The Department of Health's (DOH) Oct. 18^th quarterly report on Home and Community-Based Services (HCBS) Enhanced Federal Medical Assistance Percentage (eFMAP) spending to the Centers for Medicare and Medicaid Services (CMS) provides progress and activity updates, modifications to spending proposals, lessons learned, plans for sustainability, and individual activity updates for each spending proposal. The report can be found here.

At present, the State is largely focusing its efforts on launching proposed activities, drafting spending authorities, and preparing for implementation.

CMS’s letter from Aug. 25^th fully approved 14 of the proposed activities. Currently, there are 25 activities pending CMS approval. In its capacity as the single state Medicaid agency, DOH responded to CMS’s requests for clarification about the 25 pending activities on Sept. 3^rd and awaits full approval. 

According to the report: 

DOH and the Partner Agencies have worked diligently to architect the necessary foundational components for these activities in anticipation of their approval. Based on these efforts, significant progress has been made on nearly all activities to obtain needed federal authorities to implement these proposed activities, including the drafting and posting of some State Plan Amendments (SPAs), and development of directed payment preprints under 42 C.F.R. § 438.6(c) (Section 438.6(c)). DOH is confident that our progress in building a strong foundation and implementation plan for all 39 activities, including potential future modifications to these proposals or the development of new proposals or emergent needs are identified, will enable successful outcomes and positive long-term impacts for individuals served by HCBS across the state.

DOH is also considering new proposals related to the impacts of vaccine mandates on the HCBS workforce, the expansion into HCBS provider types permitted by CMS administrative guidance that were previously unaddressed by the initial spending plan and narrative, or other new developments to expand, enhance, or strengthen HCBS programs in the state. LeadingAge NY will reach out to the Department for more detail on these modifications.

Of additional note are some funding level changes:

• Transform the Long Term Care Workforce and Achieve Value-Based Payment (VBP) Readiness – increased from $623 million to $722.5 million
• Enhanced Rates for Private Duty Nursing – increased from $10 million to $13 million 

In addition, DOH is amending its spending proposal for personal care and Consumer Directed Personal Assistance Program (CDPAP) support:

Support Program Growth in Personal Care Services and CDPAP or Ensure Capacity- Based on comments from CMS in its letter of August 25, 2021, CMS is currently unable to fund year-over-year growth in PCS and CDPAP consistent with its interpretation of section 9817 of ARPA but will consider whether incremental program growth between projected baseline spend and actual spend, due to other HCBS investments removing existing barriers, is an eligible expenditure. Accordingly, DOH is refining this proposal for CMS’s review. 

Sustainability goals are reported to include continued funding of HCBS workforce support and rate increases for services as well as digital infrastructure supports for HCBS provider agencies, including technology to allow strategic reopening of services when face-to-face is a risk and integration of technology into service delivery, documentation, and care.

LeadingAge NY will keep members apprised of any additional knowledge or developments it learns about this initiative.