October 7, 2019 Edition of The Situation Report

QIVAPP

COST REPORTS

WEBINAR: IMMIGRATION LAW

LAWTALK

As reported in an HCA alert, QIVAPP funds were announced for NYC providers, subject to state Division of Budget approval and passthrough by MLTCs to LHCSAs.

HCA continues to gain clarification and seek more time on a new cost report mechanism being developed by the Dept. of Health.

Coming soon: a new webinar on Oct. 30 to help providers understand, comply with the intricacies of immigration law pertaining to home care and hospice employers.

Our monthly LawTalk feature by counsel at Jackson Lewis explores new changes to the law on training for prevention of sexual harassment.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS Compliance Experts Lead October 17 HCA Symposium Oct. 17 (Albany) PDGM Bootcamp for Clinical Managers and Quality Staff Oct. 23 (Fairport) Webinar: Immigration Law Compliance for Home Health, Hospice Oct. 30 2-3 p.m.

Save The Date: 2020 Northeast Home Health Leadership Summit Jan. 28-30 (Boston) HCA's offices are closed in observance of the holiday on Oct. 14 and will reopen on Oct. 15. We will publish The Situation Report on Oct. 15 instead of our regular Monday distribution.

Vol. 4, Issue 35| October 7, 2019

Grassroots DSRIP Advocacy Crucial at Stakeholder Sessions and Other Venues As stressed during a statewide HCA-member call last week, New York’s proposal to extend its federal 1115 waiver – including the Delivery System Reform Incentive Payment (DSRIP) program – is a major, high-stakes focus of policymaking and state financing. The waiver amounts to an $8 billion ask of the federal government, with corresponding programmatic incentives and focal points that will directly impact your organization, your health care partners as well as the overall organization of health care services statewide.

See DSRIP p. 3

Trump Announces Medicare Proposals President Trump has issued an Executive Order with a number of actions that may impact home care providers. Please see https://www.whitehouse.gov/ presidential-actions/executive-order-protectingimproving-medicare-nations-seniors/.

See TRUMP p. 2

See EMBRACES p. 4 HCA and home care provider members from Visiting Nurse Service of New York (VNSNY) and VNS Westchester (VNSW) met with Senate Majority Leader Andrea Stewart-Cousins on October 3 to discuss each organization's value to its communities and some 2020 state budget priorities and proposals. We thank the Majority Leader for taking the time to meet with (at left) Dan Lowenstein, Vice President of Government Affairs at VNSNY, and (at right) HCA Board Member Tim Leddy, President and CEO of VNSW, who were also joined by HCA Director for Public Policy and Advocacy Alyssa Lovelace.

INSIDE Grassroots DSRIP Advocacy Crucial...................................................1 Trump Announces Medicare Proposals.............................................1 Member Hiring Announcement............................................................3 DOH Issues Minimum Wage Surveys.....................................................4 An Announcement from HCA Sponsor GWR Medical...........................4 QIVAPP Funds Announced ................................................................5 Update, Discussions on New Cost Report..........................................5 New Discharge Planning Rule for HHAs, Hospice................................6

Home Care, Hospice Compliance Work Plan Tips........................................................7 Immigration Law Webinar for Home Care, Hospice......................................................7 HCA Board Member Kaltenbach Now COO of Community Care Home Health Svcs..........8 MACs Issue Quality Reporting Non-Compliance Letters..............................................8 LawTalk: New Training Mandate, Other Changes to Sexual Harassment Laws...............8 CASPER Preview & Star Rating Reports Posted for January 2020 Refresh.......................9 VA Releases Quality Standards..................................................................................9 Preventive Pediatric Care Advisory Group Releases Final Report...............................10

The Situation Report: the Home Care Association of New York State TRUMP from p. 1 A major focus is incentivizing Medicare Advantage (MA) managed care plans. This includes reducing barriers on Medicare Medical Savings Accounts; promoting supplemental benefits and telehealth services; adjustments to supplemental MA benefits allowing Medicare beneficiaries to “share more directly in program savings”; adjusting network adequacy requirements for MA plans to enhance access with telehealth or other technologies; and modifying the Value-Based Insurance Design to remove any disincentives for MA plans to cover cost-saving and quality improvement items and services not covered by fee-for-service Medicare.

