Tag medicaid

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.

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.

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.

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.

Times-Union: Lawmakers hear of crisis in home care

By Casey Seiler, 2/27/17

The system that provides home care for New York’s ailing, elderly and disabled populations is in crisis due primarily to economic pressures, including a state reimbursement formula that has pushed some rural care providers to the brink of not being able to make payroll.

That was the message conveyed by dozens of witnesses who attended a Capitol hearing Monday called by the Assembly committees on health, aging, labor and health. The Legislature returns to Albany on Tuesday to begin the final month of negotiation of the budget.

City & State – Lawmakers: Obamacare repeal a complex and complicated equation for New York

By Ashley Hupfl, 2/21/17

The potential repeal of the Affordable Care Act and the uncertainty over what might replace it have state lawmakers warning of a major budget hole in New York – and wondering how to remedy it.

At City & State’s State of New York Finance event on Tuesday, a panel of lawmakers and industry officials had more questions than solutions for how the state will prepare for and respond to a full repeal of the health care law, widely known as Obamacare.

PRESS ADVISORY – Workers, Patient Advocates, Providers to Testify on Home Care Workforce Needs

Contact:                                                         February 21, 2017
Mischa Sogut
518-455-4941
SogutM@nyassembly.gov

On Wednesday, February 22, the Assembly Committees on Health, Aging, Labor, and Task Force on People with Disabilities will hold a public hearing in New York City on the crisis of New York’s inadequate home care workforce.

Home care allows individuals to receive health care and personal services to live at home instead of in a nursing home or other facility. There is a growing shortage of home care services for the elderly, people with disabilities, and people who are chronically ill. Advocates note that there is a shortage of home care workers that is causing waitlists for these services across the state at a time when demand is increasing. Inadequate Medicaid funding for home care may be a significant obstacle to hiring and keeping people in the home care workforce.

The hearing will focus on obstacles to recruiting, employing, and retaining a sufficient workforce. Witnesses are expected to include patient advocacy groups and self-advocates, home care and disability service providers, and home care workers and organized labor groups.

What:
NYS Assembly public hearing on home care workforce

Who:
-NYS Assembly Committees on Health, Aging, and Labor, and Task Force on People with Disabilities
-Patient advocates and self-advocates
-Service providers
-Home care workers

Where:
250 Broadway
19th Floor
New York, New York
10007

The hearings will also be webcast live at:
http://assembly.state.ny.us/av/

When:
Wednesday, February 22
11 AM

###

Times-Union: N.Y. lawmakers question health officials on drug prices, executive power, spending

By Claire Hughes, 2/16/17

Drug price controls, the adequacy of Medicaid payments and expanding the power of the Health Department were among the topics discussed at a legislative hearing Thursday on Gov. Andrew Cuomo’s proposed budget for health and Medicaid.

An underlying theme was uncertainty about what action President Donald Trump and a Republican-led Congress might take on the Affordable Care Act, which could affect health insurance subsidies for New Yorkers, and funding for women’s reproductive health clinics, including Planned Parenthood.

 “Much is happening in Washington,” state Health Commissioner Howard Zucker told lawmakers. “If the ACA were repealed, that would be a major concern, with millions of people potentially losing health care.”

BALCONY Radio interview

I spoke to the Business and Labor Coalition of NY on WOR 710 AM radio, regarding the new administration’s threats to the Affordable Care Act, and the need for a universal, single-payer healthcare system:  https://soundcloud.com/lou-gordon-845856577/balcony-ny-1-29-17 (segment starts at 23 minutes).

State of Politics: Assembly Health Chair Raises Concerns With Trump Impact

By Nick Reisman, 12/14/16

The longtime chairman of the Assembly Health Committee on Wednesday released a lengthy essay on the potential impacts on health-care policy by the incoming Donald Trump presidential administration.

Those concerns raised by Assemblyman Dick Gottfried, a Manhattan Democrat, range from the new federal administration gutting medical marijuana laws on the state level, scaling back benefits for Medicaid recipients and the repeal of the Affordable Care Act, which could blow a $2 billion hole in the state budget.

“The first step in stopping or reversing these attacks is to clearly understand what’s at stake and spread the word,” Gottfried wrote in the statement released by his office. “There is hardly anything more rigged against working people than health care. The Trump-Republican agenda will make it worse.

Gottfried’s solution to bolster health care in New York under Trump is his long-stalled proposal for universal coverage in New York through a single-payer system.

“Instead of regressive premiums, deductibles, co-pays and out-of-network charges, it would be funded fairly through broad-based taxes based on ability to pay,” Gottfried wrote. “The Assembly passed the bill in 2015 and 2016 – helping to move it from being “a great idea that could never happen” to something really achievable. In 2017, we will continue to work to build public support so it can ultimately pass the Senate.”