LeadingAge NY attended a managed care plan meeting last week with the Department of Health (DOH) and learned of DOH's plan to distribute the Home and Community-Based Services (HCBS) Enhanced Federal Medical Assistance Percentage (eFMAP) funding for workforce initiatives via directed payments through Managed Long Term Care (MLTC) plans to Licensed Home Care Services Agency (LHCSA) providers. We will be meeting with DOH again on Nov. 23^rd to hear more as they present this plan to provider associations. We have many questions, some of which are listed below. Please see DOH’s meeting slides for more detail.

In general, LeadingAge NY is aware of the following thus far: 

• Funding will be distributed through MLTCs in directed payments to LHCSA providers.
• DOH expects that 250 LHCSAs will receive this funding based on their 2019 revenues, which must meet certain revenue thresholds per region set by DOH.
• The first directed payment is $361 million.
• The second payment is up to $1.1 billion.
• Eligible spending categories are listed but are not provided in great detail.
• Payments to plans, then to providers will occur on a fairly expedited basis. 
• Providers will engage in an attestation and survey process, develop a spending plan, and complete quarterly reporting. 

The Department’s plan to spend this workforce funding benefits larger LHCSAs, while many smaller and medium-sized LHCSAs will be excluded. It will likely exclude specialized or culturally competent LHCSAs as well. Hospice and Certified Home Health Agency (CHHA) workforce funding is also not included in the plan.

As members know, these details were not presented by DOH this past summer when they were seeking input on developing spending recommendations. With workforce challenges at their greatest in recent memory throughout the state, we are hoping that the Department considers expanding eligibility for these funds. At this juncture, the plan resembles the LHCSA Request for Offers (RFO) to some degree.

We ask members to review the meeting slides and let us know what other questions and concerns you may have. Working with the Home Care Association of New York State (HCA), we have forwarded the following questions to the Department:

1. Is this initiative the one in the eFMAP plan numbered I-A ($722.5 million)?

2. Can you provide the list of LHCSAs that will receive money?

3. How does the 66 percent threshold to qualify for funding work? 

• Will it be based on 2019 revenue?
• Is there a plan for funding the agencies that do not qualify under the 66 percent threshold?
• Is there any way to appeal the exclusion from the distribution?
• Would you consider expanding eligibility to include qualifying criteria such as specialized services and/or cultural/language competency and/or access concerns?
• Has DOH considered the impact of this methodology on the individuals receiving services from excluded agencies and how they will be able to access services? 

4. Does the distribution methodology capture agencies receiving 95 percent of Medicaid revenue paid through MLTC plans to LHCSAs, or something else?

5. Regionally, how is the money allocated?

• By amounts per region? 
• By number of agencies in each region?

6. The eFMAP plan discussed HCBS staffing and Value-Based Payment (VBP) in LHCSA and Consumer Directed Personal Assistance Services (CDPAS) terms. This distribution seems to be aimed only at LHCSAs. Will there be a separate CDPAS Fiscal Intermediary (FI) “provider class” distribution? What if a LHCSA is also an FI?

7. Is there a separate distribution mechanism for CHHAs and Hospice programs?

8. Can you provide more detail on the permissible uses of funds? The allowable uses in the eFMAP plan I-A do not explicitly include raising wages (other than if raises are defined as “Adopting workforce retention and job satisfaction strategies.”) 

• Can funds be used for raising wages? For work-related supports (e.g., transportation, child care)?
• Can these funds be used for recruitment and new hires?
• Can funds be used for training by agencies, or must all training funds be funneled through Workforce Investment Organizations (WIOs)?
• Will funds be made available to support nursing and other therapeutic personnel?

9. What about Personal Care Services (PCS) and CDPAS delivered under Nursing Home Transition and Diversion (NHTD), Traumatic Brain Injury (TBI), or children’s waivers that are paid through Fee-for-Services (FFS)? What about agencies that contract with counties and provide FFS?

Please review this material and feel free to call or email LeadingAge NY with any questions or concerns you may have.