President Trump also calls for eliminating certain burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and other licensure requirements of the Medicare program.

Other proposals involve technologies like artificial intelligence as a means of combating Medicare fraud, waste and abuse; providing seniors with better quality care and cost data for decision-making; and using Medicare claims data to give providers more information on practice patterns that may pose undue risks to patients, to monitor outliers, and to detect variances from recommended standards of care.

The President also plans to review regulatory policies that create reimbursement disparities between physicians and nonphysician practitioners and a regulation that would ensure that items and services provided by these and other clinicians are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation.

HCA will be monitoring all of these proposed regulations as they roll out and look for opportunities to reduce the regulatory burden on home care and hospice providers.

The Executive Order follows two final rules by the U.S. Centers for Medicare and Medicaid Services (CMS) that provide regulatory relief for home care and hospice providers and which revise the discharge planning requirements for hospitals and home care providers (see two memos issued by HCA last week).

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 4, No. 35 October 7, 2019 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA).

Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

DSRIP from p. 1 Along with the state budget, this proposal is sure to be among the biggest actions on the state policy front for health care broadly this year. Phase II of the state’s waiver offers an opportunity to advocate for a more responsive funding and participation approach to home and community-based care, better considering this sector in a more visible, explicit and influential role.

HCA members who have participated in DSRIP projects to date – as well as those with a case to be made for more robust involvement of home and community based care during phase II – should be speaking out vigorously as part of the stakeholder process currently in motion.

HCA met last week with the Senate Majority leadership and with Paul Francis, the Deputy Secretary for Health and Human Services, to press our position, building on recommendations reflected in a letter to Francis by HCA and six colleague associations. The letter is posted to HCA’s website.

We strongly encourage all members to participate in public comment sessions on October 25, in New York City, and October 30, in Syracuse, to press the case for home care and Managed Long Term Care’s role in the waiver.

All details about these sessions, including pre-registration to deliver comments, are online at https://tinyurl.com/y6c8xpzx.

Please note that speakers will be limited to five minutes for comments. In the coming days, HCA will provide you with message points and guidance to help you make the most of those five minutes on behalf of your organization and patients.

HIRING: Clinical Assessment Managers (RNs) VNSNY is hiring Clinical Assessment (UAS) Managers to join our team. Use your clinical skills to assess member needs and identify solutions that promote high quality health care services. Option to work in any of the following counties: Monroe, Dutchess, Onondaga, Ulster, Orange, Oneida, Putnam, Delaware, Otsego, Sullivan, Rockland, Madison, Herkimer.

We offer: flexible schedules, comprehensive training and ongoing support, competitive pay rates, great benefits (for full time) and telework opportunities. Qualifications:    

Current license to practice as an RN in NYS (BSN preferred) Minimum six months of utilization review or care management experience at a Managed Care Organization or discharge planning experience required Demonstrated success with conflict management skills Knowledge of Medicaid or Medicare regulations required

Apply full time: https://jobs.vnsny.org/job/brooklyn/rn-uas-assessment-upstate-new-york-counties/1238/13316863 Apply per Diem: https://jobs.vnsny.org/job/brooklyn/rn-uas-assessments-per-diem-upstate-new-york-counties/1238/12539568 VNSNY is the nation’s largest not-for-profit home- and community-based health care organization. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

DOH Issues Minimum Wage Survey Survey is for non-NYC CHHAs and hospice The state Department of Health (DOH) recently issued two Dear Administrator Letters (DAL) on minimum wage. The DALs apply to non-New York City (NYC) Certified Home Health Agencies (CHHAs) and hospice providers, requesting information on the state’s minimum wage increase from January 1, 2020 through January 1, 2021.

Please note that the CHHA survey is for the CHHA pediatric rates only. A separate survey will be sent for the CHHA episodic rates.

