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New York State Center for Assisted Living
November 14, 2013
Carla Williams
Frank Rose
Shelley Sabo
• Chapter 165 of the Laws of 1991
• Address OBRA 87 changes that eliminated Health Related Facilities and beds in Nursing Homes
• Address growing desire to age in place in congregate setting of adult home
• “Program”= add services to existing structures
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• An entity which is approved, established and operated for the purpose of providing long term residential care, room, board, housekeeping, personal care, supervision, personal care, case management and providing or arranging for home health services to five or more eligible adults unrelated to the operator.
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• Medicaid Payment is based on assessment of participant and related to the RUGS system
• Medicaid program is approved under the State Plan Amendment for Personal Care Services
• Contract with Local Social Services District indicates ALP as provider of personal care services as well as providing program oversight
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• First need identified in 1993: 4200 beds
• Chapter 58 of the Laws of 2009: included an additional 6,000 beds linked to the decertification of RHCF beds
• Chapter 56 of the Laws of 2012: removed the requirement that RHCF bed decertification be linked to the 6,000 ALP beds
• Chapter 56 of the Laws of 2013: authorized the approval of 4,500 additional beds beyond those determined available as of April 2012 for certain adult homes.
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Authorizations for ALP Beds
1993 2007 2009 2012 2013 Total as of 9/2013
Number of New Beds Authorized
4200 1500 6000 0 4500 16,200
Number Approved 3800 1986 1282 1320 ??? 8,388
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Beds in operation as of June 2013: 6,679
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ACF/EH
LHCSA
ALP
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ACF/EH
CHHA
ALP
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ACF CON
LEGAL
ARCH
NEEDCHAR
& COMP
FIN$
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PART ONE APPROVAL
REGIONAL OFFICE REVIEW
PART TWO APPROVAL CON APPROVAL
Two Step Process:
1. Submit the ALP 4500 Conversion Initiative for Transitional AHs
2. After receipt of DOH approval to proceed, submit the ACF/ALP and HC CON
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• Identify the Eligible Applicant and Facility• Name, Address, Contact Information, Op Cert # and Legal
• Proposal Summary‒ Assuring resident living skills, choice and confidentiality‒ Access and privacy
• Program Information‒ Capacity/Bed Numbers – Current and Proposed
• Legal‒ Narrative/organizational chart of current and proposed
entity‒ Proof of site control‒ Current Operating Certificate
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• Financial Information
• Projected cost and source of funding (including rehabilitative, architecture and soft costs)
• Architectural
‒ Narrative describing auto sprinklers, smoke and thermal detectors, emergency lighting, fire alarm system, call system, exit lighting, exits and cost of renovation
• Home Care Component
• Proof of existing license/certificate or statement of willingness to obtain licensure/certification
• Notarized Certification/Attestation
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• ALP Application Schedule 1• Fill-in the box information on: Applicant/operating entity Type and Board Members/Members/Shareholders Current certification(s) Location Contracts with LDSS, CHHA or LTHHCP Program configuration Payor Source Current and Proposed Staffing Schedules for ACF and HC
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• ALP Application Schedule 2 - Legal• Narrative description and organizational chart of legal
entity• Proof of ownership or right of access• DBA/Partnership Agreement/Certificate of
Incorporation/Articles of Organization• Resolutions or Authorization Statements• Appropriate purposes language• Related contracts with other service providers• Fill-in the box information on each person with related
organization information and real property interests
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• ALP Application Schedule 3 - Financial• Letter of Commitment for Financing
• Annual Financial Statements/Tax Returns (depending on applying entity) for previous two fiscal years
• Fill-in the box information on estimated total project cost and detailed Personal Financial and Anticipated Personal Income Statements for each proprietor/member
• Projected 12 month Operating Budget
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• ALP Application Schedule 4 – Architectural
• Complete layout of existing building
• Preliminary/Detailed plans for renovation
• Fill-in the box detail on existing and planned building features
• ALP Application Schedule 5 - Character & Competency
• If no new proprietors/members/shareholders or directors, statement that the membership of entity is the same
• Fill-in the box Personal Qualifying Information on any new proprietors/members/shareholders or directors
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• Home Care/LHCSA Application (if not existing)• Fill-in the box information on Service Availability re service
type, method of provision, availability and number of cases
• Fill-in the box information on Estimated 12 month Operating costs
• Fill-in the box information on legal entity, related organizations and character & competency on proprietors/members/shareholders or directors
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• Part 2 – Describe: • Profile of ALP residents
• Pre-admission and admission process inc. staff
• Mandated and facility specific forms to be used
• Proposed weekly staff schedule (for one month)
• Job descriptions for ALP Coordinator, HHA, PCA, LPN & RN
• Clinical supervision of the ALP staff
• Activity schedule
• Diets
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• Changes to:
• Admission agreement
• Grievance policy
• Evacuation and Disaster and Emergency Plan
• Quality Assurance program
• In-service training program for direct care staff inc. possible exposure to body fluids
• Copy of:• Executed contract with LDSS
• Executed contract with CHHA(s) or LTHHCP(s)
• Executed transfer agreement with a nursing home
• Revised Resident Rights
• All policies, procedures and programmatic changes
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• DOH created an ACF Application Streamlining Workgroup in late Spring 2013
• Charge:
To review and analyze current ACF licensure application and approval processes, documents, required information, content and review processes and make recommendations to streamline and simplify the process, while maintaining quality, thoroughness and process to achieve appropriate determinations on applications.
