Category: Publications

As NY Budget Proposes 50% Workforce Funding Cut, New HCA Report Shows Devastating Impact of Pandemic on Home Care Finances and Access  

HCA calls for restoration of workforce and service funds, as well as a ‘Home Care First’ policy to meet rising demand for home care in pandemic

ALBANY — At a time when home care providers face a 50% workforce recruitment-and-retention funding cut and other reductions in New York’s budget, HCA has issued a new report showing the devastating impact of COVID-19 on home care operations and workforce amid a rising demand for services and escalating new costs for Personal Protective Equipment (PPE) and other needs. Continue reading “As NY Budget Proposes 50% Workforce Funding Cut, New HCA Report Shows Devastating Impact of Pandemic on Home Care Finances and Access  “

October (Phase III) Report: Workforce, Referral Patterns, Fiscal Impacts and Telehealth Use in the Pandemic

In late September and early October, HCA conducted our third survey of the industry to determine home care and hospice provider experiences in the ongoing public health emergency following the springtime surge and in anticipation of additional surges. The results are compiled in a Phase III COVID-19 Survey: Summary of Impact on Home and Community-Based Entities, Staff and Patients in New York State.

This third survey (Phase III) was completed on October 14, 2020, netting responses from 77 respondent organizations serving the home and community-based care needs of New Yorkers.

It examines the latest workforce, referral, access and fiscal impacts of the public health emergency on home and community-based care as well as trends like telehealth use as a means of protecting patients and staff and expanding access.

April (Phase II) Report: Home Care Provider Survey Examines Workforce, Supply, Financial Impacts of COVID-19 in NYS

The Home Care Association of New York State (HCA) has again surveyed home and community-based providers in New York State — at the COVID-19 epicenter — to learn more about specific impacts of the health emergency on home and community-based services delivered to nearly 900,000 New Yorkers. Our latest report is called Phase II COVID-19 Survey: Summary of Impact on Home and Community-Based Entities, Staff and Patients in New York State.

Our latest survey, finalized on April 6, further examines: the number of suspected or confirmed COVID-19 cases among home care staff and patients; what agencies are doing to cope with equipment shortages; percentage changes in patient counts due to COVID-19; the numbers (in ranges) of patients refusing care for fear of exposure; what agencies are doing in cases where patients are refusing care; projected financial impacts for the foreseeable future; and more.

March (Phase I) Report: Home Care Needs Priority Supplies, Regulatory Flexibility & Emergency Aid for COVID-19 Response

In a just-completed HCA survey on the COVID-19 crisis, nearly 300 home care providers in every region of New York State report that they collectively serve more than 14,100 priority level 1 patients in the community. These are patients who, without home care, would face a rapid, immediately life-threatening deterioration in their existing health condition or would need to be transferred to another setting, such as hospitals or nursing homes already stretched to capacity. Many of these most at-risk patients are homebound, or dependent on technology or ventilators, with severe life-limiting conditions. Continue reading “March (Phase I) Report: Home Care Needs Priority Supplies, Regulatory Flexibility & Emergency Aid for COVID-19 Response”

HCA Report Outlines Fiscal Pressures Facing Home Care, Hospice, MLTC

HCA has issued our 2020 State of the Industry report. Consistent with past reports, we find that the vast majority of community-based providers and Managed Long Term Care (MLTC) plans are operating with negative or negligible margins.

Providers carry an average accounts receivable of 69 days outstanding. Also, about a quarter of direct caregivers leave home care organizations for a variety of reasons, with turnover rates as high as 63 percent, imposing major unreimbursed costs on organizations.

“The fiscal pressures facing New York’s Medicaid budget are rightfully an area of concern that HCA readily shares,” HCA concludes. “However, state policymakers should not overlook other correlative trends impacting home and community-based services,” noting new obligations and responsibilities like minimum wage  changes and the expansion of MLTC benefits for which “state Medicaid funds … have fallen short while nevertheless adding to the state’s budget pressures.” Continue reading “HCA Report Outlines Fiscal Pressures Facing Home Care, Hospice, MLTC”

Use Our Grassroots Advocacy Toolkit

HCA’s grassroots advocacy seeks to enlist you, as an expert in the field and as a constituent, to lobby with local, state, or federal lawmakers on behalf of an issue or cause, with HCA providing guidance, messaging (i.e., what to say or write), and tools for action. To provide you with more information on this process, as well as tips and resources, HCA’s Director of Public Policy and Advocacy Alyssa Lovelace has developed a Grassroots Advocacy Toolkit: Inform, Mobilize and Engage. Continue reading “Use Our Grassroots Advocacy Toolkit”

Home Care: A Major Partner for Tackling Health Disparities

Home care is uniquely positioned as a model to address health care disparities. Disparities are defined as “differences in health outcomes among different groups of people.”