DOH explains that it is not surveying NYC providers because the minimum wage has reached the statutory $15 per hour in NYC, effective December 31, 2018 and forward. NYC CHHA or hospice providers with locations outside of the NYC region may complete the minimum wage survey for that other region.

DOH’s hospice survey can be downloaded at http:// www.surveygizmo.com/s3/5250393/ 56c16dcdbf76. It is based on employee wage data from April 1, 2019 through June 30, 2019.

DOH’s pediatric CHHA survey can be downloaded at http:// www.surveygizmo.com/s3/5249966/ 6b8aee88e2a1.

If your agency/facility is in multiple wage regions, please provide data for each region. DOH requests that you include hours for all workers with a payroll record, including direct contracted staff for the Northern Metropolitan or Remainder of State regions.

Surveys are due by close of business on Friday, October 18, 2019.

Additional information can be found within the DALs at https://hcanys.org/wp-content/uploads/2019/10/ 2020-CHHA-min-wage-survey-DAL.pdf (CHHA) or https://hca-nys.org/wpcontent/uploads/2019/10/2020Hospice-Min-wage-survey-DAL.pdf (hospice).

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

QIVAPP Funds Announced The state Department of Health (DOH) has announced draft Quality Incentive Vital Access Provider Pool (QIVAPP) monies.

These are funds that Managed Long Term Care plans (MLTCs) will receive and distribute at predetermined amounts to certain eligible Licensed Home Care Services Agencies (LHCSAs) in New York City for 2018-19.

However, these newly announced amounts must first be approved by the state Division of Budget (DOB) before MLTC plans will receive the payments for distribution to LHCSAs within 30 days of receipt.

For each HCA member LHCSA who qualifies, HCA has developed and sent a personalized list of the draft amounts that eligible LHCSAs should eventually receive from MLTC plans. If your organization has questions about QIVAPP, please contact Andrew Koski at akoski@hcanys.org.

Award amounts are determined by the actual hours provided by qualified LHCSAs to MLTC plans.

We stress again that the QIVAPP amounts are still subject to DOB approval, with distributions to plans arriving at an unknown later date for remittance to providers.

At this time, DOH does not intend to provide QIVAPP funds to those LHCSAs who provided aide services to Guildnet (who closed its MLTC) as Guildnet did not submit data on the number of aide hours delivered by providers. HCA is trying to get DOH to address this issue and will keep members informed.

HCA will also notify members when DOB approves the funding for distribution to the MLTC plans.

QIVAPP funding has been available since the 2014-15 state fiscal year for New York City home care providers who meet certain criteria. Those criteria and additional information on QIVAPP are explained here: https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm.

For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.

Update, Discussions on New Cost Report During a conference call with the state Department of Health last week, HCA continued to press for more time and clarification while raising additional issues regarding a new cost report DOH is developing for all home care providers and fiscal intermediaries (FIs). HCA is part of a workgroup providing feedback to DOH. DOH indicated that: 

Multiple-site agencies serving more than one county should submit one cost report for each county and use their Medicaid provider number, not their license number.



For the first time, agencies will also be required to complete a separate cost report for each county in which they serve managed care enrollees, substantially multiplying the burden on agencies, HCA said.

Continued on next page

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

Continued from previous page 

An entity with both a LHCSA and FI can use its Medicaid provider number for the LHCSA on the FI cost report if the FI does not have its own provider number. “Stand-alone” FIs without a Medicaid provider number can use a “related” number.



Waiver services data will not be captured (i.e. home and community support services).



For the salary and benefits schedule on top-ten highest-paid officials (which HCA had expressed concerns about), the state may include only administrators above a certain salary threshold.



DOH plans to release the new cost report in spring 2020 for completion sometime in the fall with extensive education.

On the call, HCA continued to advocate that the cost report not be released in 2020 (based on 2019 data).

Agencies have not collected much of the data in the format required by the cost report, and doing so is burdensome, we said. Instead, we called for a 2021 reporting cycle using 2020 data.