• The Streamlining Workgroup has met monthly.
• Subgroups for Part 1, Part 2, Architectural, Legal and Financial have met on a bi-weekly schedule since June.
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• Streamlined/consolidated existing legal and financial schedules and tables
• Combined the CON Schedule 12 Part 1, ALP and ALR applications
• Revised the format, shortened and eliminated duplicative and unnecessary questions
• Deleted Schedules/information not relevant to ACFs
• Combined, clarified and simplified (9 or fewer bed) increase in capacity apps for ACFs and 5 or fewer bed increases for SN/EALRs
• Created abbreviated apps for Business Conversion and Limited Change in Ownership notices or approval
• Created optional legal certifications and attestations for applicant’s counsel to attest to compliance with routine requirements and identify potentially non-compliant provisions and issues for further review
• Modified financial projections and created attestations for short or abbreviated applications
• Eliminated requests for SS#, bank account #s and other information not utilized for Personal Financial review
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• Created a standard waiver to simplify requests by lenders for restricted account arrangements and assignment/security interests in operational assets
• Created process for submission of Part 2 documents with Part 1 for faster RO review
• Simplified, clarified and centralized application Instructions
• Revised and combined applications for Respite and Day Care and created an improved process for review of those applications
• Created process for early start of construction, at an applicant’s own risk
• Revised and clarified the Architectural Matrix
• Addressed concerns with and streamlined the Architectural Schedule and Certification
• Suggested further statutory and regulatory revisions
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• Purpose:• Expedite review and approval of license applications through the
establishment of a streamlined application process for existing licensed ACF and ALR operators in good standing.
• How:
• In collaboration with industry representatives• Expand upon creative options already developed
• Create the streamlined process
• Make it available for use on or before 1/1/2014
• Existing operators in “Good Standing”• Relates to approval of an additional facility of the
same type• Certification process to verify sufficient financial
resources, revenue and financing• Certification process to verify legal, corporate and
organizational docs comply• Certification process to verify substantial compliance• Conditional approval to operate for limited period w/
commitment to satisfactorily complete the cert. process within that time
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• Conditional approval to construct, at own risk,upon substantial completion of arch. component
• Eliminate duplicative submission and review requirements for any docs submitted, reviewed and approved within the last 2 years
• Create an electronic application submission process• Create a combined application for all ACF facility
types and programs• RO review of program info on-site at pre-opening or
first full annual insp, if DOH approved operator to run same program at another fac within past 2 years
• Insufficient narrative on market need
• Insufficient program description
• Thoroughness of submission
• Management of consultants
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• Eligible person: requires more care and services to meet his or her daily health or functional needs than can be directly provided by an ACF.
• Medically eligible for placement in a nursing home but can be cared for in an ALP. Does not need the institutional setting to have physical needs met.
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• Assessed as having a stable medical condition.
• Take direction and action for self-preservation in an emergency.
• Not in need of continual or medical care.
• Not physically or medically impaired to such a degree that his or her safety would be endangered.
