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
NY´s Total LTC Expenditures Highest in the Nation ˜ Exceeding 2nd Highest State, California, by 39 Percent
Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services
NY & CA Home Care Spending Comparable ˜ NY Per Capita Spending Higher than CA
Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services
NY´s Average Annual Growth Home Care Expenditures is the Fifth Largest ˜ Recent Growth Strong in All States
| 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
NY´s LTC Medicaid System is Less Dependent on Institutional Nursing Facilities
˜ Community Based Services Accounts for 35% of Medicaid Spending Second Only to California at 54%
Source: CMS Financial Management Report FY 2005, Reported by States
However, the Proportion of LTC Beneficiaries Cared for In Institutional Setting is Not Significantly Different than Other States
Source: CMS Financial Management Report FY 2005
Why? NY has Highest Home Health Cost Per Beneficiary
˜ 50 Percent Higher than Second Ranked California
Source: CMS Financial Management Report FY 2005
Nationally, Private Funding of Home Health Care has Remained Flat and Public Funding has Increased Significantly
Source: CMS National Health Expenditure Fact Sheet
Reliance on Medicaid CHHA Funding in New York has Grown Significantly Since the Implementation of Medicare Reforms
Source: Department of Health ˜ Bureau of Long Term Care Reimbursement ˜ Cost Reports
New York Certified Home Health Agency Reported Patient Revenue by Payer
Average Annual Growth in NY Medicaid Spending Per CHHA Recipient has Increased 14.1%
| 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
New York City ˜ Hours Per Recipient has Increased Across All Categories in 2006
| 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
Small Number of Providers Account for the 14.3%
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
Governor´s Long Term Care Bill
- 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
Governor´s Long Term Care Bill
- 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)
LTHHCP Data
| 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.
Home Care Technical Advisory Council:
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
Principles to Guide Approaches to Reform for 2009 and Beyond
- 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
Reform Options
- Value for Participants and Payer
- Payment reform to move towards performance-based and episodic reimbursement
- Development of uniform data sets and assessment tools
- 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
- Enhance Options to Increase Personal Planning for LTC Needs
- Expand LTC Partnership coverage
- Medicaid eligibility reform
- Increase supportive housing opportunities
