1. Legislative & Regulatory Update Stephen B. Hanse, Esq. President & CEO
2017
Midwinter Executive Education Conference
Legislative & Regulatory Update
Stephen B. Hanse, Esq.
President & CEO
The Intercontinental Hotel San Juan, Puerto Rico – January 10, 2017

2. New York State Election Overview
Senate
Assembly
Congress

3. Minimum Wage NYC: $11 on 12/31/16; $13 on 12/31/17; $15 on 12/31/18
Nassau/Suffolk/Westchester: $10 on 12/31/16 – one dollar per year increase until $15 on 12/31/21
Rest of State: $9.70 on 12/31/16; $10.40 on 12/31/17; $11.10 on 12/31/18; $11.80 on 12/31/19; $12.50 on 12/31/20
State to reimburse Medicaid providers for increased minimum wage costs and ancillary benefits
Additional funds allocated based on a WEF-adjusted regional pricing methodology

4. Advanced Training Initiative
Enacted Budget – two-year “Advanced Training Initiative”
$46 million per year ($23 million State share), to educate and train SNF staff to reduce avoidable hospital readmissions
SNFs with direct-care retention rates above the State median eligible to apply for funding
Budget: advocate to expand program funding and provider participation

5. Managed Long Term Care – SNF & ALP
MLTC plans reducing nursing home provider networks
Rates must be adequate in relation to nursing home costs
Increasing SNF AR Issues
Benchmark Rate extension
Single rate cell for SNF and community based population
ALP transition to Managed Care

6. E-Prescribing Nursing Home Exemption
E-Prescribing statute prevents a nurse acting as an agent of the prescribing physician from taking verbal orders and recording them in the e-prescribing system and having them enacted by the pharmacy
DOH 1-year waiver for nursing homes expires March 16, 2017
A.9334/S.6778 – permanently exempted nurses in a SNF acting as agent of prescribing physician from electronic prescribing requirement
Veto Message: Instructing Commissioner of Health to extend the e- prescribing waiver for nursing homes from March 16, 2017 until October 31, 2017 to resolve veto concerns

7. Nurse Staffing Ratios
“Safe Staffing for Quality Care Act” (S.782/A.8580-A)
CNA: 2.8 hours of care per resident per day
LPN: 1.3 hours of care per resident per day
RN: hours of care per resident per day
“Sub Acute Units” – 1 RN for every 5 patients

8. Guardianships
January 25, 2015 NY Times article “To Collect Debts, Nursing Homes Are Seizing Control Over Residents”
A.6510-A/S.4642-A limits the ability of a nursing home acting on behalf of an alleged incapacitated person from bringing a guardianship proceeding for the benefit of the incapacitated person
Disregards protections in place to protect the liberty and best interests of the alleged incapacitated person
Guardianships are essential: no POA; the POA is incompetent; or there is no one to act on behalf of the resident
An incapacitated person cannot apply for Medicaid and receive necessary services if there is no legally authorized representative to act on their behalf.

9. Supplemental Security Income Increase
New York has not increased the State portion of the SSI rate for low income elderly and disabled individuals in ACFs in 9 years
Current $40 per day is insufficient to provide room, board, activities, case management, supervision and medication assistance
S.7333/A – Provides a 2 year phased-in increase of $7.50 per day

10. Assisted Living Program Rate Increase
ALP rates based on 1992 costs, with minimum inflationary trend adjustments through 2007
Most ALP facilities do not receive a capital component as part of their rate and are not reimbursed for capital improvements
Initially designed to reimburse providers at approximately 50 percent of SNF rate, ALP reimbursement rates have fallen below this level

11. Nurses in ACFs
Nurses working in an adult home, enriched housing, ALR or special needs ALR not permitted to provide care to the full scope of their professional practice acts
Only EALRs – which allow for “aging in place” – can directly provide nursing services
When residents of a non-EALR facility have a nursing need – the on-site nurse cannot assist the resident
Allow these ACFs the option to directly employ RNs or LPNs to provide certain nursing services to residents

12. QUESTIONS? Stephen B. Hanse, Esq. President & CEO
New York State Health Facilities Association
New York State Center for Assisted Living
33 Elk Street - Albany, NY
ext. 11
(fax)