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• Chapter 454 of the Laws of 2013 provides ALP providers the ability to retain residents who are considered chairfast under certain circumstances. Specifically, this new law amends the Social Services Law to include persons who are chronically chairfast to the definition of “eligible person” in an ALP facility. By doing so, the law authorizes an ALP to admit or retain such an individual so long as the facility is staffed to meet the needs of the resident and the individual’s physician approves the placement. The resident must otherwise be in “stable medical condition” and not in need of continuous nursing care. The law requires ALP providers to notify the Department of its intention and capacity to admit and or retain chairfast residents prior to doing so.
• Waiting for DOH guidance.32
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• Medical evaluation within 30 days prior to admission
• Interview between ALP administrator/designee and prospective resident/ family
• UAS
• Mental health evaluation for prospective residents with known history of chronic mental disability or if medical eval/assessment suggests that a disability exists.
• Prospective resident must enter voluntarily and documentation of informed choice
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• Functional Status
• Health Conditions
• Cognition
• Social Support
• Financial
• Mental Health
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• Role of LDSS/CHHA
• ALP Requirements beyond ACF
• Reimbursement and billing
• Assessment/UAS
• Audit and role of OMIG
• Case management
• Workforce
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• The operator is responsible for providing or arranging for resident services which must include, at a minimum: room, board, housekeeping, supervision, personal care, case management activities and home health services.
(b) Services included in the medical assistance capitated rate are:
(1) personal care services which are reimbursable under title XIX of the Federal Social Security Act;
(2) home health aide services;
(3) personal emergency response services;
(4) nursing services;
(5) physical therapy;
(6) occupational therapy;
(7) speech therapy;
(8) medical supplies and equipment not requiring prior authorization; and
(9) adult day health care in a program approved by the Commissioner of Health.
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• If an assisted living program is not a certified home health agency or long-term home health care program, the assisted living program must contract with a certified home health agency or long-term home health care program for the provision of nursing and therapy services. An assisted living program may contract with more than one certified home health agency or long-term home health care program.
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• Must have contract with LDSS for payment
• NYC ALP operators contract directly with NYSDOH
• Contract represents approval for the ALP to provide, and receive Medicaid payment for, services.
• Post-admission admission audits for eligibility and appropriate placement.
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• Adult care facility regulations (487.7 Resident Services)
• These are services necessary to support the resident in the maintenance of their independence of function and personal choice.
• Formal documentation of case mgmt needs and activities taken to meet those needs.
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• Initial and periodic assessment, no < 12 mos, change of condition.
• Orientation of resident and family to program
• Transition
• Maintenance of community ties
• Facility and community activities
• Arrangement of services for income, health, mental health and social services.
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• Assistance for income entitlements and public benefits
• PCP for overall management of health (including mental) needs
• Referrals for services (e.g., mental health, dental, meds, discharge, transfer, etc. )
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• Receive referrals for ALP services and provide information about such services to resident
• Refer the ALP applicant to the LDSS for eligibility determination
• Permit access by ALP resident to case records maintained by ALP
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• Establish linkages to services provided by other community agencies, provide information about those services to the ALP resident and establish criteria for referring the ALP resident to the services.
• Achieve economic efficiencies
• Arrange for the reduction or discontinuance of services when the ALP reassessment determines the resident must be reduced of discontinued.
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• Based on initial assessment and periodic reassessments; change of condition; no less than six months
• Any changes must be reflected with in the resident’s personal plan of care
• Plan of care must be updated no less than every six months
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• Staffing requirements
• Staff medical assessments• Flu masks and influenza reports
• Criminal History background checks
• Home Care Services Worker Registry
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• Requirements for qualifications for administration, case managers and personal care aides.
• Personnel credentials under a LHCSA or CHHA must be adhered to
• Operator qualifications: identical to Adult Home administrator or Enriched Housing Coordinator. Must match or be an approved director of the home health program.
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• Case managers• < 50 beds, administrator or home care director may assume case
management functions.• Current RN with one year FT experience• MSW from an accredited university• Bachelor’s degree with major work in human services and one year FT
experience in providing services to an adult dependent population• AA degree, major work in human services, three years of FT experience in
providing services to an adult dependent population.
• ALP > 50 beds, a case manager must be on staff and on duty for ½ hour per week per each additional bed over 50, up to 40 hours per week.
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• Personal Care Aides• ALP must develop and submit a plan to DOH to assure that all staff
assigned to perform personal care functions are trained as required in section 505.14(d) and (e) of Title 10 or successfully complete a basic training program in HHA services or an equivalent examination approved by DOH.
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• Transitional Adult Homes
• Staff exclusion list
• State Central Registry
• Effective 020110 LHCSAs associated with ALP are subject to CHRC.
