Assembly Identifies Budget Priorities

Late Tuesday night, the Assembly majority released their amendments to the Governor’s proposed 2014-15 State Budget. We are pleased to see a number of our concerns addressed by the Assembly. At the same time, we are concerned that language related to patient handling mandates has been included in the Assembly’s budget. While we support measures to ensure safe patient handling, the mandates in the bill are costly, redundant and do not provide adequate patient protections. LeadingAge NY feels strongly that patient handling legislation should be considered outside of the state budget and will continue our advocacy in that regard.

The Senate has not yet released their budget recommendations but we expect them shortly. The Legislature hopes to pass their budget recommendations today and tomorrow and will immediately convene Budget Conference Committees. We will keep you updated as the budget negotiations unfold. In the meantime, below is a list of the Assembly’s budget priorities. Please note that we have not included all the key budget provisions, but rather have highlighted items that the Assembly has altered from the Governor’s proposal. We encourage you to continue your advocacy on these issues as the Legislature begins intense negotiations over the next two weeks. All the resources you need are available on our web page: http://www.leadingageny.org/advocacy/main/legislative-action-center/.

Here are the Assembly budget items of most interest to long term care and senior services providers:

Assembly Funding Changes

Allocates $4,650,000 for a Cost of Living Adjustment (COLA) for services administered by the NYS Office for the Aging (NYSOFA) for the period of April 1, 2014 through March 31, 2015. The COLA was previously eliminated from the Governor’s Executive Budget.
Allocates $4 billion for reinvesting savings from MRT initiatives, pending approval from CMS to amend the existing 1115 Waiver (partnership plan) or if DOH receives approval for a new 1115 MRT Waiver.
Allocates $600 million to the Balancing Incentive Program (BIP), calling on the Commissioner of Health to report quarterly to the Legislature on any projects, programs or initiatives and project allocations. The BIP funding has already been approved by CMS and payments to the state actually began in 2013.
Reappropriates past funding for the EnAbLE program for Adult Care Facilities (ACFs), which the administration has yet to disburse. We have been advocating strongly for these funds to be reappropriated.

Assembly Language/Programmatic Changes

Rejects the proposal to permit private equity investment in up to 5 operators of health care facilities licensed under Article 28. We have voiced strong opposition to this measure.
Revises the capital restructuring financing proposal to include assisted living and home care agencies and to permit grants for telehealth projects. We had advocated strongly for the inclusion of these provisions, along with funding for health information exchange, though that component is not included.
Includes language requiring NYSOFA to develop an application process for the approval of entities to offer enriched social adult day services.
Includes language mandating safe patient handling provisions in nursing homes, hospitals and clinics. The Assembly recognized some of our concerns, but the language remains problematic and we will push hard to have this issue addressed outside of the budget.
Slightly modifies the streamlining provisions to the ACF/AL application. The modifications require that operators must be in good standing (as defined by the Assisted Living Reform Act) in order to expand an existing EALR or SNALR by up to nine beds utilizing an expedited process.
Rejects the Governor’s proposal to require spousal support for the costs of community-based long term care (i.e., “spousal refusal”).
Accepts proposals governing out-of-network access, notification, appeals, and independent dispute resolution requirements for hospitals, professionals, and managed care plans. These requirements would arguably apply to MLTCs, FIDA plans, and nursing homes. Establishes a work group on out-of-network reimbursement.
Includes language providing a new prompt payment provision applicable to health insurer and managed care plan payments to entities licensed or certified under Article 36 (i.e., home care). The language is consistent with existing prompt payment requirements.
Exempts any Nurse-Family Partnership home visiting programs from the requirement of Article 36 licensure/certification.
Adds a provision authorizing mainstream Medicaid managed care plans and managed long term care plans to contract with LHCSAs and CHHAs and directs the commissioner to seek any necessary federal waivers to implement this authority. This is an effort to override the recently-issued DAL on managed care-home care contracting. We have advocated strongly for DOH to revisit this problematic directive.
Rejects the extension of the Mercer contract for development of managed care rates and contracts to support MRT waiver projects without a competitive bid or request for proposals. Mercer is the state’s managed care actuary.
Omits the Governor’s proposed two-percent cap on nursing home case mix increases. We strongly advocated for the elimination of this proposal.
Modifies the Governor’s nursing home standard wage language by adding a provision requiring managed care plans that contract with nursing homes to submit an attestation to the Department that it is in compliance along with certifications from the nursing homes and their labor subcontractors. We continue to be opposed to this onerous mandate.
Adds a provision to provide VAP-like payment to fiscal intermediaries administering Consumer-Directed Personal Assistance Services (CDPAS) programs.
Adds provisions requiring managed care plans (including MLTCs) to ensure that contracts with certified home health agencies (CHHAs), long-term home health care programs (LTHHCPs) and CDPAS fiscal intermediaries provide sufficient resources to support wage parity and recruitment and retention of home care workers. They also include provisions requiring DOH to consider the costs associated with wage parity and with maintaining a qualified home care workforce when setting mainstream and MLTC managed care plan rates. We have been strongly advocating for adequate and timely funding to both managed care plans and provider agencies.
Rejects the repeal of recruitment and retention funding for CHHAs, LTHHCPs, and hospice programs serving medically-complex children.
Rejects the governor’s advanced home health aide proposals, but accepts a narrow amendment to the Education Law to expand the flexibility of the CDPAS program.
Adds a provision that limits MLTCs to non-profit entities, unless the MLTC was approved prior to the effective date of the provision; authorizes MLTCs to serve as “participants” (members of the governing body) in ACOs; and authorizes MLTCs to serve as “providers” that provide services to ACOs and/or their patients.
Includes language clarifying that Medicaid beneficiaries are not required to exhaust their independent external review remedy, in relation to medical necessity denials of services, prior to exercising fair hearing rights.
Adds a provision that ensures fair hearing rights for Medicaid managed care enrollees without regard to the expiration of a prior service authorization.
Makes significant changes to the Medicaid Managed Care Advisory Review Panel, increasing its members from twelve to fifteen and expanding its jurisdiction to Child Health Plus, Basic Health Program, MLTC programs, care coordination models for dually eligible individuals and other programs like health homes and medical homes.

Please contact Ami Schnauber, Alyssa Lovelace or another member of our Advocacy and Public Policy team if you have any questions at 518-867-8383.