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.
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.
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.
As uncertainty over the future of the federal healthcare system persists, state Senate Democrats are proposing the creation of a single-payer public health system as part of a package of bills to help the state prep for potential repeal of the Affordable Care Act.
The legislation, touted by the Minority Democrats on Wednesday, would set up the frame work for a single-payer system, tasking state health officials with the actual implementation and devising the exact funding mechanism.
Assembly Health Committee Chairman Richard Gottfried in an interview Tuesday said the possible repeal of the Affordable Care Act strengthens his long-sought effort to create a single-payer system in New York.
“What I think New York ought to be doing and the only thing a progressive state can do is enact a state-based improved Medicare for all or single-payer system,” Gottfried said. “The enormous savings we’d get by eliminating the administrative costs in the current system is the only way we can free up enough money to fill up the holes the federal government is going to be blasting in health care.”
New York officials are pondering what to do in the event of a repeal of the law by the Republican-controlled Congress. Gov. Andrew Cuomo at a press conference on Tuesday said the state can’t really plan for an unraveling of the measure or what could potentially replace it.
The state did participate in the expansion of the Medicaid program and could see its safety net shrink if block grants are created for the program.
“What really scares me is what the federal government is going to cut the Medicaid program and damage Medicare,” Gottfried said.
Still, the more popular, consumer-focused aspects of the ACA are already enshrined in state law, Gottfried said.
“Fortunately, a lot of the insurance provisions, consumer safeguards and the like in the Affordable Care, are embedded in our law,” he said. “Many of them are embedded in our law for 20 years or more.”
I represent Chelsea, Hell’s Kitchen, Midtown, and parts of Murray Hill and the Lincoln Center area in the State Assembly. I have been chair of the Assembly Health Committee since 1987. During off hours, I like to write Chinese calligraphy.