Final Budget Summary

Legislators and staff worked throughout the weekend to finalize budget bills. Several of the bills were not in print until late Saturday and Sunday night so legislators were not able to complete passage of a final budget this weekend. The Senate returned on Sunday and passed those bills that had properly aged for three days, but the Assembly postponed their session until Thursday, March 28, when all the budget bills will be live for passage.

The health and mental hygiene budget bill was printed on Saturday night. All in all, aging services providers fared quite well this budget season. We are very pleased that a number of our priorities are reflected in, and many proposals we opposed were excluded from, the final budget.

Below is an initial summary of the final elements of the bill of most interest to our members. LeadingAge New York staff are currently analyzing the budget bills and will provide a more comprehensive analysis at the end of the week.

Trend factors and 2% ATB cuts: The Legislature opposed the governor’s proposal to permanently eliminate trend factors. Instead, trend factors are eliminated only through 2014. The 2% across the board cut is extended through 2015, but the executive has said that the state will eliminate the cut as soon as there is room under the Medicaid Global Cap. In addition, as in past years, the state will work with providers to determine the best way to implement the 2% cut.

Spousal refusal: The executive’s proposal to eliminate spousal refusal was rejected in the final budget. However, the budget does extend spousal impoverishment protections and include spouses of MLTC enrollees.

Expanded enrollment in MLTC: The final budget includes provisions to carve in new populations into MLTC ((1) Native Americans; (2) people expected to be eligible for less than 6 months; (3) persons eligible for TB related services only; (4) persons receiving hospice care; (5) persons enrolled in TPHI; (6) persons receiving family planning services only, and (7) persons eligible pursuant to the Breast and Cervical Cancer Treatment Act) once program features and reimbursement rates are approved.

Consolidated funding for public health programs: The proposed elimination of 89 discrete programs by DOH and the creation of outcome based block grants has been rejected. Funding for the programs, including funding for Adult Care Facilities and the Enriched Housing Subsidy, reflects a nearly 6% cut.

Capital investment pilot: No provisions are included to allow for private investment in health care facilities.

Minimum wage increase: The final budget will increase the minimum wage from $7.25/hour to $9.00/hour over three years, beginning with $8.00 by the end of 2013, $8.75 by the end of 2014, and $9.00 by the end of 2015.

Nursing Homes
Standard wages in nursing homes: No standard wage provisions are included in the final budget. We have been told that the state may administratively move to implement wage standards in MLTC contracts.

Capital reimbursement for nursing homes: The final budget excludes the governor’s proposal that would have given DOH sole regulatory authority to establish capital reimbursement methodologies for nursing homes. The state has a federal waiver request to authorize fee-for-service capital reimbursement to continue under managed care.

Financially disadvantaged payments for nursing homes: The final budget agreement will end the financially disadvantaged program and transfer it to the Vital Access Provider (VAP) program.

Specialty nursing home rates: The final budget excludes the governor’s proposal to unilaterally develop a pricing methodology for specialty nursing homes.

6% assessment tax: The current 6% reimbursable tax has been extended to March 31, 2015, rather than being permanently extended as originally proposed by the executive.

Home Care
Home health aide scope of practice: The final budget excludes the proposal to expand the scope of practice for home health aides to include administration of medications under the supervision of a nurse as well as the proposal that would have authorized advanced aides to provide nursing services to self-directing individuals.

HCBS workgroup: The final budget creates a workgroup within DOH to examine and make recommendations on issues including:

State and federal regulatory requirements and related policy guidelines (including the applicability of the federal conditions of participation);
Efficient home and community based care delivery, including tele-health and hospice services; and
Alignment of functions between managed care entities and home and community based providers.

Prompt payment: The final budget adds LHCSAs, CHHAs, LTHHCPs and fiscal intermediaries to insurance law provisions (§3224-a), which sets standards for prompt, fair and equitable payment of claims.

Managed Long Term Care
Expansion of MLTC slots: The final budget does not include the governor’s proposed expansion in MLTC certifications, leaving the cap at 75.

Hospice coverage under MLTC: The final budget includes provisions clarifying that individuals enrolled in managed long term care do not need to disenroll in order to access hospice care.

Standard wage mandate: No standard wage provisions are included in the final budget. We have been told that the state may administratively move to implement wage standards in MLTC contracts.

Adult Care Facility/ Assisted Living
Quality funding: The final budget includes discrete quality funding for adult care facilities at $6.5 million, nearly 6% less than last year.

SSI enriched housing subsidy: The final budget includes discrete funding for the SSI enriched housing subsidy at $474,900, nearly 6% less than last year.

ALP Expansion: The final budget includes provisions to allow transitional adult homes across the state to transition to an ALP and provides associated capital reimbursement.

Senior Housing
Supportive Housing: The final budget includes $173.8 million in funding for affordable housing, reflecting a $5 million reduction from the executive’s original proposal. The allocation plan approved by DOH related to this funding includes $3 million for our supportive senior housing proposal.

NORC/Neighborhood NORCs: These programs are both level funded at $2,027,500.
Pay for Success: The final budget included the executive’s proposed social impact bond demonstration, but cuts the funding to $30 million from the originally proposed $100 million.

Access to Home: The budget includes $1 million for this program, which provides building modifications for seniors and the disabled to remain independent.

Low-income Housing Trust Fund: The budget includes $32.2 million for the fund, providing grants to finance construction or rehabilitation of low-income apartment buildings.

Public Housing Modernization Program: The budget provides $6.4 million to level-fund this program.