HOME CARE and
the OLTC
Mark Kissinger, Deputy Commissioner
Office of Long Term Care
New York State Department of Health
October 27, 2009
Goals for Home Care 2010
and Beyond
¾ Better utilization of State resources
¾ Improve quality of care
¾ Rationalize reimbursement system
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Organizational Changes in
OLTC / DHCBS
ƒ Mary Ann Anglin, Division Director
ƒ Lydia Kosinski, Director Bureau of
Medicaid Waivers
ƒ Rebecca Fuller-Gray, Director Bureau of
Quality Assurance, Surveillance and
Licensure
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UNIFORM ASSESSMENT
TOOL (UAT)
ƒ $5 million in 2009-2010 SFY budget to
support the creation of an automated,
statewide assessment instrument (UAT)
for DOH home and community based
programs.
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A Uniform Assessment
Tool will:
ƒ Evaluate patient care needs.
ƒ Generate care options for consumers.
ƒ Provide consistency within regions and
among programs with respect to the
assessment process.
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Background
ƒ Current assessment tools are often used
simply because they were available and
familiar.
ƒ None of these tools have assessments
based on empirically tested and validated
means.
ƒ Several of our current tools are being
challenged regarding their validity.
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Why NYS needs UAT
ƒ Multiple tools for service eligibility and
screening: 12 or more used in LTC.
ƒ Lack of standardization.
ƒ Not tested for validity and reliability.
ƒ Assessment fatigue.
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Goals for the UAT
¾ Assessments are uniform from program to
program and region to region.
¾ Assessment is based on validated means.
¾ The results of assessments are useful to
developing care plans.
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The Chosen Tool Will:
ƒ When fully implemented, provide assessment for all
LTC programs and services with minimum duplication
and maximum consistency.
ƒ Determine eligibility for nursing home level of care.
ƒ Offer consistency of data to all LTC settings.
ƒ Assess functional and clinical needs through
empirically tested and validated means.
ƒ Improve quality and consistency in assessment and
care planning.
ƒ Provide information for state policy making and
oversight.
ƒ Support values of the Omstead decision.
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Important Features of
Implementation
ƒ The tool will be web-based.
ƒ Training on the use of the tool will be
provided to all assessors.
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Implementation Plans
ƒ Stage 1
ƒ Implement over a subset of programs
ƒ Implement over a subset of geography
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Why the Home Care
Registry?
ƒ Required by Chapter 584 of Laws of
2008
ƒ Ensure suitability of HHAs and PCAs
ƒ Properly trained
ƒ Approved for employment
ƒ Protect vulnerable New Yorkers
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Aides in Registry:
11,087 as of 10/26/09
12000
10000
8000
Aides in
Registry
6000
4000
2000
10/23/2009
10/16/2009
10/9/2009
10/2/2009
9/25/2009
0
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Help Desk
Help Desk
Phone Calls
10
/2
3/
20
09
10
/1
8/
20
09
10
/1
3/
20
09
10
/8
/2
00
9
10
/3
/2
00
9
9/
28
/2
00
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Emails
9/
23
/2
00
9
9/
18
/2
00
9
450
400
350
300
250
200
150
100
50
0
YTD incoming calls: 1,754; 733 emails
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How do we support you?
¾ Help desk toll-free number & email
¾ User manual available by Thanksgiving
¾ Quick Tips
¾ FAQs regularly updated
¾ Training – onsite & webinar
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Quality Improvements
within HCR
Communication:
provider organizations, training programs, and
state agencies
Functionality:
enhancements to system performance
Usability:
increase user functionality
Reports:
management & user reports
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Home Care Reimbursement
Workgroup
ƒ Report by December 1, 2010
ƒ Issues identified include:
ƒ Outlier policy
ƒ Level of funding
ƒ Subcontracting/Transparency
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Flu Vaccine Mandate
Update
ƒ October 16: A judge issued a temporary restraining
order regarding the mandatory healthcare worker
vaccination regulation.
ƒ October 22: The Governor announced that the State
Health Commissioner suspended the mandatory
vaccination of healthcare workers for both H1N1 and
seasonal flu due to the inadequacy of the supply of
these vaccines.
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State Budget Situation
ƒ Majority of states saw record tax revenue drop during
second quarter. (Rockefeller Institute, October 2009)
ƒ New York hit hardest by Wall Street downturn: 20% of
state’s revenues come from Wall Street.
ƒ In New York State, revenues down over 36% for the
last 3 months.
ƒ For this fiscal year, New York State has a $3 billion
budget gap.
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First Quarter 2009-2010
Revenue Data
• General Fund personal income tax collections
declined by $4.2 billion or 35% to $7.7 billion.
• General Fund sales and use tax collections
declined by 6 percent to $2.6 billion.
• Declines are unprecedented, exceeding
declines following 9/11 and recessions of the
1980s and 1990s.
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Budget Reduction
Proposals
ƒ Governor’s plan closes this year’s budget gap and
addresses long-term structural deficit.
ƒ Proposed spending reduction plan spreads the pain
without increasing taxes.
ƒ Current year reductions: $1.8 billion; $500 million
administrative agency spending cuts and $1.3 billion
cut resulting in a 10% across the board reduction in
local assistance spending.
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Next Steps
ƒ 2009-2010: DRP actions debated in
legislature.
ƒ 2010-2011: Every program being
reviewed.
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QUESTIONS?
Contact:
Mark Kissinger
Deputy Commissioner, Office of Long Term Care
New York State Department of Health
[email protected]
518-402-5673 (phone)
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