Home and Community-Based Care Work Group Reconvenes

The Department of Health Home and Community-Based Care Work Group resumed meeting on July 21. During the meeting several regulatory areas were brought up again for discussion on how to move forward within managed care. Those areas included:

• Physician orders – obtaining signed physician orders within 30 days and an exemption code to the 90-day Medicaid billing limitation when orders haven’t been received. Members continue to lose thousands if not millions of dollars on this issue alone;
• Definition of home care services vs. public health services - examine how these services are defined under Article 36 and when local health departments are under contract with managed care;
• Assessments – discussion of multiple assessments, costs to agencies and cost to patient with assessment fatigue. Requested further discussion on a shorter version of the UAS-NY if an OASIS has already been completed;
• Streamlining responsibilities between home care and managed care- follow-up to last year’s work group on developing a chart to cross-walk the regulatory requirements and proposing regulatory relief. LeadingAge NY and several associations met on July 29 to resume the process;
• HCBS Setting Final Rule – discussion on Person-Centered Planning (PCP) and the timeline for five year transition to be in compliance; and
• Transformation of the Long-Term Services and Supports (LTSS) assessment – brief discussion of the implementation of an independent and conflict-free LTSS needs assessment system that needs to be in place starting October 2014. According to the Special Terms and Conditions, managed care plans will not complete LTSS needs assessments/eligibility determinations for individuals requesting services prior to enrollment in the plan.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871