• New Administration
• Medicaid Redesign Team (MRT)
• Macro Budget Issues - Short and Long Term
• Federal Health Reform
• Aggressive Timelines
• Global Cap

• Managed Long Term Care MRT #90
• DOH implementation efforts are starting:
  • enrollment process changes
  • application revisions underway
  • CMS approval still needed
• Building off Chapter 659 of 1997
• Guidelines on Care Coordination Models under development
  • Must support the coordination and integration of services
  • Current providers, such as long term home health programs, will be considered if they can meet service requirements and financial criteria

• Implements per patient spending limits
• Methodology establishes provider caps adjusting for case mix, including adjustments for high need patients
• Implements episodic payment system in 2012 for under 120 days ultimately
• State plan amendment submitted to CMS for approval

• DOH will consult with Labor on implementation of the requirement
• DOH will issue an official notice of minimum compensation by area each December for the following year
• Effective in NYC , Westchester, Nassau, and Suffolk with varying effective dates

• DOH will implement a uniform assessment tool for entry and reassessment in long term care
• DOH will tailor an evidenced-based software program using InterRAI tools that will provide individual assessment and system wide data collection
• Projected full implementation is fall of 2012

• Many screening and assessment tools in use today; lack standardization creates significant redundancy.
• Extensive research identified excellent replacement candidate: interRAI Community Health Assessment.
• Procured services vendors to implement the interRAI suite electronically and to assure quality and completeness of the system. (GCOM Software and NYSTEC)

• UAS-NY Will Be Used Initially by Eight Long Term Care Programs:
  • Assisted Living Program
  • Personal Care Services Program; Consumer Directed Personal Assistance Program
  • Adult Day Health Care
  • Long Term Home Health Care Program
  • Nursing Home Transition and Diversion
  • Traumatic Brain Injury Waiver
  • Care at Home I and II Waivers
  • Managed Long Term Care

• Vendors are Onsite and Working
  • System Development: May 2011to March 2012
  • Beta Testing: March 2012 to May 2012
  • Pilot Implementation: June 2012 to September 2012
  • State-wide Implementation: September 2012
• Preparing for Statewide Implementation
  • Computer Readiness Survey; will be used to identify Beta and Pilot participants.
  • Beta, Pilot and Implementation includes training on the UAS-NY and the interRAI assessment tool.

• Palliative care recognizes the need for pain management and supports for people with serious illness or injury - not just people in the last stages of life
• New law includes assisted living, home care, nursing homes, and hospitals

• Waiver Renewal Implementation Guidance (GIS and ADM) - Issued
• LTHHCP Manual Revision to reflect changes
• Future of the Program in a managed care environment is under active discussion

• Several regulatory changes to reduce burdens on health care providers; homecare changes include:
  • Extend end user reporting and data entry requirements for HCR from 5 days to 10 days: implemented May 2011.
  • Allow home health aide training programs to have a single qualified supervisor RN for multiple training programs: OLTC has a workgroup with provider representatives that will include this initiative in their revised guidelines for training programs.
  • Eliminate the requirement for a physician to be on the Quality Improvement Committee of Licensed Home Care Services Agencies: revised regulation is in internal review process.

• Expands the scope of practice for Nurse Practitioners, RNs, LPNs, PCAs and HHAs
• Allows Nurse Practitioners to sign medical evaluations and LPNs to complete assessments in LTC settings
• Work in progress

• CDPAP regulations finally issued
• Input from stakeholders will be sought at several points in the process

• Adds a new option for the Partnership for Long Term Care
• Staff are also investigating additional incentives for purchase of private LTC insurance

• Limits Level I PCS to 8hrs weekly
• DOH staff is completing required regulatory changes to support the budget language on personal care Level 2
• DOH is preparing administrative directives to implement regulatory changes as well as Fair Hearing notices to implement the provision

• Expand concurrent and curative care to adults; regulatory changes are in internal review process
• Expand definition of terminal illness; working with CMS
• Integrate hospice into medical homes and ACOs

• Staff are identifying agencies and programs to participate
• One of 9 MRT sub-committees
• MRT website is a great resource

• CHHAs
  • Acceptance of Patients, Plan of Care and Medical Supervision
  • Plan of Care
  • Coordination of Patient Services
  • Periodic Review of Plan of Care
  • Drug Regimen Review
• LHCSAs
  • Patient Care Record
  • Patient Rights
  • Governing Authority
  • Personnel
  • Records and Reports

• CHHAs : 85%
• LTHHCPs : 91%
• LHCSHs : 39%

Department will seek enforcement.

• Proposed ideas include:
  • Address licensure process and surveillance/monitoring of quality of care using third party entities such as accreditation agencies
  • Require license renewals at periodic intervals
• Over 30 LHCSA applications are tentatively scheduled for the first PHHPC agenda.

• Governor Cuomo Launches the Spending and Government Efficiency (SAGE) Commission Web Site for Public to Submit Ideas on How to Make Government More Efficient     www.governor.ny.gov/sage

• Participate
• Communicate
• Embrace Change

Questions?
mlk15@health.state.ny.us
(518) 402-5673