How New York LHCSAs Can Thrive Under the 2018-2019 State Budget

11-06-2018
Desmond Martinez


This post is brought to Viventium by Desmond Martinez, Director of Business Development, at HHAeXchange

New York State’s recently passed state budget has been a big topic of discussion in the home care industry since it was passed earlier this spring. In an already competitive industry, the 2018-2019 budget has several new provisions that will have a significant impact on licensed home care services agencies (LHCSAs). In this post, I’ll outline the key changes New York agencies need to be aware of and the ways that agencies can differentiate themselves and thrive in this new environment.

Two-Year Moratorium on New LHCSAs

The 2018-2019 budget established a statewide freeze on the licensing of new LHCSAs for two years, starting April 1, 2018 and ending March 31, 2020. This moratorium comes on the heels of frequent national reports forecasting a shortage of home health aides and an increased desire for home care services over traditional hospital care. However, there are a few exceptions in which agencies can apply for a new license:

  1. Applications submitted as part of an Assisted Living Program (ALP)
  2. Transfer or change of ownership of an existing LHCSA that has been in business for five years
  3. Establishing a LHCSA where the applicant demonstrates there is a lack of access to home care services in a geographic region or lack of adequate care

You can get more details on the specific exceptions on the New York State Department of Health website.

Managed Long Term Care Plan Contracting Limits

Effective October 1, 2018, managed long-term care plans (MLTCs) must limit the number of LHCSAs they contract with. The formula for these limits is tied to a few different factors, such as MLTCP region and number of enrollees.

For New York City, Nassau, Suffolk, and Westchester counties, the new ratio is one LHCSA per each 75 enrollees. For the rest of the state, the ratio is one LHCSA per each 45 enrollees.

These contracting limits mark a notable shift away from previous policy that encouraged more managed care enrollment. As a result, we’re predicting more market consolidation as agencies merge or get acquired.

Cost Reporting

The Commissioner of DOH will require LHCSAs to report costs incurred in providing health care services to Medicaid beneficiaries. Once a LHCSA receives notice from the Commissioner, they will have 90 days to provide the required report, and an additional 30 days to correct any inaccuracies identified by DOH. A 30-day extension may be granted by DOH if, for reasons out of its control, any LHCSA cannot submit the report by the designated date.

Preparing for Change

It’s no surprise that New York LHCSAs have a lot on their plate in preparing their businesses for these changes. While some agencies will undergo consolidation, others will turn these challenges into an opportunity to thrive.

In order to grow your business in New York’s new homecare environment, LHCSAs need to focus on improving patient outcomes and instituting quality metrics to measure their progress.

We recommend focusing on 3 key initiatives:

  1. Empower your aides to create real-time interventions to improve outcomes

With the right tools and software, you can enable better care at the point of visit. Now that most aides have smart phones, you can prompt aides with patient-specific questions and collect these answers in order to stay up-to-date on the status of patient progress. Plus, with the right software, you can enable real-time interventions and involve nursing staff when needed, resulting in early identification of changes in patient condition and reducing the risk of avoidable accidents.

  1. Maximize efficiencies and implement outcome-based strategies company-wide

Proving value is a challenging undertaking on top of the day-to-day workflows necessary to run a successful home care business. Automating key business functions, like overtime management, billing audits, and care compliance plans, will not only free up time and ensure accuracy – it will also allow more effective reporting, resulting in better opportunities to show value for providers and payers.

  1. Establish quality metrics that help differentiate your agency when contracting with MLTCs

With built-in reporting and BI tools, you can automatically track the quality metrics that correlate with improved patient outcomes. Additionally, you can stay on top of exactly how much you are billing and always be prepare for any cost reporting requests that come in from the DOH.

To learn more about how you can deliver better value-based care and report on your quality metrics, visit HHAeXchange.

Desmond Martinez is HHAeXchange’s Director of Business Development. Desmond has more than 15 years of experience in the healthcare/home care software space, with a strong focus on the New York market for the past decade. HHAeXchange is New York’s leading home care management software partner, helping LHCSAs deliver value-based care and achieve operational efficiencies.

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