Healthy Aging and New Nursing Home Transfer of Ownership Regulations Discussed at PHHPC Meetings
In two meetings last week, the State's Public Health and Health Planning Council (PHHPC) considered issues affecting long term care providers and the older adults they serve. The first meeting, convened by the PHHPC's Public Health and Health Planning Committees, considered the progress the State has made over the past two years in advancing its Prevention Agenda. In addition to reviewing various elements of the Prevention Agenda, the PHHPC also received reports from Department of Health (DOH) staff on its healthy aging initiatives and its Section 1115 Medicaid waiver concept paper. PHHPC members signaled that they are interested in examining the State's strategy for long term care. Meeting materials are available here, and a recording is available here.
DOH, the State Office for the Aging, and the Department of State briefly described several different initiatives to support healthy aging, including the following:
- Age Friendly Health Systems;
- Age Friendly Communities;
- Age Friendly Housing grant with New York Academy of Medicine that will educate local health departments about age-friendly housing concepts;
- State Master Plan for Aging, which was referenced in the Executive Budget;
- Alternatives to institutional care for older New Yorkers, including the Green House model and supportive housing; and
- Memory care accreditation and staffing requirements.
The State's Medicaid Director, Brett Friedman, presented on the Department's Section 1115 Medicaid waiver concept paper. This concept paper will serve as the basis for a waiver application that will replace the Delivery System Reform Incentive Payment (DSRIP) Medicaid Waiver that expired in 2021 and was temporarily extended through March 2022. Friedman indicated that the Centers for Medicare and Medicaid Services (CMS) has responded favorably to the 1115 waiver concept paper. He emphasized that once the waiver application is submitted, there will be several opportunities for public comment. LeadingAge NY has submitted two sets of comments on the concept paper (available here and here), criticizing its failure to address the needs of older adults and lack of support for long term care and suggesting modifications.
Friedman’s presentation confirmed our understanding that waiver funding would run through managed care plans under value-based payment (VBP) arrangements. These arrangements have historically failed to yield funding for long term care providers because of the bifurcation of funding and services between Medicare and Medicaid. Friedman indicated that, under the waiver, DOH would provide additional funding to managed care plans that engage in VBP arrangements that meet certain criteria, such as:
- Aligning with the goals of regional health equity organizations;
- Engaging in higher level risk arrangements;
- Including behavioral health and social care providers; and
- Addressing the needs of populations that have experienced disparities.
In conjunction with the waiver, DOH is seeking to align all payers, including commercial managed care plans, into global payment pilots. This will be incorporated in the proposed Medicaid managed care competitive procurement proposed in the Executive Budget. Managed care plans with multiple products will be expected to participate in global payment arrangements. DOH is also working on developing new measure sets based on health equity and on social care risk adjustment for managed care premiums.
Karen Lipson provided public comment on the presentations on behalf of LeadingAge NY and its members. She stressed the need for a concerted focus on the needs of older adults in prevention initiatives and in the 1115 waiver. She noted that, under the DSRIP Waiver, long term care providers received only about 2 percent of DSRIP funding, and that the new waiver seems poised to repeat that pattern. She pointed to several concrete steps the State should take to promote healthy aging and address the long term care needs of our aging population, including expanding service coordination in affordable senior housing and connecting the dots between Medicaid and healthy aging initiatives. She also noted that the Department's plan for a competitive procurement of Managed Long Term Care (MLTC) plans threatens to eliminate MLTC plans sponsored by long term care providers and replace them with large plans that do not focus on the needs of older adults.
In a second meeting on March 2nd, the PHHPC considered several applications to transfer ownership of nursing homes under the State's new character and competence regulations. The new regulations include a seven-year lookback period for purposes of determining whether proposed owners with other facility relationships have provided a consistently high quality of care. The new process also includes consideration of the star ratings of the facilities in the proposed owner's portfolio. All of the applications considered were approved. A recording of the meeting is available here, and meeting materials are available here.
LeadingAge NY's comments on the new regulations are available here, the new regulations are here, and a summary of the underlying law is available here.
We will be meeting with the Department regarding these and other matters and will keep members apprised of new developments.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383