CFC Advisory Group MOE and Program Design

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KAREN AMBROS AND KAREN MEIER
DOH, DIVISION OF LONG TERM CARE

August 6, 2012

Maintenance of Expenditure

  • 441.570(b) of Final Rule:
    • "For the first 12 month period in which the State plan amendment is implemented, the State must maintain or exceed the level of State expenditures for home and community-based attendant services and supports provided under sections 1115, 1905(a), 1915 or otherwise under the Act, to individuals with disabilities or elderly individuals attributable to the preceding 12 month period."

MOE: Complicating Factors

  • Recent budget/MRT actions, including limiting the hours for PC level I services, reduced CHHA rates, and requiring those with services for 120 days or more to enroll in managed care, have or will reduce state expenditures on personal care attendant services and related supports.
  • It is not clear what the fiscal impact of managed care on personal care expenditures will be as more individuals are enrolled in MC or MLTC plans.
  • Settings discussion impact - expenditures on personal care services to individuals in certain group homes, for instance, may be excluded as institutional services.

Timing and MOE

  • When should NYS implement the CFC Option?
  • Optimal base year is one in which the expenditures that comprise the MOE have borne the full impact of all the recent budget/MRT actions and policy changes.
  • Other factors may include UAS implementation, OPWDD waiver implementation and other ongoing policy initiatives.
  • The next chart illustrates some options for implementing CFC in NYS.

Example Projection of Optimal Base Year for MOE Compliance

Recent MRT/Budget Actions SFY 11/12 SFY 12/13 SFY 13/14
  1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
  4/1/11-6/30/11 7/1/11-9/30/11 10/1/11-12/31/11 1/1/12-3/31/12 4/1/12-6/30/12 7/1/12-9/30/12 10/1/12-12/31/12 1/1/13-3/31/13 4/1/13-6/30/13 7/1/13-9/30/13 10/1/13-12/31/13 1/1/14-3/31/14
SFY 10/11: Several Level II policy changes - $$ - $$ - $$ - $$                
7.1.2011: Limit level I PC service to 8 hours   - $$ - $$ - $$ - $$ - $$            
5.1.12: Episodic Payments for CHHA         - $ - $$ - $$ - $$ - $      
7.1.2012: Mandated MLTC           ? $$ ? $$ ? $$ ? $$ ? $$ ? $$ ? $$
12.1.2012: Mandated MC             ? $$ ? $$ ? $$ ? $$ ? $$ ? $$
Conclusion:                        
Best CFCO Implementation Date assuming MLTC/MC will increase PC expenditures: 5.1.2013                 X      
Best CFCO Implementation Date assuming MLTC/MC will reduce PC expenditures: 10.1.2013                     X  

MOE Chart

  • State Plan Amendment applications are expected to include a chart comparing existing State level expenditures on all required and any permissive services presently offered and project anticipated spending under CFC.
  • This chart would also include any new services funded under CFC as projections but not current expenditures.

Example MOE Chart

EXAMPLE: Chart of Maintenance of Expenditure Base Year and Projected Spending under CFC
Existing State Plan Programs Examples of Current & Additional
Services offered under CFCO		 Base Year MOE Projected Spending Under CFC
Personal Care
  Personal Care Level I $$ $$
  Personal Care Level II $$ $$
CDPAP
  Personal Care $$ $$
  New Service # 1 under CFC   $$
Home Health
  Home Health Aide $$ $$
PERS
  PERS $$ $$
DOH Waiver Programs: LTHHCP, TBI, NHTD, CAH
  Service Coordination $$ $$
  Supervision & Cueing $$ $$
OPWDD Waiver Program
  Consolidated Supports & Services $$ $$
OMH Waiver Program
  Skill Building $$ $$
 
Total   $$ $$$

Program Design

  • Related to MOE is program design. The MOE Chart will vary depending on what services are offered under CFC.
  • Options range from simply separating out required CFC services from those offered through the state plan currently to providing any PASS that are currently available through waivers to all eligible individuals through the CFC Option in the State Plan.
  • Individuals may be enrolled in CFC and also access state plan services and/or non-duplicative waiver services.

CFC Options

  • State Plan Services
    • A minimum CFC Option design may include only PCSP and/or CDPAP.
  • DOH Waivers
    • Under a maximum CFC Option design, some services still won't be included due to program restrictions or other limits.
  • OPWDD Waiver(s)
    • There will be both ineligible persons and ineligible services that we must design around regardless of program design.
  • OMH Waiver
    • Some specialized waivers may be best left as is to avoid moving highly specialized services into the state plan.

HCBS Long Term Care in NYS

CFC Option Eligible

  • CFC Option Services

    State Plan Personal Care Services Program, CDPAP, personal care provided now through the waivers, including supervision and cueing, health related tasks that are able to be delegated to aide, training, and backup mechanisms including PERS

    Includes

    Any eligible individual who requires any CFC Option Service, specifically Medicaid eligible individuals with an Institutional LOC . May require waiver amendments to avoid duplicative services. Personal care outside of CFC services would continue to be available in optional state plan services only for those without an Institutional LOC. Other waiver services would continue to be offered through the original waivers to waiver eligible individuals. Service expansion would occur as a result of opening CFC Option Services to all Medicaid eligible individuals rather than limiting those services to those enrolled in existing waivers.

Waiver Eligible

  • OPWDD Waiver(s)
  • Bridges to Health/CAH Waiver OCFS
  • DOH Waivers: CAH, LTHHCP, TBI, NHTD
  • OMH Waiver

Medicaid eligible

  • MC/MLTC, including personal care for those not Institutional LOC eligible