Since late 2023, the Hospice and Palliative Care Association of New York State (HPCANYS), The Coalition to Transform Advanced Care (C-TAC), C-TAC Innovations, and TFA Analytics have collaborated on a project to develop a comprehensive set of policy recommendations to expand access to palliative care services for adults, children, and their caregivers throughout New York State. This initiative is funded through grants from The Fan Fox and Leslie R. Samuels Foundation, the Ralph C Wilson, Jr. Foundation, and the Mother Cabrini Health Foundation.
As of June this year, New York is moving ever closer to realizing a palliative care benefit for its Medicaid and dually eligible population.
Throughout 2024, HPCANYS and the project team engaged hundreds of people across New York to gather feedback on the benefits design. Providers, pediatric specialists, long-term care administrators, hospice providers, health plan leaders, health system administrators, caregiving administrators, and leaders from community-based organizations provided their feedback, along with people with lived experience of a serious illness and their caregivers. This feedback was used to tailor the policy recommendations to fit the unique environment and needs of New York State’s Medicaid population.
To understand the need for services and who delivers them, HPCANYS, C-TAC, and TFA worked with the New York Department of Health to identify the number of Medicaid recipients with a serious illness in the state that might be eligible for the benefit, compared to the number of providers delivering palliative care in each community. This analysis showed that the state has the capacity to meet the anticipated demand for services. In addition to proving “state wideness” of the benefit, TFA conducted a business case analysis for the state Medicaid program to prove ROI on the benefit. This showed that NYSDOH and managed care organizations (MCOs) can cover the costs of delivering palliative care services for Medicaid-only adults and children and dual eligible beneficiaries under the current budget due to associated cost savings.
These findings, along with the policy recommendations, were presented to a statewide advisory council on palliative care services to gain their feedback, followed by a presentation to the NYSDOH Office of Medicaid. The policy recommendations presented cover key aspects of the benefit, including eligibility criteria, services, provider types and qualifications, reimbursement, and monitoring and performance evaluation.
Following the presentation to NYSDOH, the project team believes moving forward with pursuing a Medicaid state plan amendment for palliative care services seems very likely. If New York does pursue an SPA, it would be following in the footsteps of Hawaii, which passed its own state plan amendment last year.
HPCANYS, C-TAC, C-TAC Innovations, and TFA Analytics will continue to work to advance the benefit. A final recommendations report will be submitted to NYSDOH for consideration in July, along with further recommendations that the state hold discussions with the community to gain a deeper understanding of the technical aspects of benefit implementation and the challenges and opportunities they present.
Considerations regarding implementation can be centered on provider workforce capacity, provider training, and community and provider awareness. Based on the analyses in the report, recommendations from the project team related to these areas include:
- Training plans for participating providers to access reimbursement and meet reporting requirements
- Provider education and training in the clinical and administrative aspects of delivering palliative care services
- Workforce education efforts for individual members of the palliative care interdisciplinary team with high vacancy or low rates (e.g., social workers, nurses)
- Capacity building in low-capacity areas through innovative models (e.g., ECHO) and contracting partnerships
- Statewide registry of palliative care providers to identify providers licensed to deliver specialty palliative care
- Messaging and awareness campaigns for consumers, caregivers, and providers to explain palliative care as preventive and how to access it
- Efforts to help health plans understand how to implement and engage their members
Ultimately, the project team hopes to continue working with the state to develop a draft state plan amendment to be submitted to CMS for approval, paving the way for New Yorkers living with serious illness and their caregivers to access the comprehensive, coordinated care they need.
