Generative Resources

A Legacy of Care

This 15 minute plenary session video produced by HRSA HIV/AIDS Bureau  first aired during the 2010 Ryan White Grantee Meeting.

Interviewees from New York include:

• Peter Gordon, MD
• Jay Dobkin, MD
• Victoria Sharp, MD
• Eli Camhi, LMSW

http://www.youtube.com/watch?v=SOGD8dueHeI&feature=youtube_gdata_player/

As of July 2010 the following Plans/SNPs are available to eligibles Medicaid beneficiaries in New York City:

On July 1, 2010 the NYSDOH Office of Medicaid Managed Care announced a revised start date of September 1, 2010 for mandatory Medicaid managed care enrollment for eligible PLWHAs. Mandatory packets will be sent to Brooklyn residents first.

SSI beneficiaries have 90 days to choose a Mainstream Plan or SNP. Non-SSI beneficiaries have 60 days to choose but can request an additional 30 days. If the client does not choose a Mainstream Plan or SNP then they will be auto assigned to a Mainstream Plan. They will not be auto assigned to an HIV Special Needs Plan. Approximately 2,500 Packets per month will be sent.

The estimated number of eligibles by borough are:

5,148 Brooklyn

6,084 Bronx

3,528 Manhattan

1,768 Queens

514 Staten Island

17,042 Total

In addition a city-wide “Heads Up” letter will be sent August 1, 2010 to all eligibles alerting them of mandatory implementation.

For the most current information regarding mandatory managed care in New York State visit:

NYSDOH

http://www.health.state.ny.us/health_care/managed_care/living_with_hiv/

NYCDOHMH

http://www.nyc.gov/html/doh/html/hca/hca1.shtml

The following calendar shows the possible implementation timeline based on public notices.

On Friday evening December 4, 2009 President Obama’s Office of National AIDS Policy  hosted a Community Discussion on HIV/AIDS in the Alumni Auditorium of Columbia University.  Jeffrey Crowley, ONAP Director served as host and Rosie Perez, Actor and long time HIV/AIDS advocate moderated.   While there were some brief introductions and comments by local politicians (Congressman Eliot Engel and City Council Speaker Christine Quinn), the event primarily permitted  a steady stream of 90 second statements from anyone attending who choose to wait in two lines to open microphones.  I think it went on for about 3 hours.

So how do you insure that all are heard.  You have Rosie Perez moderate.  She advised the group early on that comments would be limited to 90 seconds and she would gently but firmly enforce that limit.  And she did.  And everyone complied.  You go Rosie!  If you think all she can do is act, forget about.

ONAP recorded  the entire event and posted it on the White House  website.  Follow this link to see the video: http://www.whitehouse.gov/administration/eop/onap/events/newyork

If your clinic or practice hasn’t implemented an Electronic Health Record (EHR) the New York City Department of Health and Mental Hygiene has a program that you might consider. The Primary Care Information Project (PCIP) (http://www.nyc.gov/pcip) has been in existence since 2005 and has completed 1,500 EHR implementations in NYC. It currently offers: subsidized licensing of eClinicalWorks (http://www.eclinicalworks.com), support for installing and implementation, assistance in practice redesign, privacy and security, meaningful use, pay for performance and biosurveillance. I have attached the Program Application including a description of the Program Eligibility and Program Benefits.  PCIP Application

You can also apply online at: http://www.nyc.gov/html/doh/html/pcip/pcip-ehr-app.shtml#7

While PCIP has included a subsidy for the eClinicalWorks license this
support is running out and it is uncertain if it will continue in 2010.
Practices considering participation should contact PCIP (pcip@health.nyc.gov) as soon as possible.

The PCIP project has applied for funding as a Federal Health Information Technology Regional Extension Center (http://healthit.hhs.gov/extensionprogram) which would permit continuing support for EHR-enabled primary care.

Bill Kelly of Treo Solutions offers these FAQs on Ambulatory Patient Groups.  

pdf-frequently-asked-questions-eapgs

As of December 1, 2008 fee for service Medicaid reimbursement to Designated AIDS Centers will be based on Ambulatory Patient Groups (APG) rates. Except for Therapeutic Visits for case management, 7 Tier rates will no longer be available for fee for service Medicaid outpatient care.

In this first year of APGs the formula for reimbursement is 25% of the State regional (Downstate or Upstate) outpatient APG rate and 75% of the hospital blended clinic rate plus hospital capital. The  State published APG regional rates for outpatient care are: $276.38 Downstate and $219.69 Upstate. The rates are posted here on the State’s web site. I have posted a spreadsheet example of a 7 Tier Routine visit for an AIDS patient using APG rates for NewYork-Presbyterian Hospital.

Click here for the spreadsheet example >>>   7tier-example

Note that the blended rate and capital allowance are selected from the State published hospital rate list here.

I offer this document for illustrative purposes only. Please verify the financial assumptions with your fiscal advisors to ensure validity.

The NYSDOH AIDS Institute established the Designated AIDS Center model about 20 years ago.  It essentially provided enhanced reimbursement for outpatient HIV Primary and per diem rates for inpatient care.  Hospitals contracted with the State to receive these rates and were required to meet staffing levels and quality standards for the multidisciplinary care of those living with HIV and AIDS.  While predominately a Medicaid model, many DACs provide services for the uninsured population through ADAP and are also contracting with HIV Special Needs Plans.  Outpatient reimbursement for DACs will change in December 2008 when the State converts to a new payment methodology called Ambulatory Patient Groups (APGs).

There are currently 44 DACs operating in New York State.  You can see a list here.

There are currently three delivery system options that New York City Medicaid beneficiaries with HIV may choose: the fee-for-service system, mainstream managed care plans or HIV SNPs. The Department of Health designed a study to determine how the three delivery systems compared on a variety of quality of care and service utilization measures. Preliminary results follow. more…