Case-Mix Advocacy Update and Call to Action

The final budget for State Fiscal Year (SFY) 2019-20 required the Department of Health (DOH) to convene a Nursing Home Acuity Workgroup to discuss case-mix methodology changes. During the first Workgroup meeting on May 22^nd, DOH revealed its plans to revise the case-mix determination for the July 1, 2019 rates by using all Minimum Data Set (MDS) assessments of Medicaid residents for the period Aug. 8, 2018 – March 31, 2019, rather than using the longstanding approach of a snapshot of the Medicaid residents on a given date. DOH also indicated that this proposal was expected to generate the $246 million of case-mix savings included in the State Financial Plan for the current fiscal year.

LeadingAge NY, other associations, and other Workgroup members sought to have DOH reconsider this approach but were ultimately unsuccessful. We followed up with meetings with the Governor’s Office and the Division of the Budget (DOB). Our subsequent and ongoing advocacy efforts on this issue have included the following:

CMS: DOH has requested federal approval to change the methodology used to adjust the direct component of the Medicaid rate for case-mix. LeadingAge NY, together with its association colleagues, wrote a letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to disapprove the proposed Medicaid State Plan Amendment (SPA). A follow-up discussion with CMS has since occurred.
New York Congressional Delegation: LeadingAge NY and its association colleagues wrote to all members of the New York congressional delegation, asking them to urge CMS to disapprove this proposal. We are meeting with key members of the delegation to reiterate this request. For a copy of the letter to Congress, click here.
New York State Legislature: Within the last week, LeadingAge NY and its association colleagues also wrote to all members of the New York State Legislature, asking them to urge the Governor to suspend this proposal. The associations have met with Assembly Health Committee Chair Dick Gottfried and are planning additional conversations with Assembly and Senate leadership. For a copy of the letter to the Legislature, click here.
Legal Services Committee: LeadingAge NY staff and our general counsel briefed the association’s Legal Services Committee last week on the situation and will be discussing it with the LeadingAge NY Board next week.

Grassroots Advocacy Needed

Now that the State Legislature has received communication from LeadingAge NY and other associations, it is time that they hear directly from you, their constituents. LeadingAge NY has developed several advocacy tools for you to use in this effort:

This Word document includes two different templates for a letter from your facility to your State Senator and Assemblymember. The first version is more specific about potential actions your facility may need to take if the cut is implemented, while the second version is more generic in discussing the potential consequences. The document also includes an informative one-pager on the case-mix cut as well as a sample letter your legislator can send to the Governor, both of which should be included with your legislator letter.
Our Medicaid Case-Mix Calculator allows members to assess the impact of the proposed case-mix cut. Your letter will be much more compelling if you quantify and include the estimated dollar impact of the case-mix cut for your facility. Please include your dollar impact in your correspondence to members of the Legislature and share your impact estimate with Darius Kirstein at dkirstein@leadingageny.org. To model the impact of the case-mix methodology change on your facility’s Medicaid rate, you can follow the steps in our how-to guide.

After you have sent the above letter and attachments to your legislators, we ask that you mobilize others in your organization to take action as well. Click here to urge elected officials to oppose a cut to case-mix adjustments, and share the link with friends and colleagues so we can send a strong message to the State Legislature and the Governor.

Thank you in advance for your participation in our advocacy efforts. Kindly let us know of any legislators who are willing to be involved on this issue or who need additional information we can be helpful with. We will continue to keep you updated on our efforts.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866