• Unlicensed staff (HHA, PCA and volunteers) in direct contact with residents or access to resident property are subject to CHRC.
• Home Care Services Worker Registry• Each DOH approved education/training program for HHA or PCS as well as LHCSAs,
CHHAs, and LTHHCPs must request and submit information about the employment history and training of aides into the Home Care Services Registry
• Home care agency accountable for information entered
• Required information must be entered into the registry within 10 business days after a triggering event such as a hire or completion of training.
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• DAL 071713: Prevention of Influenza Transmission by Healthcare and Residential Facility and Agency Personnel
• Effective July 31, 2013
• Applies to LHCSAs
• Requires documentation of influenza vaccination status of personnel
• Requires unvaccinated personnel to wear masks at all times while in resident areas
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• DAL 13-19 Revised Medical Eval for ALP• DAL 13-18 Revised Equivalency List• 071713 Prevention of Influenza Transmission• DHPCO Memo 011413• DAL 060712= Recent Changes to ALP• GIS dated 062812• GIS dated 020911• GIS dated 110910• DAL DRS ACF 09-07 Criminal background checks• DAL HCBC 08-04 ALP DME Claims• Administrative Directive 112202- Hospice
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• Linked to UAS
• Contract with LDSS
• Formulation of ALP rate
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• Rates of payment: direct versus indirect• Direct component
• Nursing administration, activities, social services, transportation, PT/OT/ST, pharmacy, central service supply.
• Indirect component
• Fiscal services, administrative services, plant operations and maintenance, grounds, security, laundry and linen, housekeeping, food services, cafeteria, non-physician education, medical education, housing and medical records.
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• Draft Audit Protocols (042612)• Resident record, assessments and medical evaluation, plan of care, service
documentation, billing, training, immunizations, personnel records, performance evaluations.
• Out-of-date as written in 2012. Geared toward PRI for all of resident sections.
• NYSCAL submitted formal comments.
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• ALP is required to provide residents with all the necessary rights and protections that an adult home or enriched housing program is obliged to provide
• Copy of the resident right’s must be posted conspicuously in a public place
• Each staff member must receive a copy
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• Include but not limited to:• Resident’s civil and religious liberties, independent personal choice shall not be infringed
upon.
• Private communications and consultations
• Right to present grievances without repercussions
• Right to manage own affairs
• Privacy in treatment and care of personal needs
• Confidentiality of personal and medical information
• Courteous, fair and respectful treatment
• Right to receive and send personal mail without interference or interruption
• Responsible for compliance of facility regulations
• Responsible to treat other residents with respect and observe their rights
• Personal version of incidents within the home
• Ability to receive visitors as authorized by resident
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• eFINDS
• HEC
• NCAL Risk Page
• HCS Portal
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Major challenges include:
• Medicaid rates often inadequate.
• Payment for AL incomplete: Housing, food, utilities not covered; SSI check insufficient to fill gap.
• States shifting to managed care for long term services & supports:• # of managed care states rose from 8 in 2004 to 16 in 2012.• By 2014, about half are expected to used managed care for LTSS.
• Many recent federal initiatives tend to exclude assisted living, including CMS’ proposed rules defining HCBS settings.
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By FY 2011, 47percent of Medicaid LTSS spending was on HCBS: CMS
% HCBS v. institutional care expected to continue rising as states respond to consumer demand and public policy initiatives including:
• 1915i HCBS state plan option (12 states)
• State Balancing Incentive Program, offering increased Medicaid federal match to state meeting HCBS expansion targets
• Money Follows the Person grants (>40 states)
• Community First Choice Option under which states can provide HCB attendant services under their state plan with increased federal match (2 states so far)
CMS has published a series of proposed rules intending to enforce Supreme Court Olmstead decision in Medicaid community-based settings.
• Concepts being promoted include: community integration, resident-centered care, home-like settings, and individual autonomy.
• Raises issue of whether assisted living is too institutional in nature.
• Possible consequence: exclusion of AL from Medicaid.
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• In April and May, 2012, CMS published a revised definition of Medicaid HCBS settings in final rule implementing Community First Choice program and proposed rules implementing revisions to 1915i program.
• While improved over 2011 version, the proposed definition still could exclude some AL communities.
