Development of protocols for issuance of LLHCSA licenses, completed in
The first program was fully approved, licensed and enrolled in the MMIS payment system in March of 1999. There are currently 32 programs licensed. Appendix A contains a list of the 32 currently licensed programs, as well as whether or not each program became a LLHCSA as a conversion program.
As of January 2005, Medicaid claims had only been received from 14 of the licensed and operational providers. One of these providers closed in May, 2004 but we have included their data in the following analyses. Claims had been received for 183 Medicaid recipients across these 14 providers. Expenditures from 1999 until November 2004 for personal care and RN services totaled $1,316,417 or $7,194 per recipient. Although the number of recipients receiving these services is relatively small it does allow for some initial analysis of data.
Some issues that have been identified by provider groups and other interested parties may represent barriers to the expansion of the program. These include:
No Cost of Living Adjustment (COLA). The rates were set in late 1997 and there is concern by providers that these levels have not kept pace with inflation or with the major increase in home care provider wages given workforce-driven rate enhancement and development of living wage laws in several local jurisdictions.
Denial of personal care services under the LLHCSA. The LLHCSA statute allows for authorization of personal care services “provided, however, that the services provided by such agency are not services that must be provided to residents of such facilities pursuant to article seven of the social services law and rules and regulations of the department of social services” This refers to two sets of regulations:
Those governing the operation of an adult home which include the provider’s responsibility with regard to personal care as follows: “Personal care functions shall include direction and some assistance with grooming…dressing, bathing, toileting; walking and ordinary movement from bed to chair or wheelchair, eating, taking and recording weights monthly and assisting with the self administration of medications…” (487.7(e)(2)(I-viii), social services regulations).
Those governing the Personal Care Program (505.14(a)(2)(I-ii)) which were written for home care services provided in the single site setting and make a distinction between an individual’s need for “some assistance” and “total assistance” with a personal care task as follows:
Some assistance shall mean that a specific function or task is performed and completed by the patient with help from another individual;
Total assistance shall mean that a specific function or task is performed and completed for the patient.