DOH ALP Hospice Workgroup Continues to Discuss Implementation of Change
(April 8, 2025) LeadingAge NY participated in a recent meeting of the Assisted Living Program (ALP) Hospice Workgroup to continue discussion to enable Medicaid-eligible residents of ALPs to receive hospice services without having to disenroll from other services. Members may recall that this workgroup was convened with LeadingAge NY and other stakeholders as a result of legislation we worked to pass enabling Medicaid-eligible ALP residents to access hospice care. The workgroup, which was required in the legislation, was convened by the Department of Health (DOH) to make recommendations on the coordination and division of services, responsibilities, and reimbursement. Click here for more background. DOH received State Plan Amendment (SPA) approval from the Centers for Medicare and Medicaid Services (CMS) to facilitate this change, and we are now working to ultimately implement the change.
The below is a summary of issues discussed, but no decisions were made.
Contract: There was discussion regarding whether the ALP and hospice provider should have a contract with one another, as is done in the nursing home setting. It was acknowledged that that is helpful and useful to understand one another’s requirements and obligations, but it was also noted that there are significant differences between the nursing home and ALP settings. The hospice would not be contracting with the ALP for the provision of any hospice services, nor would money be exchanged between the two parties. Further, hospice contracts directly with the resident. It was noted that requiring the execution of a lengthy contract could be a barrier to the provision of services. DOH’s legal team is reviewing this issue.
Narcotics: There was discussion regarding narcotics: how an individual can be assisted with the self-administration of narcotics, options when someone can no longer participate in the self-administration, and the destruction of narcotics once the individual has passed. While we believe that prior guidance and decisions will offer a guide to these issues, this issue is being reviewed further with the Bureau of Narcotic Enforcement (BNE).
Payment and Rate Setting: These issues were deferred to a future conversation; however, it was noted that we did not anticipate any changes to rates.
Avoiding Duplication: DOH remains concerned regarding avoiding duplication of services and ensuring that providers are clear on responsibilities. DOH also stressed the importance of case management and communication between the two parties.
DOH Form 5778: Lastly, it was noted that ALP providers will need to be made aware of the hospice requirement to complete DOH Form 5778, Entity/Facility Notification of Hospice Non-Covered Items, Services, and Drugs. The ALP may provide information to the hospice provider to complete the DOH-required form. This Dear Administrator Letter (DAL), which was written for hospice providers, explains the form. DOH will provide more information to ALPs when ready to enable Medicaid-eligible ALP residents to access hospice services; however, we share for member awareness.
LeadingAge NY will continue our work on this workgroup and hopes that we can soon come to resolution so that ALP residents can access hospice care. We encourage members to reach out with any questions, so that we may try to get them addressed through this stakeholder effort.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828