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DOH Post-Acute Care Management Models Work Group Discusses Regulatory Reforms

The Department of Health's (DOH) Post-Acute Care Management Models Work Group met for the second time on Sept. 18th to discuss potential policy changes to support access to post-acute care and care management. The Work Group is one of the groups being convened by the Department in connection with its "Regulatory Modernization Initiative." It was established at the urging of certain hospitals and Performing Provider Systems (PPSs) to address regulatory barriers to the provision of post-acute care by hospitals. Information about the first meeting is available here.

Yesterday's meeting included remarks by representatives of the Visiting Nurse Service of New York, Suffolk Care Collaborative Performing Provider System, and One City Health, describing successful hospital-home care partnerships and post-discharge care management practices. These presentations were followed by wide-ranging discussions of the regulatory, workforce, information technology, and payment challenges facing hospitals and home care agencies in delivering post-acute care. Representatives of long-term/post-acute care providers spoke of successful partnerships with hospitals, as well as frustration when their capacities are overlooked by hospitals. Hospital and PPS representatives expressed support for care models that incorporate home visits by physicians, paramedics, nurses, community health workers, and care managers. They expressed a preference for delivering home visits directly rather than partnering with home care agencies due to (i) ineligibility of patients for Medicare home health services; (ii) the hospitals' inability to send home care agency nurses into a home on short notice; (iii) incompatible electronic health records and the inability to share information electronically with home care agencies; (iv) unnecessary visits for home infusions required by certified home health agencies (CHHAs); (v) the need for acute care services that they believe home care agencies cannot deliver; and (vi) the need for one-time or isolated nursing visits that are not cost-effective for CHHAs or LHCSAs. Work Group members and members of the public discussed at length the confusing proliferation of care managers and coordinators in the field and the need to identify a care management quarterback. Representatives of home care workers and unions spoke of the need to leverage the value of home care aides to perform care transitions responsibilities.

LeadingAge NY pointed to successful collaborations between home care agencies and hospitals and noted that many of the barriers cited by hospitals and PPSs were payment- or technology-related, rather than regulatory in nature. We emphasized the importance of specifying the models being advanced and the obstacles to those models (whether payment, federal, or state regulation, workforce, or technology) prior to embracing a change in the licensure or certification required for home care. We urged careful consideration of the implications of any expansion in the entities authorized to deliver home care for the existing delivery system and home care infrastructure. In particular, we noted that hospitals have a different cost structure than home care agencies and that an expansion of hospital-delivered services into the home care space could result in higher health care spending. Such an expansion of hospital-delivered services might also result in additional pressure on the home care workforce to the extent that hospitals compete with home care agencies for nurses and aides.

The Department presented a series of draft proposals for the Work Group's consideration, including:

  • Providing funding to hospitals and partnering providers to develop and sustain care transition interventions;
  • Developing and funding community paramedicine;
  • Allowing RNs to make a visit to patients' homes for short-term follow-up care if the patient does not meet requirements for certified home health services;
  • Establishing a Medicaid reimbursement mechanism under Public Health Law (PHL) section 2803(11) for home visits by RNs, which are not limited to established hospital clinic patients;
  • Modifying or waiving regulatory constraints which inhibit the use of integrated care teams to provide acute care to patients in their homes;
  • Revising Consumer Directed Personal Assistant Services regulations to allow for one to five hours of care while the patient is hospitalized to receive transition training;
  • Adjusting payments to enable skilled nursing facilities (SNFs) to have separate compensation for specialized transplant and oncology medications;
  • Adjusting payments to enable SNFs to bill separately for the personnel related to transportation costs associated with follow-up visits; and
  • Working with the Centers for Medicare and Medicaid Services (CMS) to provide an anti-kickback safe harbor for hospitals that are willing to take on the financial burden of expensive drugs for SNFs.

LeadingAge NY asked the Department to add the following to its list of proposals:

  • Allowing nurses to practice nursing in adult care facilities;
  • Allowing hospice services to be provided to assisted living program residents;
  • Eliminating the Patient Review Instrument (PRI); and
  • Allowing cross-training of aides in all settings.

The Department will be considering comments on these proposals and collecting additional proposals with the aim of issuing a set of regulatory and statutory proposals by the end of the year. LeadingAge NY encourages its members to weigh in on these proposals by contacting Karen Lipson and/or by sending an email to the Department's Regulatory Modernization Initiative mailbox. Comments should be submitted by Fri., Sept. 29th, if possible.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124