2016 Budget and Legislative Agenda
CDPAANYS 2016 Budget and Legislative Agenda
Consumer Directed Personal Assistance (CDPA) is a rapidly growing and integral part of the community based long term supports and services system, different from traditional community-based long term services in that it gives primary control of the everyday operation of the service to the consumer instead of an agency. The consumer is responsible for recruiting, hiring, training, supervising, and if necessary, terminating his or her own workers. This level of control provides the consumer with a degree of independence to consumers and cost-effectiveness for the state that more traditional models cannot match.
Over the past several years, the state and managed care companies have relied on CDPA to provide high quality services for less money, allowing the state to meet its goals related to the Medicaid Spending cap, and allowing plans to maximize their capitation rate. Despite this, CDPA has not received the funding or protection necessary to maintain its core infrastructure.
CDPAANYS proposes the following agenda in order to protect, maintain and grow CDPA and protect the consumers who rely on the service.
Protect CDPA by funding the minimum wage increase and rationalizing reimbursement –Stagnant reimbursement and cuts, combined with steadily escalating costs for worker’s compensation, unemployment and payroll tax obligations are threatening the fiscal viability of CDPA, even as it saves Medicaid millions per year. Compounding this, the current lack of funding for the minimum wage increases is worsening the debilitating funding gap for many fiscal intermediaries (FIs), posing a $35 million gap in funding in 2016-17 alone. Without taking immediate steps to address these shortfalls, CDPA will not survive to transition to the new healthcare economy DOH envisions.
- Any change to the minimum wage must be fully funded.
- Reimbursement rates must be rationalized and account not just for minimum wage increases; but also for reimbursement that has steadily fallen. This includes rebasing the fee-for-service rate and ensuring that managed care plans adequately reimburse providers for services in a timely manner.
Overtime and travel must be fully funded – Overtime and travel costs under the Fair Labor Standards Act must fully funded in order to prevent a crisis in continuity of care. Since consumers, not fiscal intermediary providers, hire and schedule workers, CDPA is in a unique position in relation to this topic that traditional agencies do not face. The proposed budget includes a 50% cut in funding from the 2015-16 budget as it relates to funding for overtime and travel in CDPA, as $0.34/hour across CDPA accounts for approximately $10 million of the $20 million that was allocated last year. Compounding this problem is that last year’s funding has been promised but not delivered.
- The State must develop a rate for both overtime and travel within CDPA.
- Until the new rate can be approved, the Department must fully fund overtime and travel with a stop-loss pool payable to providers based on costs.
Fiscal Intermediaries must be certified – The increasing popularity of CDPA has led many to provide the service without understanding it. This has led to organizations that use the lack of programmatic requirements in CDPA to circumvent existing legal requirements in home care while also leading a “race to the bottom” in worker reimbursement. This lack of understanding leads to a potentially dangerous situation where consumers and workers are exploited as unscrupulous agencies that do not know the program create a legalized scofflaw home care system.
Create a high-needs rate cell in managed long term care – The adequacy of a capitated benefit is key to adequate reimbursement from the plan to the provider. Without a high-needs rate cell, plans are forced to spread risk across a wider spectrum, and the capitated rate cannot possibly account for the variation that occurs. To more accurately capture the costs associated with individuals in need of live-in or continuous care, and to prevent “cherry-picking” low need individuals in the managed long term care system, the state must create a high-needs rate cell to differentiate between groups.
Utilize a statewide workgroup to reduce workforce shortage, with immediate funding – The NYS Departments of Health and Labor should work together to conduct ongoing labor market analysis to ensure a sufficient workforce throughout the state. This analysis would include an examination of the wages needed to recruit and retain the home care workforce, including personal assistants, essential to the achievement of New York’s Medicaid Redesign. Workforce capacity should be evaluated and steps should be taken to mitigate the growing shortages.
Include CDPA under Paid Family Leave – The State has committed to offering 12 weeks of Paid Family Leave to employees who pay into it. As written in the budget, however, paid family leave is available for employees whose family members are receiving services from licensed medical professionals only. This would exclude CDPA consumers’ family members from the paid family leave benefit, as workers in CDPA are not licensed.
Restore spousal refusal and enhance the spousal resource allowance – The ability of a spouse to refuse to bankrupt him or herself to pay for the long-term care of his or her spouse is an essential part of keeping people in the community. It serves a triple aim of allowing the individual to receive the services needed in the community; saving Medicaid money in the long-term by increasing the amount of time the spouse can remain off Medicaid when they need benefits; and protecting the dignity of marriage by preventing needless separations. Additionally, the resource allowance serves these same needs, and should be enhanced rather than cut.
Enforce managed care plan education on CDPA – Managed care plans are required to offer CDPA to all members who are eligible for a nursing home level of services, but it is clear that plans have dramatically different ideas as to what CDPA is and how it is run. To ensure programmatic uniformity, the state should mandate plans undertake an education initiative to ensure care managers and social workers fully understand the program.
CDPAANYS is the only organization whose sole mission is to represent the interests of Consumer Directed Personal Assistance and represents 23 fiscal intermediaries, over 11,000 consumers, and more than 20,000 personal assistants statewide. For more information, visit us online at http:www.cdpaanys.org, or call at 518-813-9537.