In many instances, home care providers are the main conduit between patients and their physicians and other providers. They offer special care training and assignment, including language and cultural competencies.

What’s more, in-home telehealth interventions are designed to support the clinician’s work addressing disparity-prone conditions such as diabetes, asthma, hypertension, cardiovascular disease, mental health, maternal and child health, HIV/AIDS and others.

Read our publication on Home Care: A Major Partner for Tackling Health Disparities to learn more.

Report Shows Financial, Workforce Struggles of Home & Community Care Sector Amid State Budget Talks

ALBANY — Coinciding with today’s state legislative hearing on the health and Medicaid budget, the Home Care Association of New York State (HCA) today released the findings of our annual financial and trends report for the home and community-based care sector, which serves approximately 500,000 patients and families in New York State.

The report is culled from the latest available state Medicaid financial reports and a survey of providers. It shows: financial margins; revenue and cost cycle and accounts receivable data; workforce turnover and vacancy rates; access issues; and more.

“The data reveals urgent vulnerabilities and needs in the vital in-home safety-net,” said HCA President Al Cardillo in prepared testimony to the Legislature today. (The report is here; HCA’s testimony is here.)

Continue reading “Report Shows Financial, Workforce Struggles of Home & Community Care Sector Amid State Budget Talks”

Home Care Emergency Preparedness Toolkit

HCA and the New York State Association of Health Care Providers (HCP) offer an Emergency Preparedness Toolkit for home care and hospice providers, their patients and families.

This compilation of resources is for agencies to use in assisting patients and families on preparations for any type of emergency situation. The information can be provided to patients and their families at the time of admission so that the planning process is begun and in place as intended – well before an emergency event takes place.

The resources address a variety of issues and considerations necessary for effective preparedness planning. This Toolkit should also assist agencies and patients under the new federal Conditions of Participation for emergency preparedness, which require patient-specific emergency plans.

Slide Presentation: Legislative Forum on Home and Community Care Services

On January 8, HCA, the Hospice and Palliative Care Association of New York State and the New York State Association of Health Care Providers held a forum for state legislators and their staff offering background on home and community care services – in particular, home care, hospice/palliative care and MLTC – that may aid in:

  • Assisting constituents, families and communities with their health care needs.

Continue reading “Slide Presentation: Legislative Forum on Home and Community Care Services”

Document Drop: Co-Sponsor and Pass Bipartisan Bills to Protect Medicare Home Health under PDGM

The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized the biggest change in funding and reimbursement for Medicare home health services in two decades.

Of nationwide concern, this new system is front‐loaded with provider cuts tucked in by unverified CMS predictions about future provider behavior in a system not even yet implemented. Home care in New York State needs your support on bipartisan legislation (H.R. 6932, S.3545 and S.3458) to ensure that this reimbursement overhaul does not jeopardize services for seniors who rely on home care.

Read our white paper to learn more here.

Saluting Veterans in Home Care and Hospice

For Veterans Day, the Home Care Association of New York State (HCA) joins its home care, hospice and managed long term care provider members throughout New York State in recognizing exceptional individuals who have made the ultimate sacrifice through military service.

Our observance of veterans also coincides with National Home Care and Hospice Month in November.

HCA honors the wishes of patients, including our nation’s veterans, to live independently, with dignity, and with the medical,
social or assistive services to help them fulfill those wishes in the community setting.

If you are a veteran – or if your veteran constituents need care – HCA is proud to be a resource for services at (518) 426‐8764.

Document Drop: HCA Seek Fixes to Medicare Payment Reform, NPP Authorizations & Continued NY Exemption from Pre-Claim Review

HCA is seeking technical corrections that would mitigate the financial and service impact of this change for providers and beneficiaries. We also urge a piloting mechanism so that the payment reforms are tested first on a demonstration basis. These and other recommendations are included in a new HCA piece being shared with Congressional offices, titled Vital Corrections, Safeguards Needed in 2018 Home Health Payment Reform Act (see here).

