GIS 14 MA/09:2014 Long Term Home Health Care Program (LTHHCP) Expenditure Caps

To: Local District Commissioners, Medicaid Directors, and Long Term Home Health Care Coordinators

From: Mark Kissinger, Director
Division of Long Term Care

Subject:2014 Long Term Home Health Care Program (LTHHCP) Expenditure Caps

Effective Date: Immediately

Contact Person: Vicki Rockefeller (518)474-5271

The purpose of this General Information System (GIS) message is to provide local departments of social services (LDSS) with the 2014 LTHHCP participant maximum allowable monthly expenditure caps for each county and New York City. The 2014 Statewide LTHHCP expenditure cap table entitled, "2014 MAXIMUM ALLOWABLE MONTHLY EXPENDITURE CAP PER PATIENT UNDER THE LONG TERM HOME HEALTH CARE PROGRAM BY LEVEL OF CARE", is attached.

Long Term Home Health Care Program expenditure caps are calculated in accordance with 10 NYCRR Part 86-5.10. Expenditure caps are based on the January 1, 1992 average Medicaid reimbursement rates for nursing facilities in a county trended forward to the current year. Due to an elimination of the trend factor in 2014, the participant expenditure caps have not changed from the maximum allowed in 2013.

Note: Additional language has been added to the Expenditure Cap table headings to reflect the use of the Uniform Assessment System-New York (UAS-NY) assessment instrument when determining nursing facility level of care (LOC), in place of the Long Term Care Placement Form Medical Assessment Abstract (DMS-1). The LOC score of 15 + on the UAS-NY is equivalent to a DMS-1 score of 180 + and a LOC score of 5-14 on the UAS-NY is equivalent to a DMS-1 score of 60-179.

A chart with the new FPLs is attached to this GIS.

If you have questions regarding the LTHHCP, please contact Vicki Rockefeller at (518) 474-5271.