{"id":5217,"date":"2022-03-23T19:31:18","date_gmt":"2022-03-23T19:31:18","guid":{"rendered":"https:\/\/melodybenefits.com\/?p=5217"},"modified":"2022-06-08T20:48:22","modified_gmt":"2022-06-08T20:48:22","slug":"nys-lhcsa-rfo-advice-and-advocacy","status":"publish","type":"post","link":"https:\/\/melodybenefits.com\/nys-lhcsa-rfo-advice-and-advocacy\/","title":{"rendered":"The Impending NYS LHCSA RFO: Advice and Advocacy"},"content":{"rendered":"
\u201cWe\u2019re still dealing with the tremors from the first earthquake\u2014yet the ground is opening up again with a new seismic shock.”<\/span><\/p>\n <\/p>\n So says <\/span>Roger Noyes<\/span><\/a>, <\/span>recent past <\/span>Director of Communications at the <\/span>Home Care Association of New York State<\/span><\/a> (HCA-NYS). He\u2019s referring to the upcoming Licensed Home Care Services Agency Authorization Process, a.k.a. the LHCSA RFO.<\/span><\/p>\n <\/p>\n Delivery of managed and non-managed care services in NY is always a shifting field. With varying degrees of success, the legislature tries to balance the (often conflicting) needs of patients, agencies, home healthcare aides, Medicaid budget, and the government\u2019s administrative burden.\u00a0<\/span><\/p>\n <\/p>\n And given the complexity of the system, lawmakers may be voting on changes without fully anticipating their implications.\u00a0<\/span><\/p>\n <\/p>\n The twin stories of the FI (Fiscal Intermediary) and LHCSA RFOs highlight the inconsistencies in the state\u2019s design and oversight of the system. Even more importantly, they underscore the need for advocacy by home healthcare agencies<\/a> and FIs.<\/span><\/p>\n <\/p>\n Noyes encourages both FIs and LHCSAs to reach out to their legislators about the RFOs. To help, he outlines four clear talking points. But first, let\u2019s review a brief history of how we got to where we are today.<\/span><\/p>\n <\/p>\n TL,DR: Click here<\/a> to skip the background and go straight to the recommendations.<\/span><\/i><\/p>\n <\/p>\n In 1992, New York introduced the Consumer-Directed Personal Assistance Program (CDPAP). CDPAP empowers patients receiving Medicaid-certified home care to hire and manage their caregivers.\u00a0<\/span><\/p>\n <\/p>\n Noyes explains that CDPAP benefits consumers in two ways:<\/span><\/p>\n <\/p>\n Medicaid pays the CDPAP caregivers through FIs who handle administrative and other responsibilities for the consumer and personal assistants. An FI can be a stand-alone business or also a LHCSA.\u00a0<\/span><\/p>\n <\/p>\n Experts estimate that up to 90% of FIs are also LHCSAs.<\/span><\/p>\n <\/p>\n By 2019, there were 600 licensed FIs in New York State. In its ongoing efforts to control Medicaid spending and increase efficiency, the legislature made a move to limit that number:<\/span><\/p>\n <\/p>\n The DOH (Department of Health) issued an RFO, Request for Offers, for all FIs who wanted to continue serving as CDPAP contractors.\u00a0<\/span><\/p>\n <\/p>\n While the DOH\u2019s goals were understandable, the RFO raised serious concerns. \u201cWe\u2019ve found that the process was lacking in transparency. What were the standards for which FIs are in and which are out? Many quality FIs with years of experience didn\u2019t get the award,\u201d says Noyes.<\/span><\/p>\n <\/p>\n In fact, in February 2021, <\/span>the state awarded less than 70 FIs<\/b> to be lead FIs, contracting directly with Medicaid. The other hundreds of FIs can only operate as collaborating partners, sharing their patients\u2014and profits\u2014with the lead FIs. Many FIs can\u2019t run a viable business with that model.<\/span><\/p>\n <\/p>\n The opacity of the FI RFO process is heightening industry concerns over the all-too-similar impending LHCSA RFO. While the DOH hasn\u2019t yet started the process, the intent is clear:\u00a0<\/span><\/p>\n <\/p>\n Limit the number of LHCSA just as it limited the number of FIs.<\/b><\/p>\n <\/p>\n There\u2019s pushback both from industry groups and within the legislature. For example, in March 2021, Assembly Health Committee Chairman Richard Gottfried introduced a bill to repeal Section 3605-c and introduce a second FI RFO for non-awardees. Senator Rachel May introduced a companion bill in the Senate.<\/span><\/p>\n <\/p>\n Although the FI RFO bill was not included in the final budget, there was a bright spot. As a compromise, <\/span>the NYS 21-22 budget<\/span><\/a> permits the DOH to make additional FI awards, based on a two-step process.\u00a0<\/span><\/p>\n <\/p>\n First the DOH will survey all FIs to determine:<\/span><\/p>\n <\/p>\n <\/p>\n Based on the survey responses, the DOH will make additional FI awards. The language allows for the DOH to add anywhere from 24 to more than 40 new awardees.\u00a0<\/span><\/p>\n <\/p>\nCDPAP<\/b><\/h2>\n
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FI RFO<\/b><\/h2>\n
LHCSA RFO<\/b><\/h2>\n
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