Home Care Association
of New York State
2008 Annual Conference
June 3, 2008
New York State Department of Health
Mark Kissinger, Office of Long Term Care
Lana I. Earle, Bureau of LTC Reimbursement
NY’s Total LTC Expenditures Highest in the Nation ~
Exceeding 2nd Highest State, California,by 39 Percent
2004 LTC Expenditures, All Payers (Millions $)
$19,385
$13,961
$9,379
$9,204
$8,353
$6,442
$5,867
$5,688
M
ic
hi
ga
n
ew
N
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u
M
as
sa
Je
rs
ey
se
tts
s
no
i
Ill
i
o
O
hi
s
Te
xa
a
Fl
or
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ia
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ew
Y
or
k
$4,519
Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services
2
NY & CA Home Care Spending Comparable ~
NY Per Capita Spending Higher than CA
2004 Home Health Care Spending All Payers (Millions $)
$7,000
$350
$312
$6,000
$300
$271
$5,000
$250
$153
$4,000
$200
$159
$3,000
$154
$6,021
$165
$150
$133
$2,000
$5,537
$2,876
$1,000
$131
$99
$3,604
$1,519
$1,743
$1,269
$1,427
$1,326
$0
$100
$50
ich
ig
an
Je
rs
Ne
w
hu
s
sa
c
as
M
M
ey
s
ett
in
oi
s
Ill
o
Oh
i
Te
xa
s
a
rid
Fl
o
ia
rn
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Ca
l
Ne
w
Yo
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k
$0
Home Health Care
Per Capita Spending
Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services
3
NY’s Average Annual Growth Home Care Expenditures
is the Fifth Largest ~ Recent Growth Strong in All States
California
Michigan
Massachusetts
New Jersey
New York
Florida
Illinois
Ohio
Texas
% Change
2003-2004
Annual
Average %
Change
$5,537
11.30%
14.47%
$1,125
$1,326
17.87%
5.77%
$1,396
$1,561
$1,743
11.66%
5.53%
$1,115
$1,171
$1,296
$1,427
10.11%
4.95%
$4,578
$4,625
$4,852
$5,520
$6,021
9.08%
3.63%
$2,166
$2,168
$2,262
$2,330
$2,520
$2,876
14.13%
2.95%
$1,102
$1,031
$996
$1,011
$1,058
$1,111
$1,269
14.22%
2.38%
$1,327
$1,331
$1,275
$1,282
$1,299
$1,408
$1,519
7.88%
2.28%
$3,200
$2,479
$2,286
$2,501
$2,786
$3,173
$3,604
13.58%
2.00%
1998
1999
2000
2001
2002
2003
2004
$2,461
$2,910
$3,106
$3,627
$4,318
$4,975
$947
$969
$996
$985
$1032
$1,262
$1,197
$1,208
$1,315
$1,068
$1,170
$1,121
$4,861
$4,683
$2,416
Source: National Health Expenditure Data, 2007 Center for Medicare and Medicaid Services ~ Includes All Payers
4
NY’s LTC Medicaid System is Less Dependent on Institutional Nursing
Facilities ~ Community Based Services Accounts for 35% of Medicaid
Spending Second Only to California at 54%
100%
2004 % Medicaid Spending
90%
80%
70%
54.28%
60%
50%
34.95%
40%
28.51%
30%
22.36%
20%
12.25%
7.04%
5.31%
10%
0%
California
New York
Texas
Nursing Facilities
Mass
Michigan
Florida
Ohio
Home Care & Personal Care
5
Source: CMS Financial Management Report FY 2005, Reported by States
However, the Proportion of LTC Beneficiaries Cared for In
Institutional Setting is Not Significantly Different than Other States
90%
2004 % of Medicaid Beneficiaries by Category
80%
70%
60%
50%
40%
35.59%
24.12%
24.46%
30%
22.16%
20%
17.97%
16.86%
10.90%
10%
0%
New York
California
Florida
Nursing Facilities
Mass
Michigan
Texas
Ohio
Home Care & Personal Care
6
Source: CMS Financial Management Report FY 2005
Why? NY has Highest Home Health Cost Per Beneficiary
~ 50 Percent Higher than Second Ranked California
$6,000
$5,912
$5,911
2004 Cost Per Beneficiary
$5,000
$3,677
$3,935
$3,801
$4,000
$2,800
$2,712
$3,000
$2,429
$1,810
$2,000
$1,391
$1,175
$1,414
$1,000
$76
$0
$0
New York
California
Florida
Home Care
Mass
Michigan
Texas
Ohio
Personal Care
7
Source: CMS Financial Management Report FY 2005
Nationally, Private Funding of Home Health Care has Remained
Flat and Public Funding has Increased Significantly
$40
National Health Expenditures ~ Billions $
$35.8
$35
$39.7
$31.0
$26.7
$30
$23.2
$25
$20.0
$20
$12.1
$15
$11.8
$11.1
$12.1
$13.0
$11.3
$10
$5
$0
2001
2002
2003
Private $
2004
2005
2006
Public $ (Fed & State)
8
Source: CMS National Health Expenditure Fact Sheet
Reliance on Medicaid CHHA Funding in New York has Grown
Significantly Since the Implementation of Medicare Reforms
60%
Balanced
Budget Act
August 1997
50%
55.6%
Prospective
Payment System
October 2000
50.2%
48.4%
46.9%
41.2%
49.7%
40.6%
40.4%
?
