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ADHCC Update - Feb. 10, 2017

The following update was shared to ADHCC members via email on Feb. 10, 2017.

We have several updates to share with you on this Friday afternoon. Please forward this to your staff or Administrator as you see fit.

  • Advocacy Day recap
  • ADHC transportation advocacy conference call: Mon., Feb. 13, 10-10:30 a.m. (see attachment)
  • HCBS Settings Rule amended Statewide Transition Plan (STP)
  • DOH HCBS Settings Rule webinar Thurs., Feb. 16
  • MLTC fair hearing webinar recording (April 2016)

Over 20 ADHCC members traveled to Albany Feb. 7 for Advocacy Day! Advocacy Day participants spoke to over 30 state legislators on how their program and registrants rely on Method 1 for safe, dependable and person-centered transportation. Legislators responded positively to our budget ask to amend and include ADHC transportation in social services law (see issue brief attachment). Thank you to all of the members who spent the day away from their programs advocating on this important issue.

ADHC transportation advocacy conference call is scheduled from 10-10:30 a.m., Mon., Feb. 13. The purpose of this conference call is to discuss the 2017-18 budget proposal to eliminate Method 1 transportation and advocacy members must take to protect it. We made strides meeting with Assembly/Senate Health and Aging chairs and over 30 legislators, but we have a long way to go before the final budget is negotiated. We need everyone’s help to successfully defeat this proposal. Please print the transportation issue brief found on our website for the call Monday.

We are using a new conference call system at LeadingAge NY/ADHCC. You do not need to register for this call and the call will not be recorded. We will start promptly at 10 a.m. and will try to conclude by 10:30 (depending on the number of questions). To participate, dial: 1-888-585-9008 and use conference room number 303-148-806 when prompted.

DOH amended the State’s transition plan for Home and Community-based Services (HCBS) Settings Rule implementation and posted it here.  As members are aware, the federal HCBS Settings Rule impacts every adult day health care program in New York State. The rule defines what is and what isn’t a home and community-based service for purposes of federal Medicaid reimbursement. Under this rule, ADHC programs are presumed to be institutional settings because of the physical proximity to and relationship with the sponsoring nursing home. ADHC programs will undergo a “heightened scrutiny” process by which the State will collect information to overturn this presumption. The amended STP reflects some of the questions we submitted in Sept. 2016, however, there are still many unanswered questions and we are extremely concerned how this rule will impact ADHC programs. Key takeaways from the amended STP include:

  • Every ADHC program will undergo heightened scrutiny and site-level assessment (assessment, process, timeline to be determined);
  • DOH intends to work closely with stakeholders throughout the heightened scrutiny process and educate providers and ADHC participants on the assessment and remediation before the rule is fully implemented;
  • DOH will conduct three HCBS STP regional forums this summer to gather additional stakeholder input;
  •  DOH is in the process of developing ADHC provider compliance training; and,
  • ADHC will not be carved out of the 1115 waiver (MLTC and MMC) and reimbursed 100% from Medicaid State Plan share.  

We continue to meet regularly with DOH to offer solutions for compliance and advocate for ADHC. Last summer, we provided DOH with sample site-level survey questions to demonstrate how ADHC meets the new, federal definition of home and community-based. DOH is very aware of our concerns and supports nursing home-sponsored, co-located ADHC programs.

We are pleased DOH accepted our invitation to present on the HCBS Settings Rule at our annual conference, Thurs., April 20.

DOH is hosting a webinar on the HCBS Settings Rule Thurs., Feb. 16 from 3:00-4:00 p.m. State staff will provide an overview of the recently amended State Transition Plan. Included in the webinar will be a discussion of next steps in order to come into compliance with the rule. To register for this webinar, click here. After registering, you will receive a confirmation email containing information about joining the webinar. It is unclear if the webinar will be recorded. This is not an ADHCC-sponsored webinar.

ADHCC members should be familiar with registrant and provider rights to managed care fair hearing. Any time a managed care organization changes the care plan for a registrant (i.e. reduces the days the individual attends ADHC), the registrant is entitled to a fair hearing. It is incredibly important for every provider to understand the fair hearing policy and process. LeadingAge NY/ADHCC provided a free, member-only webinar in April 2016 that takes you step-by-step on how to win your appeal. This webinar, conducted by Stephanie Piel, Esq., Hinman Straub, is still available on our website (locked for members only); the handout is available by emailing Anne or Meg. If you are experiencing any MLTC changes to registrant care plans, I highly suggest you download the handout and listen to the webinar.

If you have any questions about the contents of this email, please contact me at ahill@leadingageny.org or call 518-867-8836.