)
  • High-need rate cells or risk adjustments for managed long term care: (Administrative action, see side-letter.) DOH will work with legislators,  advocates, providers, and managed care organizations to evaluate separate rate cells or risk adjustments for the nursing home, high-cost/high-need home and personal care, and Health and Recovery Plan (HARP) populations.  Resulting adjustments will require approval by the federal Centers for Medicare and Medicaid Services.
  • Delaying TBI/NHTD carve-in to managed care: (Administrative action, see side-letter.) DOH will further delay the carve-in of the Traumatic Brain Injury and Nursing Home Transition and Diversion waivers into managed care from April 1, 2018 to January 1, 2019.
  • Nursing home bed-hold: The legislature restored the bed-hold payments for therapeutic leaves of absence at a 95% payment rate for up to 14 days annually.
  • Nursing home benchmark rates: The transitional “benchmark” Medicaid payment rate for nursing homes patients moving from fee-for-service to managed care will be extended until 2020.
  • Managed Long-Term Care (MLTC) and Adult Day Health Care (ADHC) transportation: (Administrative action, see side-letter.) DOH will not carve-out the Medicaid transportation benefit from MLTC or ADHC programs for the 2017-2018 fiscal year.
  • Spousal and family support: The Legislature protected the resources of family members by rejecting the Governor’s proposal to require them to pay for an individual’s long-term care before the individual could become Medicaid eligible. This was the 28th consecutive year that this has been proposed by five governors and rejected by the Legislature.

Capital Tonight re: Single-Payer and the Affordable Care Act

3/28/17, interview on Capital Tonight regarding single-payer healthcare and updates on the State budget and Federal action on healthcare.  Video here:
http://www.twcnews.com/nys/capital-region/capital-tonight-show/2017/03/28/capital-tonight-032717.html

Albany Times-Union – Lawmakers call to fund donor breast milk for premature babies

By Rick Karlin, 3/27/17

As they have with several measures that have bubbled up in recent weeks, lawmakers are reviving a bill that was vetoed by Gov. Andrew Cuomo last year with instructions that it should be a part of the budget package.

Both GOP Sen. Kemp Hannon and Democratic Assemblyman Richard Gottfried, who head their respective health committees, on Monday urged passage of a measure that would allow Medicaid to cover the cost of donated breast milk, which they said can be a life-saving nutrient to premature infants who develop necrotizing enterocolitis, a serious intestinal ailment that can hit such babies.

NY Times: Extra! Extra! Albany Lawmakers Face Five-Day Week in Capitol

By Jesse McKinley, 3/27/17

ALBANY — It’s an occurrence as uncommon in these parts as a bearhug from the governor or an indictment-free year.

On Monday, New York State legislators embarked a rare and rigorous five-day workweek here, the first time in nearly six years that they have been scheduled to be in the Capitol from Monday through Friday.

The prospect of spending five consecutive days at your place of employment might not be a shock for someone with, say, a job. But the lawmakers say their seemingly light legislative schedule does not take into account ample time spent on the clock in other ways: budget hearings, which can drag on; community and district events, which often occur far from Albany; fielding constituent concerns, via phone, email and the occasional screed; and researching the myriad issues they are responsible for tackling.

All of which, it can be argued, makes criticizing their lack of time in the Capitol unfair.

“It’s kind of like saying your workweek is the time you spend typing on a keyboard, or that a radio reporter’s workday is the three minutes their voice is on the air, or that a schoolteacher doesn’t spend time grading papers,” said Assemblyman Richard N. Gottfried, a Democrat from Manhattan, who is his chamber’s longest-serving member. “I can’t imagine any legislator that only works a five-day week.”

Legislative Gazette – NYCLU demands legislative action on civil liberties issues

By Katherine Carroll, 3/15/17

Members, supporters and advocates for the New York Civil Liberties Union rallied Monday outside the Capitol in support of several bills they say would protect and expand civil rights. Public defense funding and reform, reproductive rights, transgender discrimination, electronic privacy, and police data transparency were all on the agenda for the group’s day of action.

Speakers Jonathan Gradess, executive director of the New York State Defenders Association, and Darren Mack, a former inmate at Rikers Island prison, advocated for the Justice Equality Act (A.1903), sponsored by Assemblywoman Patricia Fahy, D-Albany.

ABC News 10 (w/ video) – NY Senate Democrats calling for proper healthcare

Nick Perrault, March 9, 2017 (video in link)

ALBANY, N.Y. (NEWS10) – Senate Democrats in New York are calling out Republicans in their chamber for failing to act to ensure all New Yorkers have proper healthcare.

The conference introduced legislation this week they say will protect everyone.

“We are in the midst of experiencing a calamity out of Washington D.C in our country,” Senator Democratic Deputy Leader Michael Gianaris, said.

TWC News (with video) – With Health Care in Upheaval in Washington, Democrats in Albany Push for Single-Payer System

By Nick Reisman (video in link), March 8

With the Affordable Care Act under fire in Washington, Democratic lawmakers in Albany are pushing for a measure creating a single-payer system — universal health care.

“We have an obligation to protect the 3.6 million New Yorkers enrolled in comprehensive health coverage enrolled through our state’s exchange,” said Senate Minority Leader Andrea Stewart-Cousins.

Capitol Pressroom with Susan Arbetter (audio)

March 6, 2017


The Capitol Pressroom features Assembly Health Committee Chair Richard Gottfried on changes to the ACA and his push for a single-payer health care system in New York State.

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WAMC: NY’s Abortion Services Could Be Caught Up In ACA Repeal Fight

By Karen DeWitt, March 8, 2017 (link includes audio)

A provision in the Obamacare replacement plan by Republicans in Congress sets up a potential clash with New York state over abortion coverage.

Gannett: N.Y. assesses impact of GOP health plan

By Jon Campbell, Gannett (via WGRZ), March 7

ALBANY – House Republicans’ long-awaited plan to replace the Affordable Care Act led New York officials Tuesday to assess its impact on the state and its residents as Congress grapples with the bill’s chances of passage.