38.1%
40%
33.3%
30%
1996
1997
1998
1999
2000
2001
Medicare % Share of Revenue
2002
2003
2004
2005
2006
Medicaid % Share of Revenue
9
Source: Department of Health ~ Bureau of Long Term Care Reimbursement ~ Cost Reports
New York Certified Home Health Agency Reported Patient Revenue by Payer
Average Annual Growth in NY Medicaid Spending
Per CHHA Recipient has Increased 14.1%
Medicaid Expenditures Per Recipient Certified Home Health Care Services
2003
2004
2005
2006
% Change
2005 to
2006
Statewide
$8,212
$8,991
$10,307
$12,193
18.3%
14.1%
New York City
$11,865
$13,174
$15,346
$18,184
18.5%
15.3%
Suburban NYC
$3,519
$3,773
$3,982
$4,171
6.2%
5.8%
Upstate Rural
$2,297
$2,454
$2,415
$2,724
12.8%
5.8%
Upstate Urban
$3,516
$3,711
$3,623
$3,917
8.1%
3.6%
Source: Department of Health DataMart
Average
Annual
% Change
10
New York City ~ Hours Per Recipient
has Increased Across All Categories in 2006
Average Hours per Recipient per Week ~
Services Provided by Home Health Aid and Billed by the Hour
Average
Annual %
Change
Beneficiary
2003
2004
2005
2006
% Change
2005 to
2006
Overall
19.4
19.8
19.1
25.0
30.9%
8.7%
Seniors
21.0
21.4
20.7
27.6
33.3%
9.4%
Adults
15.6
15.8
14.8
18.0
21.6%
4.8%
Children
23.9
24.4
21.8
25.9
18.8%
2.7%
Source: Department of Health DataMart
11
Small Number of Providers Account for the 14.3%
Annual Average Increase in Expenditures
What is
Driving the
Increase?
Bold Italics: Top 10
Providers Highest
Expenditures
Source: Department of
Health DataMart
2006 Expenditures of New York City CHHA Medicaid Providers
2003
2006
Average Annual
Percent Change
Total
638,340,095
954,052,323
14.3%
A
22,849,003
142,367,583
84.0%
D
5,717,056
50,775,511
107.1%
E
33,393,182
66,153,796
25.6%
G
1,307,019
31,106,504
187.6%
I
2,733,926
40,525,569
145.7%
L
12,076,587
37,086,454
45.4%
M
16,227,242
26,380,005
17.6%
O
307,792,609
273,972,823
(3.8)%
All Other
236,243,471
285,684,078
6.5%
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Governor’s Long Term Care Bill
„ Begins the reform efforts by:
„ Authorizing aggregate cap approach for Care at Home I/II
„ Addressing key issues related to the Long Term Home
Health Care Program
„ Remove reference to health related facilities while
allowing programs to exceed caps for certain
subpopulations if allowed by CMS
„ Extend reassessment period to 180 days
„ Create equity statewide by assuring all available waiver
services are provided
„ Authorize demonstrations to develop alternative methods of
program administration related to assessment and care plan
development
13
Governor’s Long Term Care Bill
„ Expand the focus of the Long Term Care
Insurance Education and Outreach Program
beyond insurance
„ Allow income protection for the New York State
Partnership Plan
„ Require external appeals for long term care
insurance
„ Require insurers to promptly pay claims (20 days
with electronic submission and 45 day by other
means)
14
LTHHCP Data
NYS Medicaid Expenditures and Utilization for LTHHCP
Service Date: Calendar Year 2006 and 2007
Medicaid Expenditures
Calendar
Year
All Services
Waiver
Services
Non Waiver
Services
Unduplicated Recipient Counts
All
Waiver
Services Services
Non
Waiver
Services
2006
$634,518,195 $33,984,767 $600,533,428
27,603
22,573
27,076
2007
$632,035,069 $32,921,590 $599,113,479
26,265
21,714
26,041
Source: NYS DOH/OHIP Datamart (based on claims paid thru 4/2008)
Questions: Contact Woopill Hwang @518-473-2230.
15
Home Care Technical Advisory Council:
Evaluate and make recommendations related to:
„ The relevancy of Article 36 PHL and its implementing
„
„
„
„
regulations;
The availability of needed services to New Yorkers
regardless of where they live;
The role of technology in expanding services and reducing
costs;
The development of quality indicators that can be reported
publicly and that are related to desired outcomes in health
status; and
Reimbursement methodologies to evaluate appropriate
incentives
16
Principles to Guide Approaches to Reform
for 2009 and Beyond
„ Support and enhance family care giving resources
„ Increased consumer choice and control for older individuals, persons with
„
„
„
„
„
„
„
disabilities, and chronic illness.
Ensure access to an appropriate array of home and community based long
term care supports and institutional care when necessary.
Reduce costs and promote payment mechanisms that support and reward
better performance
Encourage personal planning for long term support needs among
individuals and their family members – including greater awareness of
private sources of funding.
Reverse the institutional bias in Medicaid eligibility.
Enhance quality measurement to enable the provision of high quality long
term care in the setting most appropriate for an individual’s needs.
Improve coordination of long term care and post acute care services.
Utilize enhanced health information technology to better inform
beneficiary choices, clinical decisions, payment and care coordinate
functions
17
Reform Options
1) Value for Participants and Payer
„
„
Payment reform to move towards performance-based and episodic reimbursement
Development of uniform data sets and assessment tools
2) Support/Enhance Care in Community Settings
„
„
„
„
„
„
Cash and Counseling
Home Care Licensing & Certification Changes
Balance nursing home bed need methodology to support care in community
NYConnects -What are the next steps?
Significantly increase caregiving resources
Expansion of non medical programs (EISEP, Adult day care) – Build on 2008
Budget
3) Enhance Options to Increase Personal Planning for LTC Needs
„
„
„
Expand LTC Partnership coverage
Medicaid eligibility reform
Increase supportive housing opportunities
18