ACF Tiered Fee Arrangement Update
The Department of Health (DOH) sent the below email to adult care facility (ACF) providers on March 15th:
On April 12, 2019 the Department of Health (“Department”) issued the attached Dear Administrator Letter (DAL) 19-06 to clarify its historical position regarding the use of tiered fee arrangements in Adult Homes, including Assisted Living Residences with an Adult Home base license. On January 21, 2021 the Albany County Supreme Court approved a settlement agreement in the matter of Empire State Association of Assisted Living, Inc. v. DOH. Pursuant to the terms of this settlement agreement Adult Home operators were given additional time to cure non-compliant Admission and Residency Agreements.
This is a reminder to Adult Home operators with admission or residency agreements that do not meet the requirements set forth in DAL 19-06 that they may submit to the Department proposed revisions to their effective residency agreements to ensure compliance with DAL 19-06. Such operators need only submit those sections of their admission/residency agreement that are inconsistent with DAL 19-06’s requirements. Applicable information should be submitted by close of business May 15, 2021, to acfra@health.ny.gov and indicate Operator’s name and “DAL 19-06 Review” in the subject line. Please understand that all revised agreements and additional revisions requested by the Department must be submitted in this manner.
If you have any questions, please contact the Division of Adult Care Facility and Assisted Living Surveillance via email to acfra@health.ny.gov or via phone to at (518) 408-1133.
Background
Members are encouraged to review the DAL dated April 19, 2019, referenced in the above message. This outlines the Department’s position that certain services should be included in a facility’s base rate in any tiered fee arrangement, including medication management. It further outlines that tiered billing arrangements must be clear, concise, easily understood, and contain distinct and measurable thresholds for each tier.
It is notable that the April DAL attempts to apply this requirement to enriched housing programs; however, it is our understanding that the requirement, per the settlement, applies only to adult homes (including assisted living residences with adult home base licensure). The Department expects any adult home providers with tiered fee arrangements that do not comply with requirements to provide revised Admission/Residency Agreements for review and approval by May 15th.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828