Home Care Association of New York State

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Home Care Association of New York State

2008 Annual Conference
June 3, 2008

New York State Department of Health

Mark Kissinger, Office of Long Term Care
Lana I. Earle, Bureau of LTC Reimbursement

2004 LTC Expenditures

Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services

2004 Home Health Care Spending All Payers

Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services

  1998 1999 2000 2001 2002 2003 2004 % Change
2003-2004
Annual
Average %
Change
California $2,461 $2,910 $3,106 $3,627 $4,318 $4,975 $5,537 11.30% 14.47%
Michigan $947 $969 $996 $985 $1,032 $1,125 $1,326 17.87% 5.77%
Massachusetts $1,262 $1,197 $1,208 $1,315 $1,396 $1,561 $1,743 11.66% 5.53%
New Jersey $1,068 $1,170 $1,121 $1,115 $1,171 $1,296 $1,427 10.11% 4.95%
New York $4,861 $4,683 $4,578 $4,625 $4,852 $5,520 $6,021 9.08% 3.63%
Florida $2,416 $2,166 $2,168 $2,262 $2,330 $2,520 $2,876 14.13% 2.95%
Illinois $1,102 $1,031 $996 $1,011 $1,058 $1,111 $1,269 14.22% 2.38%
Ohio $1,327 $1,331 $1,275 $1,282 $1,299 $1,408 $1,519 7.88% 2.28%
Texas $3,200 $2,479 $2,286 $2,501 $2,786 $3,173 $3,604 13.58% 2.00%

Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services ˜ Includes All Payers

˜ Community Based Services Accounts for 35% of Medicaid Spending Second Only to California at 54%

2004 Medicaid Spending

Source: CMS Financial Management Report FY 2005, Reported by States

2004 Medicaid Spending

Source: CMS Financial Management Report FY 2005

˜ 50 Percent Higher than Second Ranked California

2004 CostPer Beneficiary

Source: CMS Financial Management Report FY 2005

2004 CostPer Beneficiary

Source: CMS National Health Expenditure Fact Sheet

2004 CostPer Beneficiary

Source: Department of Health ˜ Bureau of Long Term Care Reimbursement ˜ Cost Reports
New York Certified Home Health Agency Reported Patient Revenue by Payer

Medicaid Expenditures Per Recipient Certified Home Health Care Services
  2003 2004 2005 2006 % Change
2005 to 2006
Average
Annual
% Change
Statewide $8,212 $8,991 $10,307 $12,193 18.3% 14.1%
New York City $11,865 $13,174 $15,346 $18,184 18.5% 15.3%
Suburban NYC $3,519 $3,773 $3,982 $4,171 6.2% 5.8%
Upstate Rural $2,297 $2,454 $2,415 $2,724 12.8% 5.8%
Upstate Urban $3,516 $3,711 $3,623 $3,917 8.1% 3.6%

Source: Department of Health DataMart

Average Hours per Recipient per Week ~ Services Provided by Home Health Aid and Billed by the Hour Services Provided by Home Health Aid and Billed by the Hour
Beneficiary 2003 2004 2005 2006 % Change
2005 to
2006
Average
Annual %
Change
Overall 19.4 19.8 19.1 25 30.9% 8.7%
Seniors 21 21.4 20.7 27.6 33.3% 9.4%
Adults 15.6 15.8 14.8 18 21.6% 4.8%
Children 23.9 24.4 21.8 25.9 18.8% 2.7%

Source: Department of Health DataMart

Annual Average Increase in Expenditures

What is Driving the Increase?
Bold Italics: Top 10 Providers Highest Expenditures
2006 Expenditures of New York City CHHA Medicaid Providers
  2003 2006 Average Annual
Percent Change
Total 638,340,095 954,052,323 14.30%
A 22,849,003 142,367,583 84.00%
D 5,717,056 50,775,511 107.10%
E 33,393,182 66,153,796 25.60%
G 1,307,019 31,106,504 187.60%
I 2,733,926 40,525,569 145.70%
L 12,076,587 37,086,454 45.40%
M 16,227,242 26,380,005 17.60%
O 307,792,609 273,972,823 -3.80%
All Other 236,243,471 285,684,078 6.50%
Source: Department of Health DataMart
  • Begins the reform efforts by:
    • Authorizing aggregate cap approach for Care at Home I/II
    • Addressing key issues related to the Long Term Home Health Care Program
      • Remove reference to health-related facilities while allowing programs to exceed caps for certain subpopulations if allowed by CMS
      • Extend reassessment period to 180 days
      • Create equity statewide by assuring all available waiver services are provided
      • Authorize demonstrations to develop alternative methods of program administration related to assessment and care plan development
  • Expand the focus of the Long Term Care Insurance Education and Outreach Program beyond insurance
  • Allow income protection for the New York State Partnership Plan
  • Require external appeals for long term care insurance
  • Require insurers to promptly pay claims (20 days with electronic submission and 45 day by other means)
NYS Medicaid Expenditures and Utilization for LTHHCP Service Date: Calendar Year 2006 and 2007
Calendar Year Medicaid Expenditures Unduplicated Recipient Counts
All Services Waiver Services Non-Waiver Services All Services Waiver Services Non-Waiver Services
2006 $634,518,195 $33,984,767 $600,533,428 27,603 22,573 27,076
2007 $632,035,069 $32,921,590 $599,113,479 26265 21,714 26,041

Source: NYS DOH/OHIP Datamart (based on claims paid thru 4/2008)
Questions: Contact Woopill Hwang @518-473-2230.

Evaluate and make recommendations related to:
  • The relevancy of Article 36 PHL and its implementing regulations;
  • The availability of needed services to New Yorkers regardless of where they live;
  • The role of technology in expanding services and reducing costs;
  • The development of quality indicators that can be reported publicly and that are related to desired outcomes in health status; and
  • Reimbursement methodologies to evaluate appropriate incentives
  • Support and enhance family care giving resources
  • Increased consumer choice and control for older individuals, persons with disabilities, and chronic illness.
  • Ensure access to an appropriate array of home and community based long term care supports and institutional care when necessary.
  • Reduce costs and promote payment mechanisms that support and reward better performance
  • Encourage personal planning for long term support needs among individuals and their family members - including greater awareness of private sources of funding.
  • Reverse the institutional bias in Medicaid eligibility.
  • Enhance quality measurement to enable the provision of high-quality long-term care in the setting most appropriate for an individual´s needs.
  • Improve coordination of long-term care and post-acute care services.
  • Utilize enhanced health information technology to better inform beneficiary choices, clinical decisions, payment and care coordinate functions
  1. Value for Participants and Payer
    • Payment reform to move towards performance-based and episodic reimbursement
    • Development of uniform data sets and assessment tools
  2. Support/Enhance Care in Community Settings
    • Cash and Counseling
    • Home Care Licensing & Certification Changes
    • Balance nursing home bed need methodology to support care in community
    • NYConnects -What are the next steps?
    • Significantly increase caregiving resources
    • Expansion of non-medical programs (EISEP, Adult day care) - Build on 2008 Budget
  3. Enhance Options to Increase Personal Planning for LTC Needs
    • Expand LTC Partnership coverage
    • Medicaid eligibility reform
    • Increase supportive housing opportunities