Based on a prior meeting and questions submitted by HCA, providers and others, DOH compiled a list of issues and how they have been addressed. HCA is reviewing them to determine if any future action is required.

For more information, including a review of the proposed cost report, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662; or Patrick Conole at pconole@hcanys.org or (518) 810-0661.

Details on New Discharge Planning Rule for HHAs, Hospice HCA has prepared a memo (https://hca-nys.org/wp-content/uploads/2019/10/ 100119MemoonDischargePlanning.pdf) on a recently finalized discharge planning rule that goes into effect system-wide on November 29.

This final rule coincided with another one that provides regulatory relief to home care and hospice agencies in a number of areas. HCA summarized that rule in an alert and memo sent to members on September 27.

(See https://hca-nys.org/wp-content/uploads/2019/09/092719MemoonRegRelief.pdf).

The discharge planning rule, in draft form, was originally published on November 3, 2015. It required home health and other providers to meet specific discharge planning requirements in order to participate in Medicare and Medicaid among other policies.

Back then, HCA highlighted concerns about the burden the rule would have on home health providers and the problematic nature of the “quality” data required in discharge planning. The rule also underestimated proposed new and unfunded costs, we noted, and it did not consider circumstances where dual-eligible patients are enrolled into managed care plans.

In response, CMS determined that significant policy issues needed to be resolved. In November 2018, CMS announced a one-year extension for publication of a final rule.

While the final rule does eliminate some of the proposed requirements affecting home health agencies, there are still many important provisions in the final rule that providers should be aware of.

Please look for further follow-up information from HCA as additional guidance or other information is provided.

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

Home Care, Hospice Compliance Work Plan Tips at HCA Symposium Internal auditing and monitoring processes help you stay compliant with federal and state rules and regulations. These internal checks and reviews of compliance program operations ensure quality control.

They also verify that all procedures are functioning as they should be within the compliance program.

HCA’s Corporate Compliance Symposium, on October 17, will feature a session outlining the essential elements that every home care and hospice agency should have in place to ensure ongoing compliance with state and federal regulations.

Randi Seigel, Partner at Manatt Health, will identify specific review processes to help you ensure that necessary procedures, policies, and safeguards are in place to avoid high risks of compliance lapses and to run an effective compliance program.

You’ll also learn tips for verifying that your workforce is aware of and trained on required federal and state laws as well as internal procedures and conduct.

This session is just one of several led by eight prominent health care law and compliance experts to ensure that your organization knows the rules and regulations, has tools to assess compliance risk, and responds to those risks with routine activities and procedures as part of your compliance work plan. No other area of your operation is more important.

Register today at https://tinyurl.com/yy4vwxdk.

Immigration Law Webinar for Home Care, Hospice At a time of intense national conversations and scrutiny of immigration policy, it is imperative for home health and hospice employers to develop compliance safeguards and practices. Doing so is both right and prudent; and it is especially important given that immigrants comprise a large and integral part of the home care and hospice workforce.

Please join HCA on October 30 for a webinar (2-3 p.m.) with labor, employment and immigration law expert Joanna Silver of Bond Schoeneck and King to learn more about HR policies and practices necessary to comply with immigration law and regulations. (Registration is here: https://tinyurl.com/y62ga8gb).

Silver will review the most prominent immigration law issues, including the upcoming “public charge” rule, social security “no-match” letters, U.S. Citizen and Immigration Services employment verification documentation (I-9 forms), and more.

This program is part of HCA’s comprehensive legal and compliance education agenda for home care and hospice, which also includes our upcoming Corporate Compliance Symposium on October 17.

Visit our education and events page for all upcoming programs at https://hca-nys.org/events-education/upcoming-events.

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

HCA Board Member Kaltenbach Named COO of Community Care Home Health Svcs.

HCA Board Member Walter Kaltenbach – a veteran executive in home care and a longtime member of HCA – was recently appointed Chief Operating Officer of Community Care Home Health Services.

