On October 20th, the New York State (NYS) Department of Health (DOH) posted the first quarterly update to its enhanced Home and Community-Based Services (HCBS) spending plan under the American Rescue Plan (ARP). In this update, DOH estimates that it will be directly eligible for $2.248 billion in state share savings through this program, up from $2.146 billion in the original spending plan. As these funds may be additionally used as state matching funds to receive additional federal financial participation of at least the same amount, the original plan estimated a total of $5.4 billion in expenditures, a figure which has not yet been revised in the quarterly update.
The Centers for Medicare and Medicaid Services (CMS) provisionally approved New York’s spending plan on August 25th, including full approval of 14 of the State’s 39 proposals. It requested further information on the remaining 25 proposals. New York sent a response on September 3rd and, as of the date of the quarterly report (October 18th), was awaiting a final approval.
The update outlines certain modifications made to DOH’s original spending proposals, including:
- Increased Spending
- The estimated spending for the long-term care (LTC) workforce payments (“Transform the Long-Term Care Workforce and Achieve Value-Based Payment Readiness”) has been increased from $623 million to $722.5 million.
- The estimated spending on enhanced rates for Private Duty Nursing has been increased from $10 million to $13.1 million.
- Request to Fund Growth in Personal Care
- CMS will not accept NYS’s request to fund year-over-year growth in Personal Care Services (PCS) and Consumer-Directed Personal Assistance Services (CDPAS). However, it will consider whether incremental growth between projected baseline and actual spend, “due to other HCBS investments removing existing barriers,” may be funded. DOH is revising this proposal, which had been estimated at $415 million, accordingly. A portion of these funds may therefore be available for other HCBS initiatives.
- Room and Board
- NYS has clarified that the Office for People with Developmental Disabilities (OPWDD) projects “Integrated Housing Pilot” and “Incentives for the Development of More Integrated Residential Services” will not include room and board expenses, which CMS will not fund.
- Implementation Mechanisms
- NYS plans to revise some of the implementation mechanisms, such as investments in the OMH and OASAS workforce, which will now be made through rate enhancements where possible (rather than state-directed payment preprints).
SPG has updated its reference guide to the proposals, including the State’s status updates on each proposal, which is available here. The full quarterly report can be viewed here, and a revised budget projection is available here.