ADHCC Update – Jan. 23, 2020

The Department of Health posted to the Health Commerce System (HCS) the Program Survey Report (PSR) for ADHC providers. The Dear Administrator Letter (DAL) can be found on the front page of the HCS under “New Items” as DAL NH 19-18. Each program must complete the survey and return to the regional office in which the program is located by  February 28, 2020. Please see the memo attached to this email with the list of regional offices.

On Tuesday, Gov. Cuomo released his proposed budget for State Fiscal Year 2021, covering 2020-21. ADHCC and LeadingAge NY are carefully reviewing the Proposed Executive Budget. A comprehensive budget memo for long term care providers will be issued on Tues., Jan. 28^th.  Instead of proposing specific cuts to address the Medicaid Budget deficit, the Governor has reconvened the Medicaid Redesign Team (MRT) to identify cost-containment measures that will provide approximately $2.5 billion in gap-closing savings in FY 2021 and ensure Medicaid spending in future years adheres to the Global Cap indexed rate. The MRT II is required to report back by early March with a plan to deliver $2.5 billion in recurring savings. The MRT II proposals will be incorporated into the Executive Budget for consideration by the Legislature.

The exact language of the Executive Budget does not contain any limitations on how the MRT II is to achieve these savings. For example, there is no budget proposal to cut ADHC Method 1 transportation. The Budget Briefing Book, however, does direct that the MRT II cannot rely on local governments, have no impact on beneficiaries, and find solutions through industry efficiencies and/or rely on new resources provided by the industry itself. The MRT II members will be appointed over the coming days. In the event the Legislature fails to enact $2.5 billion in savings proposed by MRT II, the Executive Budget authorizes uniform across the board reductions applied to Medicaid appropriations necessary to achieve $2.5 billion in savings.

LeadingAge NY/ADHCC Advocacy Day is Tues. Feb. 4^th. Click here to register. MRT II must find $2.5 billion in savings by March. We anticipate ADHC transportation and significant rate cuts to ADHC providers to be on the table. Legislators need to hear from you on how these cuts will impact your business and registrants. After you register for Advocacy Day, you will need to identify your legislators and schedule appointments. If you need help scheduling your appointments, please contact Drue Pamadora at dbarton@leadingageny.org. Drue and Anne love to advocate for ADHC! If you would like one of us to accompany you on visits, let us know. ADHCC members who register for Advocacy Day are invited to participate in a prep call on Fri., Jan. 31^st. An email with the time and call-in number will be sent to Advocacy Day participants shortly. New to advocacy? Contact Anne or Drue to learn more.

Registration is now open for several Regional Training sessions across the State. The Department of Health (DOH) recently issued a notice on additional person-centered planning training, a requirement for ADHC providers under the federal Home and Community-Based Services (HCBS) Final Rule. Follow the link for more information on the training opportunities and to see all available sessions: www.nydohpcptraining.com/events. DOH will be adding several additional sessions through the end of 2020.

DOH is offering continuing education hours for 2020 Regional Trainings

Learning Institutes

DOH will also be offering several Learning Institute opportunities in 2020. These unique opportunities involve multiple in-person training days, as well as webinars, learning journeys, coaching circles and other exploratory and supportive learning experiences, and are facilitated by international leaders in person-centered planning. To learn more about the Learning Institutes, visit www.nydohpcptraining.com/events. If you have questions about the training, please email NYDOHPCPTraining@pcgus.com.

Uniform Assessment System for New York (UAS-NY) Project Team has issued a new directive to all UAS-NY users to provide notification that certain courses will be set to “Required” at the close of business on Mon., Jan. 27, 2020. At that time, users who have not completed these two courses will not be allowed access to the UAS-NY without first completing both courses. It is highly recommended that users do NOT wait until Jan. 27^th to complete their required courses. Click here to view the directive.

According to the directive, questions can be directed to the Department of Health’s (DOH) UAS-NY Project Team at 518-408-1021 or uasny@health.ny.gov. They ask that you provide your Health Commerce System (HCS) User ID in such communications.

In a letter dated Dec. 19, 2019, the Centers for Medicare and Medicaid Services (CMS) notified the State that it has approved the proposed amendment to the State’s Medicaid 1115(a) waiver that limits the partially capitated Managed Long Term Care (MLTC) plan nursing home benefit to three months for individuals who are designated as long-stay residents. Under the State’s proposal, such members would need to be disenrolled from Medicaid managed care and revert to fee-for-service (FFS) Medicaid after a three-month period. Additionally, individuals entering nursing homes for Medicaid-funded long stays would no longer be mandated to enroll into MLTC and would remain in FFS Medicaid. This waiver amendment impacts nursing home residents only and does not affect ADHC.

This provision was enacted in the 2018-19 State Budget and has been the subject of lengthy negotiations between the State and CMS. While the Department of Health (DOH) has been preparing for the change in anticipation of CMS approval, the requirement to notify MLTC members of benefit changes and other implementation details will likely mean that the shift of existing long-stay residents back to FFS may not begin immediately.

We anticipate that DOH will soon provide additional information and guidance as to the timing and procedures for implementing this change. However, both nursing homes and MLTC plans should be monitoring for any potential payment or eligibility issues that may arise. Please let us know if you identify concerns as the process unfolds.

The approval also covers the State’s proposal to align the MLTC enrollment lock-in policy with that of Mainstream Medicaid managed care. Once effective, the policy will restrict the ability of members to transfer from one partially capitated MLTC plan to another without good cause. CMS notes: After this policy goes into effect, mandated enrollees of partially capitated MLTC plans will be limited in their ability to transfer to another MLTC partial capitation plan for 12 months from the effective date of enrollment. Enrollees may transfer to another partially capitated plan without cause during the first 90 days of the 12-month period. Regardless of whether they transfer to another plan, after the first 90 days the enrollee may not transfer to another partial capitation plan unless there is good cause to do so. Enrollees will receive notice of this change and a list of good cause reasons. These reasons may include moving away from the service area, inability of the plan to provide appropriate and accessible services and/or supports, poor quality care, lack of access to providers experienced in caring for the individual and a determination that the enrollment was non-consensual.

ADHCC will share additional guidance on the lock-in period as it becomes available.

Mark your calendar! ADHC annual conference will be held Oct. 27, 28 and 29 at the Embassy Suites in Saratoga.

If you have any questions about the contents of this email, please contact ADHCC at adhcc@leadingageny.org or call 518-867-8836.