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In the latest proposed rules, CMS states:
“…home and community-based settings shall have all of the following qualities, and such other qualities as the Secretary determines to be appropriate, based on the needs of the individual as indicated in their person-centered service plan:
The setting is integrated in, and facilitates the individual’s full access to, the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, in the same manner as individuals without disabilities;
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• The setting is selected by the individual from among all available alternatives and is identified in the person-centered service plan;
• An individual’s essential personal rights of privacy, dignity and respect, and freedom from coercion and restraint are protected;
• Individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact are optimized and not regimented;
• Individual choice regarding services and supports, and who provides them, is facilitated.;
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• In a provider-owned or controlled residential setting, the following additional conditions must be met. Any modification of the conditions, for example, to address the safety needs of an individual with dementia, must be supported by a specific assessed need and documented in the person-centered service plan:• The unit or room is a specific physical place that can be
owned, rented or occupied under another legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law of the State, county, city or other designated entity;
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• Each individual has privacy in their sleeping or living unit:-- Units have lockable entrance doors, with appropriate staff having keys to doors;--Individuals share units only at the individual’s choice; and--Individuals have the freedom to furnish and decorate their sleeping or living units;
• Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time;
• Individuals are able to have visitors of their choosing at any time; and
• The setting is physically accessible to the individual.
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We also plan to propose that home and community-based settings do not include the following:
1) A nursing facility;2) An institution for mental diseases; 3) An intermediate care facility for the mentally retarded;4) A hospital providing long-term care services; or5) Any other locations that have qualities of an institutional setting, as determined by the Secretary.
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• The Secretary will apply a “rebuttable presumption” that a setting is not a home and community-based setting, and engage in heightened scrutiny, for any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment in a building on the grounds of, or immediately adjacent to, a public institution or disability-specific housing complex...”
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NCAL & AHCA asked CMS to:
• Strike the “rebuttable presumption” that certain provider-controlled settings are institutional (those on or near institutional settings or disability-specific housing complexes);
• Use care planning process to ensure resident-centered care, not arbitrary definitions related to facility location;
• Make sure eviction procedures accommodate state standards for residential care/assisted living facilities;
• Make sure that standards for sharing units are workable and realistic about economic constraints facing states (i.e., no mandate for single occupancy); and,
• Permit secure perimeters (locked units) for residents with dementia.
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• Managed Care: Population vs. Benefits
• ALP Benefit to be added in 2015 for MLTC and MMC
• Residents of ALP (population) excluded from FIDA (Fully Integrated Duals Advantage)• “Facility-based Long Term Services and Support” i.e. nursing home
residents start opt in 7/1/2014
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• Most ALP beds in the FIDA region
• ALP residents may be in managed care plans (Duals –Medicare Advantage Plans; Medicaid- only – Medicaid Managed Care Plans)
• Need to be prepared to work with many Plans; demonstrate value of aging in place; facilitate admissions and discharges back to community
• IT and billing resources will be critical
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• 1115(a) “Partnership Plan”= demonstration waivers to implement Medicaid Redesign initiatives.
• Medicaid managed care; Managed Long Term Care
• 08.31.12: requirement that all dual eligibles needing more than 120 days of community based long term care to enroll in managed long term care plans.
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• In 2015, ALP residents will be enrolled into MLTCs. (this is a result of the 2011 budget authorization to DOH).
• CMS Special Terms and Conditions (STCs) published.
• Identifies the types of settings that MLTC enrollees will need to receive services in order to participate.
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• Medicaid Redesign Team established in 2011.
• Stakeholders and experts statewide
• Purpose: to reform the Medicaid system and reduce costs.
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• Phase 1: a plan was developed to lower Medicaid spending by $ 2.2 billion. Included 79 recommendations to redesign and restructure the Medicaid program to be more efficient and produce better outcomes for patients.
• 78 recommendations were approved by Legislature as part of the enacted budget and are currently being implemented.
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• Phase 2: established 10 workgroups to address more complex issues; monitoring progress on recommendations in Phase 1.
• Added 175 stakeholders to the MRT.
• Result: “multi-year road map that leads NY to a more efficient program and system that is affordable and will achieve better health outcomes for New Yorkers.”
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• Current status: Medicaid 1115 waiver
• Allows the state to reinvest in its healthcare infrastructure as well as innovation.
• IN 2012, NY added initiative to improve service delivery and coordination of long term care services and supports for individuals through a managed care model.
