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HomeMy WebLinkAboutResolution No. 2013-63Suggested by: Council Member Molloy Mayor Porter Vice -Mayor Marquis Council Member Bookey Council Member Boyle Council Member Gabriel Council Member Navarre CITY OF KENAI RESOLUTION NO. 2013 -63 A RESOLUTION OF THE COUNCIL OF THE CITY OF KENAI, ALASKA, OPPOSING PROPOSED CHANGES TO REGULATIONS THAT SUBSTANTIALLY DECREASE THE MEDICAID DAILY SERVICE PAYMENT RATES FOR PRIVATELY OWNED AND OPERATED ASSISTED LIVING FACILITIES. WHEREAS, the Kenai City Council has consistently recognized the critical importance of both independent living facilities and assisted living facilities as the centerpieces of the long -term care continuum for seniors and their families in Kenai; and, WHEREAS, seniors desire and require affordable independent living and assisted living housing and services; and, WHEREAS, the availability of such housing and services helps curb the attrition of seniors leaving Kenai after retirement, and generates jobs and revenue in the Kenai economy for health care providers and for vendors of other services, food and other supplies; and, WHEREAS, in 1992, the City of Kenai established the Vintage Pointe Manor as an independent living facility for senior housing in Kenai, and the City has operated this independent living facility continuously since then, providing senior housing for seniors able to live independently; and, WHEREAS, the City of Kenai does not provide an assisted living facility; and, WHEREAS, for many years, the Kenai City Council and Administration have supported the interests and efforts of nonprofit agencies and private developers in studying the feasibility of developing and operating assisted living facilities in Kenai, in recognition of the benefits such services will provide to the community; and, WHEREAS, private developers of assisted living facilities have private capital at risk, and their projects must be economically viable or such projects will not be developed or maintained; and, Resolution No. 2013 -63 Page 2 of 4 WHEREAS, many seniors cannot afford private assisted living rates without assistance, but can afford to rent units in private assisted living facilities which accept seniors on the Medicaid home and community -based waiver program; and, WHEREAS, privately owned assisted living facilities that accept seniors on the Medicaid home and community -based waiver program must accept the Medicaid daily payment rates that are paid by the Alaska Department of Health and Social Services (Department) under the Medicaid home and community -based waiver program for seniors on Medicaid; and, WHEREAS, the Medicaid daily payment rates paid by the Department for seniors on waivers are an important component of revenue considered by private developers in deciding upon the feasibility of developing an assisted living facility in Kenai as well as the continued viability of existing facilities; and, WHEREAS, increases in the Medicaid daily payment rates for assisted living facilities with 17 or more beds from $144.78 per unit per day (ending June 30, 2011) to $155.01 per unit per day (ending June 30, 2014) were critically important to the feasibility and the business plans of developers on the Kenai Peninsula and throughout the State of Alaska; and, WHEREAS, the Department's proposal to adopt regulation changes that will decrease the Medicaid daily payment rates for privately owned and operated assisted living facilities with 17 or more beds from $155.01 per unit per day to $124.81 per unit per day beginning July 1, 2014, an approximately 20% reduction in payment rate, equates to a loss to privately owned facilities of $30.20 per unit per day and losses of approximately $906.00 per unit per month from existing rates; and, WHEREAS, the Department's proposal to adopt regulation changes that will decrease the Medicaid daily payment rates for smaller privately owned facilities and operated assisted living facilities with 5 or fewer beds from $141.08 per unit per day (ending June 30, 2014) to $130.00 per unit per day (beginning July, 2014), results in an approximately 8.5% reduction in payment rate, which equates to a loss to privately owned facilities of $11.08 per unit per day and losses of approximately $332.40 per unit per month; and, WHEREAS, in contrast, the Department proposes to adopt regulation changes for state government owned and operated providers that will increase the Medicaid daily payment rates from $155 per unit per day to $354.55 per unit per day, an increase of over 200% for state owned and operated facilities; and, WHEREAS, these substantial decreases in payment rates to privately owned and operated providers, if adopted, will likely be financially devastating to existing private providers and discourage any new development; and, WHEREAS, the decrease in payment rates to private operators coupled with the increase in rates to state government owned providers creates an unfair competitive advantage in favor of the state in favor of the state providing the same services that private industry can and is willing to provide; and, Resolution No. 2013 -63 Page 3 of 4 WHEREAS, three seniors recently transitioned out of the Vintage Pointe Manor, and the Kenai Senior Center staff referred two of the seniors to local privately owned assisted living facilities; and, WHEREAS, these substantial decreases in payments likely will force private providers to accept less seniors on Medicaid or to go out of business and close their facilities, reducing the referral options for Kenai Senior Center staff, potentially eliminating referrals to local licensed facilities; and, WHEREAS, these substantial decreases in payment rates to privately owned and operated providers, if adopted, will harm seniors and their families by the loss of assisted living facilities, which will limit placement options; the alternatives being more in -home care and more long -term nursing care in nursing homes, which is more expensive, or re- location to assisted living facilities far away from Kenai, and even outside the State of Alaska, defeating this Council's goal of keeping seniors in our community for the benefit of the community. NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF KENAI, ALASKA: Section 1. That the City of Kenai opposes the Department's proposed regulation changes that will substantially decrease the Medicaid daily payment rates for privately owned and operated assisted living facilities in the State of Alaska. Section 2. City of Kenai request the Department default to a hold harmless rate as of July 1, 2013. Section 3. That a copy of this resolution be sent to Randall Schlapia, Department of Health and Social Services, Office of Rate Review, 3601 C Street, Suite 978, Anchorage, AK 99503, before the public comment period closes on October 1, 2013. Section 4. That copies of this resolution be sent to Governor Sean Parnell, Lt. Governor Mead Treadwell, Commissioner William Streuer (Department of Health and Social Services), Senate President Charlie Huggins, Speaker of the House Mike Chenault, Senator Peter Micciche, Representative Kurt Olson, and Kenai Borough Mayor Mike Navarre. Section 5. That this resolution takes effect immediately upon passage PASSED BY THE COUNCIL OF THE CITY OF KENAI, ALASKA, this 18th day of September, 2013. PAT PORTER, MAYOR RY N ARQ IS, VICE MAYOR Resolution No. 2013 -63 A / TIM NA�V%ARRRE,,yCO`UN�CIILL MEMBER /dam S�Y� BRIAN GABRIEI. COUNCIL MEMBER u 11KIlaye with a Past, C# with a Future" 210 Fidalgo Avenue, Kenai, Alaska 99611 -7794 Telephone: 907 - 283 -7535 / FAX: 907 - 283 -3014 MEMORANDUM TO: Mayor Porter, Council Members and Student Representative FROM: Council Member Bob Molloy n DATE: 09 -11 -13 SUBJECT: Resolution No. 2013 -63 This resolution expresses the City of Kenai's opposition to the Department of Health and Social Services' ( "Department's ") proposed regulation changes that will substantially decrease the Medicaid daily payment rates for privately owned and operated assisted living facilities in the State of Alaska. The Notice of Proposed Changes in Regulations states that any written comment must be submitted to Randall Schlapia, Office of Rate Review, 3601 C Street, Suite 978, Anchorage, AK, 99503 no later than 4:00 p.m. on October 1, 2013. The Notice also states that: After the public comment period ends, the Department of Health and Social Services will either adopt these or other provisions dealing with the same subject, without further notice, or decide to take no action on them. The language of the final regulations may be different from that of the proposed regulations. You should comment during the time allowed if your interests could be affected. The interests of the City of Kenai regarding the development and operation of privately owned and operated assisted living housing and services for seniors and their families in Kenai are affected by the Department's proposed changes to regulations that will substantially decrease Medicaid payment rates to those facilities. The Kenai City Council has consistently recognized the critical importance of both independent living facilities and assisted living facilities as the centerpieces of the long -term care continuum for seniors and their families in Kenai. Since 1992, the City has provided an independent living facility for seniors -- Vintage Pointe Manor — but the City does not provide an assisted living facility. For many years, the Kenai City Council and Administration have supported the interests and efforts of nonprofit agencies and private developers in studying the feasibility of Mayor Porter and City Councilors 09 -11 -13 Page 2 of 2 developing and operating assisted living facilities in Kenai, in recognition of the benefits such housing and services will provide to the community (such as Frontier Community Services' past study of a project in Momsen Subdivision, and Charis' Place 2012 -2013 study and development of a 22 bed facility on North Forest Drive, and other potential projects). From March 1, 2011 through June 30, 2014, there have been increases in the Medicaid daily payment rates for assisted living facilities that are privately owned and operated, referred to as "Non -State Government owned and operated provider," as