DOH/Long Term Care Perspective
- Document is also available in Portable Document (PDF)
15th Annual Elder Law Forum
Mark Kissinger, Deputy Commissioner
Office of Long Term Care
May 6, 2010
Long Term Care in NYS
- Complicated
- Comprehensive
- Programs overlap
- Reliant on informal care network
NYS Medicaid Spending
- NYS spends more than any other state per capita on Medicaid ($2,360) and twice the national average ($1,077).
- Medicaid spending will still reach $51.5 billion, a 1.8% increase over 2009, if all Executive Budget proposals are enacted.
28% of Medicaid Spending ($12.3B) is on Long Term Care Services
Data Source: NYS DOH/OHIP Datamart (CY 2008)
Medicaid Spending has Increased for Nursing Home, CHHA and
Personal Care Services while the Number of Recipients Served has Decreased
| ($ in Millions) | $ Change in Spending 2003 to 2008 | % Change in Spending 2003 to 2008 | Change in # of Recipients 2003 to 2008 | %Change in # of Recipients 2003 to 2008 |
|---|---|---|---|---|
| Nursing Homes | $715.10 | 12.00% | -7,780 | -5.60% |
| CHHAs | $414.10 | 54.50% | -11,130 | -12.00% |
| Personal Care | $503.30 | 27.60% | -7,023 | -8.30% |
| CDPAP | $147.10 | 99.40% | 3,433 | 24.20% |
| MLTC | $634.00 | 142.70% | 17,674 | 143.80% |
Principles for Reform
- Recognizing the importance of informal caregivers;
- Promoting consumer choice and independence;
- Ensuring that individuals receive care in the most appropriate setting to meet their needs while allowing for the greatest amount of autonomy possible;
- Promoting home and community-based options;
- Rightsizing the "system" of long term care to reduce costs and ensure quality care;
- Improving the quality of life of individuals receiving long term care in residential facilities and community settings; and
- Improving surveillance efforts.
Reforms in Process
- Uniform Assessment Tool (UAT)
- Rightsizing efforts (HEAL NY, ALPs, ALRs)
- Expanding home and community based options (NHTD, TBI, MFP…)
- Promoting quality of life in community-based and residential settings
- Improving safety and surveillance (Home Care Registry, QIS…)
LTC Executive Cost-Saving Proposals
- Nursing home and home care budget actions
- Personal care utilization management
Manage Personal Care Utilization
- Persons receiving PCSP will be eligible for up to an average of 12 hours/day over the course of their authorization period.
- Persons requiring services in excess of the 12 hours/day average are eligible to move into certain waiver programs.
- Affected persons can move to programs such as: Managed Long Term Care (MLTC), CDPAP, the Nursing Home Transition and Diversion Waiver (NHTD), and the Long Term Home Health Care Program (LTHHCP).
- State will pick up expenditures that fall outside the aggregate cap limitation for the NHTD waiver.
- This proposal will take effect for assessments and reassessments occurring on or after July 1, 2010.
Why manage personal care utilization?
- NYS spends significantly more, per recipient, than any other state on personal care services, spending more than $2.3 billion/year on PCSP services to approximately 82,000 individuals.
- All other states with a PCSP limit program expenditures by capping allowable hours, establishing more restrictive eligibility criteria, or providing the services only within a cost-neutral waiver program.
- A limit on the number of hours/month of PCSP services will result in individuals with significant care needs utilizing alternative service delivery models that provide care management.
Long Term Care Initiatives
- County Long Term Care Financing Demonstration Program supports up to 5 counties to shift county nursing homes to alternative settings.
- Long Term Care Financing Demonstration Program allows Medicaid eligibility for up to 5,000 persons under certain conditions.
- Nursing Home Rightsizing Demonstration Program expands to additional 2,500 beds.
County Long Term Care Demonstration Program
Establish up to 5 demonstrations in counties that operate nursing homes to transform capacity into investments in other long term care services.
- Recognizes ongoing difficulties of county nursing homes.
- Allows innovation in addressing hard to serve populations.
- Creates incentive to increase access and support for community based settings.
Long Term Care Financing Demonstration
Provide Medicaid Extended Coverage (MEC) to individuals choosing to finance part of their care.
- Allows the state to work with individuals to make private contributions for their own long term care costs.
- Allows the testing of another avenue to finance long term care.
- Limits the demonstration to 5,000 persons.
- Requires approval by the federal government.
Expand Nursing Home Rightsizing Demonstration Program
Increase the cap on the NH rightsizing demonstration from 2,500 beds to 5,000 beds.
- Rightsizing demonstration allows nursing homes to convert beds to long term home health care slots, adult day care slots, and/or assisted living program slots.
- Complements Assisted Living expansion.
Other Long Term Care Initiatives
- Undertake reimbursement study of Assisted Living Program (ALP) based on resident data generated from a uniform assessment tool (UAT).
- Extend the Transitional Care Unit (TCU) demonstration by five years and increase the number of sites by five.
- Replace EnABLE and QUIP with a new ACF quality initiative.
- Seek federal approval for establishment of a Federal - State Medicare Shared Savings Partnership.
