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LeadingAge NY Meets with DOH on Provider Financial Concerns

Last Friday, LeadingAge NY met with top-level Department of Health (DOH) staff responsible for coordinating policy and reimbursement for long term care (LTC) services. While the purpose of the meeting was to highlight the critical staffing and financial challenges that many nursing home members are facing and to explore ways to address them, the discussion included not only the possibility for immediate assistance, but also potential strategies to increase funding for nursing homes and LTC overall. We shared key data indicating the causes and magnitude of the financial stress that members were experiencing prior to the pandemic, highlighted how the pandemic and Medicaid cuts exacerbated the problem, and spotlighted some of the distinctive characteristics of our members. While the level of investment that would be needed to effectively address the staffing crisis and adjust Medicaid rates to reflect the true cost of care requires legislative involvement and would have to be done as part of the State Budget process, we stressed the importance of addressing the needs of individual providers who require immediate assistance to weather the COVID-19 storm.

To address the need of providers requiring immediate assistance and help with cash flow, we urged DOH to release any outstanding funding without delay, to provide prompt feedback for providers with pending Vital Access Provider (VAP) applications, and to make distressed facility funding available as soon as possible. We are arranging a follow-up meeting to further discuss distressed facility funding. The funding mechanism for a financially distressed hospital and nursing home pool was established in the 2020-21 State Budget through contributions from counties and New York City, but to date there has not been any public discussion of distribution mechanisms. DOH indicated that their intent is to process VAP applications promptly and requested that we provide them with an inventory of outstanding applications.

We also discussed the prospect for increasing funding for LTC in the longer run and ways to ensure that LTC is appropriately reflected in the State’s health care initiatives, such as any potential successor to the Delivery System Reform Incentive Payment (DSRIP) Program. The Department indicated that increasing levels of Value-Based Payment (VBP) arrangements and promoting the State’s equity agenda remain priorities and that they were open to innovative suggestions that would help advance these goals while helping to fund LTC. They are also seeking creative thinking regarding other initiatives, including those funded by the enhanced federal Medicaid match to enhance Home and Community-Based Services (HCBS), and pointed to the inclusion of a proposal to enhance the Advanced Training Initiative (ATI) in the State’s submitted plan as an example. Without offering any immediate relief commitments, DOH policy staff expressed an interest in working toward solutions as well as innovative models for reimagining and rebuilding the nursing home sector post-pandemic. We are pleased that DOH is interested in establishing an ongoing dialogue on these issues and are scheduling follow-up meetings. We will engage members in our ongoing efforts and keep you informed of developments.

We are grateful to those who shared financial stress information in advance of the meeting as well as those who already responded to our request for VAP information. While we need updated financial information for advocacy, instead of subjecting members to a lengthy financial survey, we will be asking that that you share a copy of your 2020 Residential Health Care Facility (RHCF) Medicaid cost report (the file with a .doh or .dat suffix) with us once it has been filed. If you have submitted a VAP application or have had a discussion with DOH regarding a project that may include a VAP application, please contact Darius Kirstein at dkirstein@leadingageny.org with the rough date of the most recent discussion with DOH and the status of the application.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841