shown in the accompanying table. For larger facilities like the new Charis Place (17 or more beds) the increases were from $144.78 per unit per day (ending June 30, 2011) to $155.01 per unit per day (ending June 30, 2014). For the smaller smaller privately owned facilities (5 or fewer beds) the increases were from $131.77 per unit per day (ending June 30, 2011) to $141.08 per unit per day (ending June 30, 2014). These increases were critically important to the feasibility and the business plans of developers on the Kenai Peninsula and throughout the State of Alaska who developed the few new larger facilities that were developed during this time period, and also to existing providers, including the smaller smaller privately owned facilities. Medicaid rates in general are under review for cost containment across - the - board. However, the Department's proposal will substantially decrease the Medicaid payment rates to the privately owned and operated providers — by approximately 20% to the larger facilities and by approximately 8.5% to the smaller privately owned facilities. In contrast, the Department proposes to adopt regulation changes that will substantially increase the Medicaid daily payment rates from $155 per unit per day to $354.55 per unit per day for state government owned and operated providers, an increase of over 200 %. The rate decreases, if adopted, will be financially devastating to facilities in Kenai, on the Kenai Peninsula, and in the State of Alaska. Private providers likely will be forced to accept fewer seniors on Medicaid or to go out of business and close their facilities altogether, reducing the referral options for Kenai Senior Center staff, and potentially eliminating availability of local licensed facilities for placements. Seniors and their families will be harmed by the loss of assisted living facilities, which will limit placement options. The alternatives are more in -home care and more long -tern nursing care in nursing homes, which is more expensive, or re- location to assisted living facilities far away from Kenai, and even outside the State of Alaska, defeating this Council's goal of keeping seniors in our community for the benefit of the community. Signature blocks for the Mayor and all Council Members are provided in Resolution No. 2013 -63. Your support of this resolution is respectfully requested. SNAP210- 2T:RJM Political Assisted Living Rates:RES Memo AL Rates.v2.doc Department of Health and Social Services Chart of Personal Care Attendant and Waiver Services Rates Rebased Rates Effective July 1, 2014 (7 AAC 145.520(h)) The following are Medicaid payment rates for specified Personal Care Attendant and Waiver Services. This chart does not cover all services reimbursed by Medicaid for Waiver Services. For services not covered here, the controlling regulation should be consulted (example: Specialized Medical Equipment, Environmental Modifications, or Specialized Private Duty Nursing). Waiver Proerams: Alaskans Living Independently - ALI Adults with Physical and Developmental Disabilities - APDD Children with Complex Medical Conditions - CCMC Intellectual and Developmental Disabilities - IDD Note: Regulatory payment restrictions such as payment limits, coverage limitations, or mutually exclusive restrictions are not addressed in this rate chart. Personal Care Assistance Services - 7 AAC 145.500 Service Service Unit Service Rate Procedure Code Waiver Program Personal Care - Agency Per 15 Minute $5.64 T1019 N/A Personal Care - Consumer Directed Per 15 Minute $5.64 T1019 U3 N/A Care Coordination - 7 AAC 130.240 Service Service Unit and Service Rate Procedure Code Waiver Program Limit Case Management Per Month $228.85 T2022 ALI, APDD, CCMC, IDD Screening One Initial $85.85 T1023 ALI, APDD, (one additional as CCMC approved) Plan of Care One Annual $364.73 T2024 U2 ALI, APDD, —Development CCMC, IDD August 16, 2013 Page 1 of 6 Rebased rates effective July 1, 2014 (7 AAC 145.520(h)) Nursing Oversight and Care Management — 7 AAC 130.235 Service Service Unit Service Rate Procedure Code Waiver Program Oversight and Care Per 15 minute — $354.55 T2031 CG ALI, APDD Management local (service $74.63 T1016 CG CCMC, IDD ALI, APDD within 200 miles of provider) Per day $130.54 T2031 US Oversight and Care Per 15 minute — Management non -local $138.50 T1016 TN CCMC, IDD ALI, APDD (recipient greater Per day $351.50 T2031 TG ALI, APDD than 200 miles from provider) Note: Non -local (greater than 200 miles) means the provider must travel to the recipient in excess of 200 miles. Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer beds $354.55 T2031 CG ALI, APDD RSL Acuity Add -on ** per EIN* Per day $130.00 T2031 UR ALI, APDD RSL - 6 to 16 beds per EIN* Per day $130.54 T2031 US ALI, APDD RSL - 17 or more beds per EIN* Per day $124.81 T2031 ALI, APDD RSL Per day $351.50 T2031 TG ALI, APDD Acuity Add -on ** *EIN is the provider's Employer Identification Number as issued by the Internal Revenue Service. The provider's residential assisted living beds must be added to determine the total. ** 7 AAC 130.267 requires that the recipient receive dedicated 1 to 1 staffing care 24 hours per day. Residential Supported Living (RSL) — 7 AAC 130.255 - State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL Per day $354.55 T2031 CG ALI, APDD RSL Acuity Add -on ** Per day $351.50 T2031 TG ALI, APDD ** 7 AAC 130.267 requires that the recipient receive dedicated 1 to 1 staffing care 24 hours per day. August 16, 2013 Dr E, c� Page 2 of 6 Lp in�3 Arvbg � r1C-)-l1KCLjZ LAW PROPOSED Rate Changes July 1, 2014 Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer Per day $130.00 T2031 UR OA, APD beds per EIN** RSL - 6 to 16 beds Per day $130.54 T2031 US OA, APD per EIN** RSL - 17 or more Per day $124.81 T2031 OA, APD beds per EIN** RSL Per day $351.50 T2031 TG OA, APD Acuity Add -on * ** Effective Dates of Service July 1, 2013 — June 30, 2014 Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer Per day $141.08 T2031 UR OA, APD beds per EIN** RSL - 6 to 16 beds Per day $145.24 T2031 US OA, APD er EIN ** RSL - 17 or more Per day $155.01 T2031 OA, APD beds per EIN** RSL Per day $342.59 T2031 TG OA, APD Acuity Add -on * ** Effective Dates of Service July 1, 2012 —June 30, 2013 Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer Per day $138.04 T2031 UR OA, APD beds per EIN** RSL - 6 to 16 beds Per day $142.11 T2031 US OA, APD per EIN** RSL - 17 or more Per day $151.67 T2031 OA, APD beds per EIN** RSL Per day $335.22 T2031 TG OA, APD Acuity Add -on * ** Effective Dates of Service July 1, 2011— June 30, 2012 Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer Per day $134.67 T2031 UR OA, APD beds per EIN** RSL - 6 to 16 beds Per day $138.64 T2031 US OA, APD erEIN* * RSL - 17 or more Per day $147.97 T2031 OA, APD beds per EIN** RSL Per day $327.04 T2031 TG OA, APD Acuity Add -on * ** Effective Dates of Service March 1, 2011— June 30, 2011 Residential Supported Living (RSL) — 7 AAC 130.255 - Non- State Government owned and operated provider Service Service Unit Service Rate Procedure Code Waiver Program RSL - 5 or fewer Per day $131.77 T2031 UR OA, APD beds per EIN ** RSL - 6 to 16 beds Per day $135.66 T2031 US OA, APD er EIN** RSL - 17 or more Per day $144.78 T2031 OA, APD beds per EIN** RSL Per day $320.00 T2031 TG OA, APD Acuity Add -on * ** Pre 2011 Cost Rate Method htto: / /medicaidalaska.com/ Downloads /Providers/TrainingMaterials Assisted Living Facility Waiver Pr esentation 2011.odf 2007 Rate Methodology http: / /dhss.alaska.gov /dsds /Documents /docs /AK HCBS initial pdf Riverside Assisted Living Soldotna, Inc. 390 Lovers Lane Soldotna, AK 99669 AI . 5 PRFM ASSISIEO IJVING RMng Me to fie Fafttsr September 18, 2013 Robert J. Molloy, Council Members Kenai City Council Kenai, Alaska RE: City of Kenai Resolution No. 2013 -63 Mr. Molloy and Council Members: l8 vJI `ilG1. :5�`. We wish to acknowledge and collaborate on the comments submitted to you by the ALAA (Assisted Living Association of Alaska), as well as make a few observations respective to Riverside Assisted Living's projected services in Kenai. We are writing this letter in support of your Resolution No. 2013 -63, which supports the assisted living industry, its residents and families, as well as this fine community. The privately owned and operated assisted living homes are a remarkably effective tool in the short-term as well as long -term planning and implementation of affordable care "as the centerpiece of the care continuum for seniors and their families in the community." However, it is vitally important that the newly proposed DHSS (Department of Health & Social Services) changes to Medicaid coverage and payment regulations specific to home and community -based waiver services, rates and personal care services... not be enacted. We believe that the disparity between governmentally owned and operated and privately owned and operated facilities, is simply too prohibitive. To increase the payment rate to governmentally owned facilities (such as the 6 large Pioneer Homes statewide) by over 200% while lowering the rate for 17+ bed privately owned facilities (like Riverside) by 20 %, is discriminatory, wrong, and demonstrates poor financial oversight of those governmentally owned facilities. For Riverside, this equates to a loss of $510 /day per 17 beds. At normal occupancies, these reductions would create substantial revenue losses. The lost income isn't "extra" money; running a quality assisted living home is not cheap. The private assisted living industry has financially suffered greatly over the past decade due to inadequate rate structures for Medicaid, and has lost some good homes across the state to voluntary closure because of it. The passing of the proposed DHSS Medicaid rate changes would serve to remove private capital and projects from the area. These facilities, together with the services they bring with them, are crucial for the growth and continuance of an economically secure base. We desire for our seniors and those in need of services to be able to continue to live in this community and have available services necessary for a high quality of life. Many small -to- midsized Alaskan communities (like Kenai) struggle with the historical attrition of retirees (to