HCA will soon reveal findings from our yearly data analysis and member survey. It will feature a range of metrics: Medicaid financial margins, workforce shortages, staff turnover and vacancy rates, all of which underscore an imperative for state budget support of home and community-based care.
Indeed, the data will show some of the vulnerabilities and urgent needs that exist in this vital in-home safety-net, as nearly three-fourths of Medicare-certified home health agencies and two-thirds of licensed home care agencies report that they are operating with rates and premiums in the red.
We urge strong consideration of these factors as state budget negotiations ramp up, and as the Legislature considers Medicaid investments necessary to cover core operational costs (like minimum wage increases), infrastructure needs, and opportunities for home and community-based providers to achieve Medicaid savings through primary care.
We are ready to offer solutions in all of these areas.
HCA’s State Advocacy Day is coming up on February 12. That day, and on other occasions over the coming weeks, the Legislature will be hearing from constituent providers and health plans, and from our state association representatives, on the following issues.
Finance
Home care providers and their MLTC partners together have major responsibilities for the home and community-based health care system in New York State.
State policy requires all long term care dual-eligible recipients to enroll in MLTCs. This policy also requires MLTCs and partnering home care providers to provide for their care. The system is staked on the viability of these managed plans and their home care partners, especially Licensed Home Care Services Agencies.
Certified Home Health Agencies, in addition to their MLTC partnerships, coordinate with hospitals and physicians on post-acute, post-surgical and medically complex care. They also serve in public health and primary care roles.
Hospices deliver palliative care and compassionate support for patients with life-limiting conditions, enabling the vast majority of their patients to spend their final weeks and days at home with loved ones.
These home care entities, MLTCs and hospices need sustainable reimbursement for the services they provide.
Home care has received few reimbursement adjustments (like “COLAs” or trend factors”) necessary for sustainability. In the past month, two MLTCs have been forced to close and/or have been taken over due to inadequate state premiums. This year’s budget contains yet a new round of cuts to certain classes of services and to MLTCs.
The health plan closures, meanwhile, leave outstanding debt to providers that exacerbates existing financial struggles across the system. The Legislature should take a stand to ensure the providers’ liabilities are responsibly covered by Medicaid funds.
Meanwhile, new mandates, while well-intended, further burden providers and plans with costs that are not captured in a timely, predictable or consistent fashion in the state’s rate methodologies – most notably the minimum wage hikes for Medicaid services, among others.
HCA appreciates the Executive’s proposed addition of budgeted funds to support the increased minimum wage levels; but, for the past three years, the funding levels have not matched the need.
The budget also contains several proposals aimed at cost and performance controls in New York’s “consumer directed personal assistance program” and the Fiscal Intermediaries that administer this program. HCA supports program improvements; but the new provisions must be modified from the Executive’s language to be workable for patients and for the administering MLTCs and intermediaries.
Workforce
On top of service costs, our survey of HCA members reveals that home care’s biggest cost demands are related to workforce recruitment, retention, supervision and assignment.
As providers work to manage staff vacancies and shortages, patients face access-to-care burdens. Workforce shortages create challenges in initiating services and doing the work that home care achieves in averting hospitalizations and other higher-cost service use.
HCA is calling for a set of proposals to address workforce needs, including: competitive nurse, therapist and home health aide compensation; state initiatives to encourage occupational entry into the home care and hospice fields; targeted support to address specialty workforce needs and geographic shortages; plus cross-training of clinicians so that the current capacity of clinicians and paraprofessionals is equipped to transfer skills across settings.
Administrative relief is also necessary, to lessen the time and cost burden of recruitment-and-retention activities. This relief will best maximize a home care agency’s human capital for cultivating a qualified workforce.
Infrastructure
The state has leveraged billions of dollars in waiver funds (through DSRIP) and other arrangements, like the new special charitable health funds negotiated from the for-profit conversion of Fidelis Health Care in its acquisition by Centene. However, these dollars have almost exclusively flowed to institutional providers.
- According to HCA’s members, 20% of home care providers with DRSIP contracts have received no payments from DSRIP, with almost 30% stating that the DSRIP funding sources haven’t involved them at all despite the fact that DSRIP’s goal is to reduce hospitalizations by 25% – and home care is the backbone of that effort.
- Meanwhile, 40% of home care agencies aren’t connected to regional health IT networks for the sharing of electronic medical records. These connections can be a game-changer for the seamless transmission of data, health care system encounters, hospital discharge clinical statistics, and other data that supports the home care system in its ability to act on transitions in care and share critical information which supports functions of the entire health care system.
HCA urges budget amendments in the State Health Facility Transformation Program to better support these vital home care infrastructure needs, including proportionate amounts of the $1.5 billion in state funds derived from the Centene/Fidelis merger which have almost exclusively been earmarked for other sectors.
Home Care Cost Savings
Home care’s instrumental cost-saving role can be better positioned to promote further improvements and savings.
Legislation introduced by Senator Gustavo Rivera (S.1816 and S.1817) would include home care in the state’s policies and strategies for public health, primary care and prevention, focusing on such high cost/high risk areas as sepsis, falls, asthma, pressure injuries, heart failure and other.
Home care can also intervene in a patient’s care progression by helping to get patients home from a hospital sooner, preventing a hospitalization from occurring, and, in some cases, preventing the need for certain hospital, nursing home placement or other high-cost interventions altogether.
Hospice is especially effective in maintaining patients with quality care and support at home when utilization and cost are often the highest at any point in a person’s life.
The Executive Budget proposal calls for an initiative to reduce avoidable hospitalizations through investments in maternity and ambulatory care.
The budget should be modified to support collaboratives with home care, adding the provisions of Senator Rivera’s home health legislation (S.1816 and S.1817) as a primary vehicle.
One study finds that acute in-home care is 52% less costly than hospital care, and that in-home care resulted in a readmission rate of 11% compared to 36% without home care. Elsewhere in this edition of The Capitol Report, we share findings of a Home-Based Asthma Self-Management Program. It’s just one intervention area for a particular cohort of patients, saving on hospital costs.
If you have any questions or need further information about these proposals, do not hesitate to contact the HCA Policy Team.