Claims data in the nine counties containing the LLHCSAs were examined for 1997 (the two years prior to any implementation) and compared to 1999 when there was minimal implementation and the period of full implementation (2001 and 2003, the latest available data). Table 4 illustrates that total personal care expenditures rose steadily between 1997 and 2001, but dropped in 2003 to approximately 1997 levels. The number of personal care recipients in adult homes in these counties also dropped between 2001 and 2003. The personal care expenditures per recipient rose between 1997 and 2001 but have dropped to less than 1997 levels by 2003.
Limitations of the Evaluation
These data, although showing some trends in cost and utilization, should be interpreted with caution.
Only 14 programs and 183 individuals have participated in the LLHCSA program for the entire 6 years in which the program has been in existence. The number of program participants is very small and geographically restricted (upstate and a single Long Island County).
It was only possible to match the comparison group to the LLHCSA group by service utilization (the utilization of personal care services in an ACF at some point during the period), and region (upstate and a single downstate county) using the claims data. No case mix adjustment based on recipient clinical characteristics or diagnosis was possible.
There were five questions which were legislatively mandated and guided the evaluation of the LLHCSA program.
1. The total number of hours provided by and individuals served by limited license home care services agencies.
Since the program began in early 1999, claims data indicate that only 183 individuals have made a limited license claim (as identified by rate codes 2412, RN nursing services, and 2413, personal care services). These individuals have accounted for approximately 121,468 hours of service, as defined by the rate codes delineated above, or an average of approximately 664 hours of service per recipient.
2. The kinds of services provided by limited license home care services agencies.
Claims data indicate that the 183 limited license recipients received a wide array of health services during the period that they were in the limited license program. These recipients received a total of 23 services, and these services are listed in Appendix B. At least one LLHCSA recipient made at least one claim in each of these categories while they were a limited license recipient.