Top Legislative Issues
Administrative and General Cap
Memo in Support
Bill Number: A 8390 (Gottfried)/S.5230-A (Hannon)
Summary:
HCP strongly supports this bill which excludes patient outreach, assessment, staff transportation and technology investments and other costs from the statewide average Administrative and General (A&G) cap for Long Term Home Health Care Programs (LTHHCPs). The legislation also requires that such reduction percentage cannot be increased for any provider as a consequence of the exclusions.
Position:
HCP strongly supports this legislation because providers who are currently servicing under the LTHHCP and subject to the A & G cap will not have to limit certain patient activities which may compromise access to care, because all of these services are currently included in the current cost cap imposed by the State. This legislation would exclude specific services from the cost cap such as staff transportation, technology investments and patient outreach so that providers are not forced to compromise care because they have to currently include such services in their cost cap.
The Long Term Home Health Care Program (LTHHCP) is a Medicaid Waiver program introduced in 1977 as an alternative to institutional long-term care. Also known as the "Nursing Home Without Walls" or "Lombardi Program," it provides and coordinates a continuous and comprehensive range of health, social and environmental services which are tailored to patients' individual needs.
In addition to traditional home care services, the covered services under the LTHHCP include: case management by a Registered Nurse; home-delivered meals; housing improvement; respiratory therapy; moving assistance; congregate meals; medical social services; nutritional/dietary services; respite care; social day care; and social transportation. LTHHCP services are provided by hospitals, residential health care facilities and Certified Home Health Agencies that have been approved by the Department of Health (DOH) to provide such services.
In order to be eligible for the LTHHCP, an individual must be Medicaid-eligible and require skilled nursing care. The total cost of each patient's care must not exceed 75% of the average annual costs of comparable institutional care. The program responds to the increasing demand for long-term care alternatives and helps to contain the high cost of institutional care to public and private payers.
In addition, in accordance with the State 2005-06 Enacted Budget, DOH implemented an Administrative and General (A&G) cost cap on Long Term Home Health Care Providers (LTHHCPs) effective April 1, 2005. The cap was determined by calculating the percent of total statewide administrative costs divided by total statewide operating costs. This new cap on A&G costs has placed an overwhelming financial strain on many of the LTHHCP providers.
HCP strongly supports passage of this legislation as LTHHCP providers would not be faced with the difficult decision to discontinue providing certain services because they would be excluded from the statewide A & G cap.