Continue reading “Document Drop: HCA Seek Fixes to Medicare Payment Reform, NPP Authorizations & Continued NY Exemption from Pre-Claim Review”

HCA’s 2018 Budget and Legislative Action Proposals

HCA has issued our 2018 Budget and Legislative Action Proposals. These include the following broad areas:

  • Reject Budget Cuts and Harmful Program Actions to MLTCs and Home Care
  • Support Budget Proposals to Reimburse Minimum Wage & Health Care Infrastructure
  • Develop Appropriate, Actuarially Sound and Timely Payment for MLTCs and Providers Address Workforce Needs in Home Care and Hospice
  • Maintain NY Licensure Standards for Home Care — and Act Against Scofflaws
  • Utilize Home Care’s Expertise to Yield Savings in Community and Public Health

Home Care, Hospice and Managed Long Term Care Financial and Program Trends 2018

HCA has prepared a 2018 report on the finance and program trends within the home care, hospice and MLTC sectors. This report is based on a statistical analysis of state-required financial documents, a survey of HCA’s membership, and other data sets. It provides aggregate data on financial margins, accounts-receivable balances, direct-care staffing vacancies and turnover rates, and other important findings within New York’s home care, hospice and MLTC sector.


HCA Issues Financial Condition Report, Budget Proposals

HCA has issued its annual financial condition report on New York’s home care and managed care systems, along with a set of vital proposals for consideration in the 2017-18 state budget.

These budget proposals cover the areas of home care and managed care Medicaid payment, regulations, workforce issues, and infrastructure investment.

The financial condition report is available here and the state advocacy agenda is here.

HCA Takes Aim at Federal Regs, Seeks CoP Implementation Delay

HCA this week prepared and circulated two new federal advocacy pieces targeting a series of problematic home care regulations while calling for a one-year delay in implementation of the sweeping new Home Health Conditions of Participation (CoPs).

In a new document, entitled Home Care Advocacy Ask: Regulatory Relief for Home Care Providers, HCA targets five areas of regulation that demand change, consistent with our past advocacy efforts and support garnered from Members of New York’s Congressional Delegation. Continue reading “HCA Takes Aim at Federal Regs, Seeks CoP Implementation Delay”

Briefing Papers: Federal Home Health Policy Summit and Capitol Hill Advocacy Day

The Council of State Home Care Associations is headed to Washington on July 12 and 13 for the first-ever Home Health Policy Summit and Capitol Hill Advocacy Day. The following are a series of briefing papers (in PDF format) about core issues for home care reimbursement, regulatory relief and program needs.

Share this Resource with DSRIP, VBP Leads so They Know Your Value!

HCA has prepared a special resource document that we hope all members find useful in communicating your value-proposition to DSRIP and Value-Based Payment Partners.

We wanted to make sure you saw this piece and find benefit in using it. We also invite you to put your own logo on this piece so that it is branded with your organization’s imprint. (See instructions below.)

The piece is called Don’t Reinvent the Wheel: Home Care is Already Your Hub for Community-based DSRIP and Value Based Dont Reinvent Image 2Services.

Why did HCA create this piece? For several reasons. One, we have heard from many members that Delivery System Reform Incentive Payment (DSRIP) Performing Provider Systems (PPSs) and their committees may not understand home care’s role in the system and the infrastructure you already provide.

What’s more, in some cases, these committees and potential Value Based Payment (VBP) partners appear to be considering options for duplicating home care services from within other settings – in ways that may even interfere with the jurisdictional requirements of Article 36 (an area of concern that HCA is working to address in other venues).

We encourage you to share this document at PPS committee meetings and VBP stakeholder or partnership interactions so that the committees: know more about what home care does; learn some data on home care’s success in meeting PPS and VBP outcomes goals; and understand the regulatory structure that governs home care.

When sharing this document, we also encourage you to present agency-specific data and narratives to support your organization’s successes in achieving the broader points about home care’s value-proposition.

The document can be downloaded in two PDF formats. One format is a four-page document that can be printed and stapled in standard paper size. The other format is designed for 11-by-17-inch printing, front and back, so that it can be produced as a bi-fold. (HCA is happy to assist if you have difficulty printing this piece or need HCA to mail you copies.) Links are below:

Want to co-brand?

