2018 Budget and Legislative Agenda

 

 

 

Click here to download the 2018 Legislative Agenda as a PDF file.

Consumer Directed Personal Assistance (CDPA) is a 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. 

CDPAANYS proposes the following agenda in order to protect, maintain and grow CDPA and protect the consumers who rely on the service.

Reform Managed Care to Protect Equitable Reimbursement and Ensure Quality Care – Since 2011 and the shift to managed care, average reimbursement to fiscal intermediaries (FIs) has fallen to an average of $19.75 per hour. In the past year, major managed care organizations (MCOs) and managed long term care (MLTC) plans, have reduced reimbursements by $1-3 per hour. This is in spite of dramatic increases in worker’s compensation (over 75% increase in the last four years), unemployment insurance, taxes, and the general cost of doing business. These decreases were not even fully reversed when the State implemented “wage parity” in New York City, Long Island, and Westchester. Some plans, including the largest MLTC plans, did not reverse their cuts at all. These reductions are placing the future of the program in jeopardy, as they are forcing reductions in already low wages and are counteracting any investments made to offset the costs associated with changes to the Fair Labor Standards Act or the Minimum Wage.

  • Managed care must be reformed to ensure that MCOs take into account adequate wages and other costs of doing business such as worker’s compensation, unemployment insurance, and more. Within traditional home care, the state utilizes a QI-VAPP pool to incentivize plans to adequately reimburse providers. CDPA has access to QI-VAPP in statute; however, no funding exists for a similar incentive through this program. This basic step will ensure reimbursement is sufficient to drive wage increases, particularly in wage parity regions.
  • The State must ensure reimbursements are sufficient to provide wages that attract a high quality workforce to meet the needs of this rapidly growing industry. PAs earn less than any other industry, including fast food, retail, and their peers in developmental disabilities. FIs strive to pay higher wages; however, falling reimbursements have in many instances forced wage cuts. To allow for higher quality care and better continuity of care, reimbursements must be increased through fixes to the direct care ceiling, alternative payment methodologies, and better oversight of managed care.
  • The State must equalize reimbursement as required by Community First Choice and ensure that the rates are honored. The State was required to take this step two years ago yet has still failed to do so. This would equalize rates between CDPA ($17.41/hr), personal care ($20.21/hr) and community habilitation (average $39.25/hr., multiple rates), as identified in the State Plan Amendment.
  • The State must recognize its ultimate responsibility: equitably funding capitation rates for MCOs to ensure they can properly reimburse FIs. This includes the creation of a high-needs community rate cell to more appropriately mitigate risk and provide appropriate reimbursement. Such changes must be attached to more stringent oversight of reimbursement of downstream providers, including FIs.
  • The State must address the workforce shortage. This must determine ways in which to capture the availability of home care aides and personal assistants in the community. It must also create a workgroup to determine an equitable wage level that will allow the industry to attract and retain a quality workforce, along with the reimbursement that is necessary to provide that wage.


Community First Choice must be properly implemented and the funds redirected to community-based services – The State has committed to the Community First Choice Option (CFCO), which enhances services available to consumers in the community and provides the state with an extra 6% in Federal matching funds. This extra funding, which amounted to over $250 million in 2016-17, must by law be reinvested back in community based services; however, right now it is merely replacing funds that are being distributed elsewhere. The intent of this law must be followed. These funds exist outside the Medicaid Global Cap and must be used to supplement existing Medicaid funding for community-based programs.

Increase the transparency of the Medicaid program to allow access to critical data important to monitoring use of the program – CDPA is growing rapidly; however, it is unclear just how rapidly. The Department of Health must make information readily available as to the number of people using CDPA, the average number of hours they are using, and the plans with which they are affiliated. The information should then be broken down by plan. This information will help consumers as they shop for plans, informing them as to the plans that are most receptive to CDPA and self-direction. It will help policymakers and advocates as they seek to analyze current policies, examine compliance with Olmstead and the Department’s progress implementing the Governor’s Olmstead plan, and develop new program options and alternatives.

Establish a budget authority model for self-direction – Since its inception, CDPA has effectively saved the State money while providing quality of care and control for consumers. Budget authority, demonstrated effective within the Office for People with Developmental Disabilities and other states, represents the next step to complement CDPA and serve as another option to increase self-direction.

Expand CDPA beyond Medicaid – Currently, only those on Medicaid have access to CDPA. While those in the Enhanced In-home Services for the Elderly Program (EISEP) have access to a modified version of CDPA, the increasing number of middle-class seniors and individuals with disabilities are excluded from this program. Extending CDPA to other models or expanding access to public long-term care measures, would extend these individuals time off Medicaid, increase their independence and enhance their dignity while also lowering the costs associated with long-term care insurance and enhancing the stability of this model. 

Establish a Care Management Bill of Rights – The State transferred individuals to managed long term care on the premise of “care management for all.” However, five years later, care management has no clear definition, and the implementation of this standard has been highly inconsistent. Some consumers do not have direct access to their care manager, while others report caseloads as high as 200 or 300 individuals per care manager. To meet the original goals of care management for all, the State must establish clear guidelines for care management and ensure consumers are informed of what they can expect.

Extend the Medicaid Buy-In for Working People with Disabilities to retirees over 64 – The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) was highly effective at helping people with disabilities enter the workforce. Now, as these individuals age and seek to retire, they realize that their efforts to create a savings through their time in the workforce only serves to penalize them. Their Medicaid benefits, which they heavily rely on, are dependent on them being in the workforce and under 65. This is discriminatory and against society’s goal of encouraging saving for retirement and should be fixed.

Enact meaningful campaign finance reform – Increasingly, the voice of seniors and people with disabilities is lost in a political environment dominated by those who donate tens, or hundreds, of thousands of dollars to campaign and “housekeeping” accounts. The only way to restore faith in the government and the voice of those who have been disenfranchised is to remove this money from the system.

CDPAANYS is the only organization whose sole mission is to represent the interests of Consumer Directed Personal Assistance and represents fiscal intermediaries, consumers and their personal assistants. For more information, visit us online at http:www.cdpaanys.org, or call at 518-813-9537.

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