powered by LeadingAge New York

LeadingAge NY Represented on Key Workgroups

LeadingAge NY and its members are well represented on two key workgroups emanating from the recently enacted 2019-20 State Budget – one on nursing home case mix and the other on Fiscal Intermediaries (FIs) for the Consumer Directed Personal Assistance Services (CDPAS) program.

Nursing home case mix workgroup appointees include LeadingAge NY members Chris Koenig (Niagara Lutheran, Buffalo); Michelle Synakowski (Community Wellness Partners, Clinton); Robert Werner (Parker Jewish Institute, New Hyde Park); and Paul Rosenfeld (Rutland Nursing Home, Brooklyn) as well as LeadingAge NY staff Dan Heim and Darius Kirstein. The FI workgroup includes LeadingAge NY member Andy Cruikshank (Fort Hudson Health System, Fort Edward) and staff person Darius Kirstein. The full rosters for these workgroups have yet to be released, so it is possible that additional LeadingAge NY members have been included.

Under the final budget, the methodology utilized to calculate case mix adjustments to nursing home rates is slated to change effective July 1, 2019. Based on advocacy by LeadingAge NY and other groups, the budget establishes a workgroup described in law as follows:

The Commissioner of Health or his or her designee shall convene and chair a workgroup on the implementation of the change in case mix adjustments to Medicaid rates of payment of residential health care facilities that will take effect on July 1, 2019. The workgroup shall be comprised of residential health care facilities or representatives from such facilities, representatives from the statewide associations and other such experts on case mix as required by the commissioner or his or her designee. The workgroup shall review recent case mix data and related analyses conducted by the department with respect to the department’s implementation of the July 1, 2019 change in methodology, the department’s minimum data set collection process, and case mix adjustments authorized under in the Public Health Law (Section 2808 2(b)(ii)). Such review shall seek to promote a higher degree of accuracy in the minimum data set data, and target abuses. The workgroup may offer recommendations on how to improve future practice regarding accuracy in the minimum data set collection process and how to reduce or eliminate abusive practices. In developing such recommendations, the workgroup shall ensure that the collection process and case mix adjustment recognizes the appropriate acuity for residential health care residents. The workgroup may provide recommendations regarding the proposed patient driven payment model and the administrative complexity in revising the minimum data set collection and rate promulgation processes. The Commissioner shall not modify the method used to determine the case mix adjustment for periods prior to June 30, 2019. Notwithstanding any changes in federal law or regulation relating to nursing home acuity reimbursement, the workgroup shall report its recommendations no later than June 30, 2019.

The following language appears in the budget legislation for the FI workgroup:

The commissioner shall convene and chair a stakeholder workgroup pertaining to fiscal intermediary services and the needs of consumers. The workgroup shall consist of, at a minimum, representatives of service centers for independent living; statewide associations of fiscal intermediaries; representatives of managed care entities under article forty-four of the public health law and local social service districts; consumers; and representatives of advocacy groups representing consumers of services under this section. The workgroup shall be established no later than May fifteenth, two thousand nineteen. The workgroup shall identify and develop best practices pertaining to the delivery of fiscal intermediary services; inform the criteria for use by the department for the selection of entities under subdivision four-a of this section; identify whether services differ for certain consumers and under what circumstances; inform criteria in relation to the development of quality reporting requirements; and work with the department to develop transition plans for consumers that may need to transition to another fiscal intermediary.

LeadingAge NY will be actively seeking input from its Cabinets and broader membership as these workgroups proceed. We will keep members updated.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866