Also, HCA is happy to work with you to include your logo on this piece so that it is a co-branded document with your organization’s imprint alongside HCA’s logo.

Please contact HCA’s Communications Director Roger Noyes if you are interested in co-branding with HCA. Just send an e-mail to and we’ll work with you to make this document as effective as possible for your purposes by inserting your logo along with HCA’s.

HCA’s “Priority Asks: Position Home Care to Meet the State’s Policy Goals”

On January 25, 2016, HCA published a two-page document outlining our “asks” of the Legislature for the 2016-17 State Budget and legislative session. The requests, in a document called “Priority Asks: Position Home Care to Meet the State’s Policy Goals,” include the need for reimbursement support and programmatic changes to support home care in a changing state health care policy environment.

New Guidebook on FLSA Changes for Home Care Overtime Pay

New federal overtime changes for home care present huge challenges for agencies seeking to understand the intricacies of the rule for compliance, managing their payroll, and structuring their assignment of staff. To help you, HCA has prepared a new Guidebook on the recently promulgated Fair Labor Standards Act (FLSA) rule for home health aide wages which all members should download and read. You can download the Guidebook here.

Home Health Prospective Payment System Rule for CY 2016: What it Means for NY Providers

On July 7, the U.S. Centers for Medicare and Medicaid Services (CMS) issued proposed payment changes for home health in a regulation known as the Home Health Prospective Payment System (HHPPS) rule for calendar year (CY) 2016.

Given the expanding need and importance of home health care as our population ages, most would expect the proposed rule to include policy changes that improve the value of Medicare home health services for patients and taxpayers. This regulation, unfortunately, proposes significant funding cuts that will directly harm home health agencies and the homebound Medicare beneficiaries receiving such critical services in all areas of New York.

This publication spells out four reasons why this proposed rule is concerning, and why we need Congress to act.

2015 Home Care Primer on Emergency Preparedness

This primer, developed by HCA and the New York State Association of Health Care Providers, is designed to educate the broader emergency preparedness and emergency management community about the role of home care in emergency response. HCA encourages home care providers to share this information with your local emergency management partners.

Allow Nurse Practitioners & Other Health Professionals to Order/Certify Medicare Home Health Services

HCA urges the New York Congressional Delegation to cosponsor the “Home Health Care Planning Improvement Act” and press for full Congressional action on this bipartisan measure. Currently, NPs and other advanced practice health professionals work closely with physicians to ensure that patients receive necessary care for many Medicare-covered services. They are increasingly providing services to Medicare beneficiaries in rural and underserved areas. In particular, they serve a vital need in communities where physician shortages exist, as they are sometimes more available than physicians to expedite the required paperwork to ensure that care to beneficiaries will be initiated and continued.

Continue 3% Medicare Add-On for Home Health Services in Rural Areas

Congress should permanently extend the 3 percent Medicare rural add-on for home health services delivered in rural areas so that access to skilled home and community based care is not threatened. Congress should also closely monitor the adequacy of the Medicare home health prospective payment system (PPS) payment so that agencies can continue to provide care to Medicare Home Care Association of beneficiaries in rural areas.

Home Health Copays and Regressive Payment Cuts Undermine Access to Services

A home health copayment is, in effect, a “sick tax” that harms access to care for vulnerable seniors on fixed incomes, many of whom have multiple chronic conditions, live alone, and need home care to prevent health or safety risks that would otherwise require higher-cost services. If charged a copay, many seniors on fixed incomes will refuse the added charge on their benefits and opt out of vital home care services that help prevent hospitalization, ER visits and other emergent care.

Repeal or Reform the Physician Face-to-Face Encounter Requirement for Home Health

As a condition of payment for Medicare home health coverage, Section 6407 of the Affordable Care Act of 2010 (ACA) establishes that a patient must have a face-to-face (F2F) encounter with the physician who certifies the need for home health services. The encounter also can be provided by certain non-physician practitioners, such as physician assistants and nurse practitioners, and it must occur no more than 90 days prior to the home health start-of-care date or within 30 days after the start of care. However, when a non-physician practitioner provides the encounter, the patient’s physician must still certify that the encounter occurred and compose documentation detailing the finding from the encounter in addition to any documentation produced by the non-physician practitioner. Continue reading “Repeal or Reform the Physician Face-to-Face Encounter Requirement for Home Health”

HCA’s Financial Condition Report: Home Care Financial and Program Support Vital for Success of New Care-Delivery Models

HCA’s annual financial condition report is a signature publication in our state advocacy efforts. The report combines a rigorous analysis of Medicaid cost reports — which are a financial reporting instrument that home care agencies are required to submit to the state — with a survey of HCA’s members seeking their responses on financial, policy and programmatic trends in home care.