Anchorage or out of state). These services are vital to stemming that tide of demographical attrition among seniors and the associated economical losses. The currently proposed DHSS rate changes and regulations jeopardize those efforts. As you are aware, Riverside has purchased land, submitted and received entitlement authorizations, and made preparations for expansion of its KPB services to Kenai. Based on the proposed DHSS rate changes to Medicaid... we would not be able to continue our development in good financial faith with such drastic measures in play. In order for tens of millions of dollars of private capital to flow into these various projects, investors need to be assured that future rate structures will not be radically changed from year to year. Alaska's 50+ population is growing (as elsewhere) and the infrastructure needed to meet the needs of the coming baby boomer senior services dilemma will be a challenge. While Riverside and those involved in the assisted living industry are very cognizant of budget cutting measures, any proposal needs to accurately capture the true costs of providing the services needed at the level of care required, and then adequately funding those costs. We believe that it would be in the best interest of all concerned to extend the hold harmless period for all rates until June 30, 2014. This would signify that all providers would operate at the hold harmless rates of July 1, 2013 until July 1, 2014, yet continue to search for ways to adequately base new rates that would support this vital industry. Riverside appreciates all the time and effort that has been put into objectively analyzing and consequently opposing these proposed rate changes ... that would serve, if it becomes law, to cripple and devastate not only this industry, but we believe the community as a whole. Please feel free to contact me if you have questions, comments, or concerns. Respectfully, Cory Castagneto Riverside Assisted Living ccastaaneto CoDrlye rsideassisted I ivi n¢. co m ASSISTED ea Kenai Peninsula Branch 2030 Muldoon Rd Anchorage, AK 99504 September 17, 2013 Robert J. Molloy, Council Member Kenai City Council Kenai, Alaska RE: City of Kenai Resolution No. 2013 -63 Mr. Molloy: We are writing this letter in support of your Resolution No. 2013 -63, which supports the assisted living industry, its residents and families, as well as this fine community. The privately owned and operated assisted living homes are a remarkably effective tool in the short-term as well as long -term planning and implementation of affordable care "as the centerpiece of the continuum for seniors and their families in the community." However, it is vitally important that the new proposed changes to the Medicaid coverage and payment regulations specific to home and community -based waiver services, rates, and personal care services not be enacted. We believe that the disparity between governmentally owned and operated and privately owned and operated facilities is simply too prohibitive. To increase the rate of a governmentally owned facility by over 200% while lowering the rate for privately owned facilities by 7.8% to 20% (depending on the size of the home) just seems wrong. There are those assisted living homes in this area that would lose over a quarter million dollars a year with the enactment of these regulations and the cuts to their present rates (that's over $70.12 per day on a 10 bed home). The lost income isn't "extra" money; running an assisted living home properly isn't cheap. The private assisted living industry has financially suffered greatly over the past decade, and we have lost some good homes across the state to voluntary closure because of it. The passing of the proposed Medicaid changes would serve to remove private capital and projects from the area. These facilities together with the services they bring with them are crucial for the growth and continuance of an economically secure base. We desire for our seniors and those in need of services to be able to continue to live in this community and have available services necessary for a high quality of life. The currently proposed regulations jeopardize that. While the association and those involved in the assisted living industry are very cognizant of budget cutting measures, any proposal needs to adequately and accurately capture the costs of providing the services needed at the level of care required. We believe that it would be in the best interest of all concerned to extend the hold harmless period for all rates until June 30, 2014. This would signify that all providers would operate at the hold harmless rates of July 1, 2013 until July 1, 2014, yet continue to search for ways to adequately base new rates that would support this vital industry. The association appreciates all the time and effort that has been put into this critical issue that would serve, if it becomes law, to cripple and devastate not only the industry but we believe the community as a whole. Please feel free to contact me directly if you have questions, comments, or concerns. Respectfully, Sherry Mettler, Consultant (907) 242 -5282 smrk@ak.net