Dick Gottfried

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.