HCA’s Legislative Advocacy Agenda: Driving Health Care Improvement and Savings through Home Care 

Driving Health Care Improvement and Savings through Home Care is HCA’s 2015 State Budget policy statement where we highlight key areas of needed financial, regulatory and programmatic support for the home care system. These policies fall into several main areas:

  • The need for state officials to move promptly on home care-managed care regulatory relief and realignment measures already in the cue as part of the state’s Home Care Regulatory Workgroup process;

Continue reading “HCA’s Legislative Advocacy Agenda: Driving Health Care Improvement and Savings through Home Care “

Home Care Face‐to‐Face Mandate A Major Problem, A Simple Fix

This special publication outlines the core problems with the Medicare face-to-face requirements and HCA’s solution to streamline the documentation process, ensuring physician oversight of home care services and Medicare integrity without jeopardizing payment and service access.

New York’s State of Home Care: Huge Changes & Vital Needs Amid State Policy Transition

This special publication provides a summary of all the major home care system transitions that have occurred in the past year, including the managed care transition, the opening of the Certified Home Health Agency certificate of need process, home health payment changes, regulatory changes and more. Along with this policy background, HCA reports on the financial condition of the home care industry using data from a statewide survey and an analysis of financial reporting instruments.

NY Home Care Faces Major Medicare Operating Losses under CMS Rebasing Plan, Threatening Access to Care

The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a plan for the “rebasing” of Medicare home health payments. Rebasing is a process of resetting the statistical base for payments and it will result in major cuts that will further drive New York home care providers into the red. This issue briefing paper summarizes the rebasing process, its impact on home health providers and a legislative call to action for a more rational approach.

A Report on the Fiscal Health of Home Care in New York State

HCA’s 2013 financial condition report summarizes the results of a financial analysis of the home care industry coupled with a survey of HCA’s provider members on their cost experiences with payment, regulatory and programmatic changes.

Home Care Provides Lifeline for Patients in Hurricane Sandy’s Wake

Home care agencies, nurses, therapists and home health aides played a vital role in response to Hurricane Sandy, reaching vulnerable patients in need of services, supplies or assistance with evacuation. Their efforts in the lead‐up and aftermath of this unprecedented storm show what an essential asset home care providers are during times of crisis — just as they provide critical supports to elderly, disabled and chronically ill patients each and every day. In this publication, HCA collects a series of press reports where national and local media highlighted the work of New York home care providers during and after the storm to ensure the safety of patients.

Innovative Home Care Models: Five Profiles in Cost Savings, Care Transitions

Using one common factor of cost-savings — the 30-day hospital readmission rate — Simione Healthcare Consultants worked with HCA on an analysis which found that the total annual cost savings of innovative care-transitions programs implemented for a defined cohort of patients at just five home care agencies in New York State amounted to an estimated $1.3 million in averted hospital expenses annually.

Home Telehealth: Enhancing Care, Saving Costs

Home telehealth involves the use of technologies in the home that allow patients to receive education and daily monitoring of vital signs and/or video visits from a registered nurse or therapist. Thus, it could be said, that home telehealth extends the eyes, ears and touch of home care, bringing specialized medical monitoring to people who need it, as a supplement to in‐person home visits. These technologies save countless health care dollars by helping to reduce hospitalizations and the use of emergent care services.

Impact of Home Health Co‐payments: Facts and Figures

Numerous proposals have been made as part of deficit reduction discussions to institute co‐payments for Medicare beneficiaries who receive Medicare‐covered home care.  President Obama’s fiscal year 2013 proposed budget includes a provision that would charge a $100 co‐payment for new home health users per episode of care (starting in 2017).  This co‐payment would apply for episodes with five or more visits not preceded by a hospital or inpatient post‐acute stay.