Senate Passes Budget Resolution Identifying Priorities

The Senate Majority Coalition released and passed their one-house state budget resolution Thursday (March 13th) evening. This will now lead the way for the Joint Budget Conference Committees to convene and begin negotiating a final budget agreement for State Fiscal Year 2014-15. The General Budget Conference Committee is planning to convene at noon on Monday, followed by the budget subcommittees.

The Senate addressed a number of our budget priorities in their Budget Resolution, Report on the Amended Executive Budget. Below are those items taken from the Senate Resolution of most significance to long term care providers.

With a number of our major budget concerns still in play (e.g., home care worker wage parity, nursing home standard wage, safe patient handling), we urge you to intensify your advocacy efforts this week and next as the Legislature moves toward a final budget agreement by the end of March. All the resources you need can be found on our Advocacy website.

Home and Community Based Services

Provides an additional $5 million for the Community Services for the Elderly program.
Denies the Executive’s proposal to eliminate Spousal Refusal provisions.
Rejects the proposal authorizing the Office of the Medicaid Inspector General (OMIG) and the Department of Health (DOH) to jointly develop pre-claim review requirements for certain home health care participating providers.
Establishes the Hospital-Homecare-Physician Collaboration Program.
Maintains the home and community based care workgroup to make recommendations regarding state and federal regulations and the alignment of functions between managed care entities and home and community based providers.
Directs DOH to promulgate regulations related to managed long term care plans and home care providers delineating plan-provider responsibilities and to require DOH to make recommendations to the Legislature regarding the feasibility and appropriateness of creating system-wide efficiencies through the establishment of certain payment practices.
Expresses concerns about wage parity as follows: The Senate is concerned about the long term adequacy of funding made available within the Medicaid Global Cap to support wage requirements of the Home Care Wage Parity Law. The Senate continues to analyze options to ensure funding made available for increased Medicaid rates are passed on to providers for payment of wages.

Adult Care Facility (ACF) and Assisted Living

Amends the $1.2 billion Capital Restructuring Financing Program to include assisted living providers as eligible participants.
Provides that DOH may authorize 6,000 Assisted Living Program (ALP) beds pursuant to a seven year, as opposed to five year, plan by requiring an annual written report to the Legislature detailing the number of ALP beds made available by county, the number of vacant ALP beds by county and any other needed information.
Adds language requiring ACFs to conduct criminal history record checks of prospective direct care employees using procedures and standards set forth in Article 28-E of the Public Health Law.
Provides $50,000 for costs related to the required ACF criminal background checks beginning January 1, 2015.

Nursing Home

Does not outright reject the governor’s nursing home standard wage proposal, but rather expresses concerns: The Senate continues to be concerned with the transition of nursing homes from the fee-for-service Medicaid program to managed long term care. The Senate continues to review the Executive’s proposal to establish a standard wage including, whether the current wage rates are adequate, the long term effect of the proposal on the wages of nursing home employees, and whether the proposal would impact the fiscal viability of the state’s more than 600 nursing homes. The Executive proposal lacks significant detail on the methodology that would be employed to establish the standard wage for nursing homes, including the adequacy of funding to support the proposal.
Modifies the governor’s proposal authorizing a private equity demonstration program to encourage the investment of private capital in health care facilities by expanding the demonstration from five to ten business corporations and ending the program in five years.
Denies the Executive’s proposal to limit nursing home case mix index growth to two percent in a six month period. • Makes technical amendments sought by LeadingAge NY to the proposal requiring managed care plans to pay the nursing home fee-for-service rate for out-of-network placements in nursing homes.
Codifies the existing Vital Access Provider (VAP) program in statute to authorize DOH to approve temporary adjustments to operating rates or temporary lump-sum Medicaid payments to eligible providers.
Removes DOH’s authority to reduce or eliminate return on or return of equity payments to for-profit facilities.
As recommended by LeadingAge NY, maintains a nursing home’s eligibility for quality pool payments in certain specific instances if the facility properly reported an incident and did not received a survey citation establishing the facility’s culpability.

Medicaid Global Cap & Medicaid Waiver

Modifies the proposal establishing a methodology for distributing available savings under the Medicaid Global Cap to eligible Medicaid providers by requiring 70 percent of savings be allocated to providers based on the prior three years of utilization and requiring the remaining 30 percent be transferred to the Global Cap Reserve Fund.
Requires a monthly accounting of the global cap that includes detailed reporting of price, utilization and other one-time initiatives by category of spending.
Requires the Division of the Budget and DOH to, upon submission of the Executive Budget, provide the Legislature a detailed accounting of the global cap on the close out of the prior year, a current year re-estimate and a prospective five-year estimate.
Establishes the 1115 Waiver Distribution Review Council to review and make recommendations on proposed expenditures of 1115 waiver funding prior to the approval of a project plan.
Requires DOH to provide the Legislature with any documents relating to State Plan Amendment applications or revisions within five business days of submission.

Housing

Modifies the Medicaid Supportive Housing program to require up to $20 million be authorized to fund four demonstration programs in counties with populations less than two million.
Advances legislation to create the Access to Home for Heroes Program to assist disabled veterans and veterans with disabilities with the cost of making accessibility modifications to their dwelling units.
Modifies the Executive proposal to utilize excess Mortgage Insurance Fund reserves for certain programs. Specifically, the Senate rejects $32 million of the Executive’s proposal for the rehabilitation of Mitchell Lama housing projects. Significant investment of State and federal resources is being requested for the improvement and redevelopment of these properties. The Senate concurs with the Executive's underlying goal of housing preservation. However, until such time as NYS Homes and Community Renewal provides a detailed response to the Senate's request for specific information related to these properties, it is unable to consider the significant commitment of resources and broader housing policy considerations related to this proposal.
Advances legislation for the creation of a Mitchell Lama 2020 Housing Trust Fund Program to address community redevelopment and reinvestment, affordable housing construction, and the maintenance of existing affordable housing, for working families, seniors, and veterans.
Advances legislation for the creation of an Affordable Housing Task Force mandated to catalogue vacant or underutilized public properties that are suitable for affordable housing development and investigate any statutory or regulatory changes that would facilitate the increased development of affordable housing statewide.
Advances legislation to increase in the income threshold to $50,000 for the Senior Citizen Rent Increase Exemption (SCRIE).

If you have any questions, do not hesitate to contact Ami Schnauber, Alyssa Lovelace or any of our other policy analysts at 518-867-8383.