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Special Terms and Conditions (STC)
• Attachment A- HCBS in MLTC must be provided in a setting that has home-like characteristics and not in institutionalized settings, unless the enrollee is in need of short-term respite.
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• Language drawn from the CMS proposed rule on HCBS• private or semi-private bedrooms
• decisions about sharing a bedroom
• full access to facilities in a home (kitchen and cooking, small dining areas)
• private or semi-private bathrooms that include provisions for privacy
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• common living areas and shared common space for resident interaction
• access to food storage or pantry 24/7
• resident decision making about activities, visitors eating times, etc.
• respect, choice, privacy, access
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• Provider owned or controlled residential settings, additional conditions:• privacy in sleeping unit
• lockable entrance doors
• shared units only at enrollee’s choice
• setting is physically accessible
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SOI Written Questions via the Department's Email August 14, 2013.
Response to Written Questions
ON HOLD
SOI Response Deadline
ON HOLD
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Schedule of Events
• NYSCAL submitted questions as requested. To view:http://www.nyscal.org/files/2013/08/080713-Draft-ALP-Questions-FINAL.pdf
• Current ALP Providers• How do current facilities fit into the proposed CMS HCBS definition?
• Managed care vs. fee for service?
• Facility renovation?
• ALPs Currently Under Construction• CMS proposed definition and impact
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• Meetings with DOH/Mark Kissinger• July; September; November
• Transition Plan due 12.31.13
• Thoughts?
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In December 2012, HHS’ OIG released a report documenting deficiencies in meeting state and federal requirements for assisted living facilities (ALFs) providing Medicaid services.
• Examined data, inspection reports, and provider care plans for 2009 in the seven states with the most assisted living Medicaid beneficiaries: Georgia, Illinois, Minnesota, New Jersey, Oregon, Texas, and Washington.
• The study encompassed many types of facilities including private residences where beneficiaries were taken care of by relatives; single-family homes that served six or fewer individuals; and multi-unit residences, some serving more than 200 individuals.
The report, Home and Community-Based Services in Assisted Living Facilities, can be found at: https://oig.hhs.gov/oei/reports/oei-09-08-00360.pdf.
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Greatest area of concern is meeting care plan standards.77 percent of beneficiaries receiving HCBS resided in ALFs cited for at least one deficiency or noncompliance with state licensure or certification standards.• Nine percent of beneficiaries’ records did not include care plans required by
the states and federal government.• Forty two percent of the care plans did not include the frequency of HCBS
furnished, as required. • In five of the seven states that also required (as a state option) care plans to
specify the beneficiaries’ goals and the interventions to meet them, 69 of 105 care plans did not meet that requirement.
• In two of the seven states that required care plans to be signed by beneficiaries or their representatives, 12 of 25 care plans did not meet that requirement.
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RTI study presented in November 2012 found that AL facilities accepting Medicaid payment were similar in many ways to those that do not:• In general, found that Medicaid facilities are “not that
different” from non-Medicaid facilities.”
• Levels of services provided and staffing generally similar.
Source: “Do Residential Care Facilities That Serve Medicaid Beneficiaries Differ From Those That Do Not?” Angela Greene, Galina Khatutsky, Joshua Wiener & Ruby Johnson, slides, Gerontological Society annual meeting, Nov. 17, 2012
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Study found some differences between Medicaid and non-Medicaid facilities:
• More Medicaid residential care facilities (RCFs) are smaller (4-25 beds).
• More non-Medicaid RCFs have dementia or Alzheimer's units.
• Higher proportion of Medicaid RCFs provide skilled nursing care.
• A slightly higher mean number of LPN hours for direct care per resident are provided in the non-Medicaid facilities and the mean number of hours of direct care per person provided by administrators in Medicaid facilities is higher.
• Non-Medicaid RCFs have higher monthly base rate.
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Resident profiles in Medicaid facilities differ from those in non-Medicaid facilities:
• Medicaid residents tend to be younger (under 65) and a higher proportion are minorities.
• Higher proportion of Medicaid residents have diabetes.
• Higher proportion of non-Medicaid residents are female and a higher proportion have Alzheimer’s disease or other dementias.
• Higher proportion of Medicaid residents are intellectually disabled or have a serious mental illness.
• Higher proportion of Medicaid residents exhibit problem behaviors such as wandering, and being verbally and physically abusive.
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Thank you!
Questions?
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New York State Center for Assisted Livingwww.nyscal.org
