Budget Update – Close but No Budget Yet
It was quiet over the Easter/Passover holiday weekend, as the legislature and governor continued negotiations to close down the 2021-2022 state fiscal year budget estimated to spend roughly $200 billion.
Of most importance to HCP and its members, is that the “Health and Mental Hygiene” (HMH) budget bill was finally introduced. Issues of significance to HCP members included are an extension of the Medicaid Global Spending Cap, an extension of the deadline to transition to Medicaid managed care the Nursing Home Transition and Diversion (NHTD) program and the Traumatic Brain Injury (TBI) program, and an issue of great interest, the future of the Consumer Directed Personal Assistance Program (CDPAP) Request for Offers (RFO).
Not included in the HMH bill is the Fair Pay for Home Care or any similar proposal appropriating funds for home care aide wage increases, nor a repealer of the Licensed Home Care Services Agency (LHCSA) RFO.
Fair Pay
On Fair Pay where things sit is not entirely clear. Issues of funding for wage increases in future state fiscal years has been a concern of policy makers. Such concerns may lead to a single-year solution appropriating dollars for the home care industry based on the enhanced Federal Medicaid Assistance Percentage (eFMAP) for home and community-based services (HCBS) provided in the latest stimulus bill. Such an approach would tie in with decisions being made by the Centers for Medicare and Medicaid Services (CMS) regarding guidance to states about how to spend eFMAP allocations. This may also tie in with President Biden’s announcement last week of investing $400 billion in HCBS for the caregiver economy as part of the Biden administration’s infrastructure spending proposal.
In considering any wage proposal, HCP has urged the legislature to learn from the experience of recent minimum wage increases and the lack of adequate reimbursement from MLTCs. In reflecting on the experience with minimum wage the legislature must safeguard home care providers. To do otherwise only serves to cripple an already fragile industry.
In its discussions HCP explains that whatever solution is proposed to increase caregiver wages, whether as a new minimum wage or a one-shot wage enhancement, providers still need relief to ensure that they can sustain the additional expenses related to COVID response, and to ensure that any proposal to increase the wages of home care aides includes the necessary and adequate direct funding to cover the wage and wage-related costs incurred by home care providers.
LHCSA RFO
Despite HCP’s efforts and the tremendous grassroots efforts of its members, the repeal of the LHCSA RFO has not been included in the budget. In calling for its repeal HCP has described the uncertainty and likely limitations on access to care experienced by the industry related to ill-conceived state policies like the CDPAP RFO.
CDPAP RFO
HCP has also been tracking the several competing proposals to address the CDPAP RFO and the positions of many stakeholders that were successful or not in the current RFO process.
In response, after many possible solutions have been circulating to address the perceived short comings of the current RFO process, language has been included in the budget, Part LL of HMH at page 41 - S. 2507-C/A. 3007-C, that would do the following:
1) The Department of Health (DOH/the Department) is authorized to reoffer contracts or use the existing offer. In doing so DOH must survey all applicants that were qualified as meeting minimum requirements of the procurement process including those that were not awarded contracts. The survey will ask:
a. Whether the applicant is a not-for-profit corporation;
b. Whether the applicant has been performing services as a fiscal intermediary (FI) prior to 1/1/2012 and has continuously provided such services since that date;
c. Primary mailing address of the applicant on its most recently filed state corporate tax return or its Federal Return of Organization Exempt Income Tax form (form 990);
d. Whether the applicant is currently authorized, funded, approved or certified to deliver state plan or home and community-based waiver supports and services to individuals with intellectual and developmental disabilities by the office for people with developmental disabilities;
e. whether the applicant has historically provided FI services to racial and ethnic minority residents or new Americans in such consumers' primary language, as evidenced by information and materials provided to consumers in the consumers' primary language or languages; and
f. whether the applicant is verified as a minority or woman-owned business enterprise (MWBE) pursuant to section three hundred fourteen of the Executive law.
2) Survey respondents will have thirty days to respond to the survey. The failure to provide the information sought within thirty-days shall disqualify such applicants from consideration of any additional awards.
Following the survey, DOH shall make awards to qualified applicants that previously submitted applications, in addition to any awards already announced, as may be necessary to ensure awards as follows:
a. DOH shall make awards to one or two additional applicants that are located in each county with a population of more than two hundred thousand but less than five hundred thousand based on primary mailing address from the survey.
b. DOH shall make awards to one or two additional applicants that are located in each county with a population of five hundred thousand or more based on the primary mailing address from survey.
c. To provide geographic distribution that would ensure access in different regions of the state DOH shall make awards to at least two additional applicants that are currently authorized, funded, approved or certified to deliver state plan or home and community-based waiver supports and services to individuals with intellectual and developmental disabilities and meet the following criteria:
i. are organized as a not-for-profit corporation; or
ii. have been FIs prior to 1/1/2012 and have been continuously providing such services for eligible individuals since that date.
d. To provide geographic distribution that would ensure access in different regions of the state DOH shall make awards to at least two additional applicants that serve racial and ethnic minority residents, religious minority residents, or new Americans in those consumers' primary language, as evidenced by information and materials provided to consumers in the consumers' primary language or languages and meet the following criteria:
i. are organized as a not-for-profit corporation; or
ii. have been FIs prior to 1/1/2012 and have been continuously providing such services for eligible individuals since that date.
e. To provide geographic distribution that would ensure access in different regions of the state DOH shall make awards to at least two additional applicants, to the extent that such applications were received, that have been verified as a minority or woman-owned business enterprise pursuant to the Executive Law.
3) DOH may only make awards to the extent that applicants that meet the new criteria, based on survey results, submitted qualifying applications and the commissioner shall not be required to make awards where no applicant meets the prescribed criteria.
4) Where an FI is acquired by, merges with, sells assets to, or engages in a transaction of a similar nature with a fiscal intermediary that was awarded a contract under the existing CDPAP RFO all the provisions of Social Services Law (SSL) Section 365-f subdivision 4-d, regarding FIs Ceasing Operation, shall apply. In providing notice required under SSL Section 365-f, the FI may inform the notice recipient of the applicable transaction and, if applicable, the ability of the consumer to remain with the awarded fiscal intermediary in accordance with any guidance issued by DOH.
5) These changes will take effect immediately upon becoming law.
Once the budget is passed, it is unclear how quickly or on what timeline these new processes will be operationalized. HCP is working to clarify those issues.
Conclusion
There are still several outstanding issues that await clarification and confirmation. HCP will have additional information about those issues once the remaining budget bills are finalized and introduced. With the state budget, nothing is done until everything is done. HCP will continue to report to members as the process, hopefully soon draws to a close.