Mr. Kaltenbach has over 20 years of leadership experience in home health care services, including at Premier Health Care, People Care, Able Health Care and, most recently, at MZL Home Care. He has been a dedicated political advocate at both the state and federal levels, especially as an active member of HCA’s Policy Council for several years, providing insight and expertise on emerging issues facing home care policy.

Community Care Home Health Services operates in all five boroughs of New York City, Nassau, Suffolk, Westchester, Rockland, Rochester and Buffalo.

HCA congratulates Mr. Kaltenbach on the recent appointment.

MACs Issue Home Health Quality Reporting Non-Compliance Letters The U.S. Centers for Medicare and Medicaid Services (CMS) reports that Medicare Administrative Contractors (MACs) are sending notices of noncompliance to home health agencies regarding Home Health Quality Reporting Program (HHQRP) requirements. The notices were also placed into agency CASPER folders in QIES on October 1, 2019.

Agencies will receive a 2 percent reduction in 2020 if they do not submit at least 90 percent of their required OASIS assessments during the required period.

Agencies that receive the letters may e-mail a request for reconsideration no later than November 1, 2019.

See the instructions for doing so in your notification and on the Home Health Quality Reporting Reconsiderations and Exception and Extension website at: https://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Reconsiderationand-Exception-and-Extension.html.

LawTalk: New Training Mandate, Other Changes to Sexual Harassment, Discrimination Laws

By Frank J. Fanshawe, Principal, and Ashley Solowan, Associate In 2019, New York State enacted sweeping legislation to further combat discrimination and harassment of all kinds in the workplace. The legislation follows and builds upon other major state legislation in 2018 addressing sexual harassment.

With the 2018 legislation, employers of all sizes are required – for both full- and part-time workers in New York State – to provide sexual harassment prevention training by October 9, 2019, as soon as possible after a new employee’s start date, and at least annually thereafter. The state Department of Labor’s website has a description of the minimum training requirements and materials (https://www.labor.ny.gov/immigrants/sexualharassment-prevention.shtm).

Continued on next page

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

Continued from previous page It’s worth noting that some employers provided initial mandated training many months – and, even, more than a year – prior to the October 9, 2019 deadline and are uncertain if their training within that timeframe would meet the initial training requirements. The answer is not entirely clear, given the crossover of calendar years in the span between the implementation date (in 2018) and the training due date (in 2019). But based on the state’s guidance, it appears that such employers could make a strong case for compliance with the October 9 deadline if: 1) the employer trained staff under the minimum standards (or greater) in 2018, and 2) if the employer then also provided its first annual training at some point in 2019 – even if the annual training takes place in November or December 2019.

The 2019 measure additionally requires employers to provide their New York employees with a notice, both at hire and during the training, containing the “employer’s sexual harassment prevention policy and the information presented at such employee’s sexual harassment prevention training program.” This notice must be in both English and in an employee’s primary language, provided that DOL has published materials in that language.

The 2019 legislation includes many other significant changes. For a summary of these changes, please see an online version of this article at https://hca-nys.org/lawtalk-new-training-mandate-other-changes-tosexual-harassment-discrimination-laws.

Home health agencies, managed long term care plans and hospices are strongly encouraged to consult with their legal counsel about both the recent and impending changes in New York state’s harassment and discrimination laws.

LawTalk is a monthly feature from HCA’s counsel at Jackson Lewis. Please note that LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship.

Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.

CASPER Preview & Star Rating Reports Posted for January 2020 Refresh Home health agencies can now download the latest Provider Preview Reports and the Quality of Patient Care (QoPC) Star Rating Preview Reports from CASPER. These reports preview data that will be displayed in the Home Health Compare website beginning around January 23, 2020. The Home Health Compare Provider Preview Reports remain in the CASPER folder and are available to providers for 60 days only. The QoPC Star Ratings Provider Preview Reports remain in the CASPER folders and are available for 90 days only.

Providers are encouraged to save a copy of their preview reports for later reference. Additional information about the Home Health quality reporting program data submission deadlines is at https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-QualityReporting-Data-Submission-Deadlines.html. Information about the Home Health Star Ratings is at https:// www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/ HHQIHomeHealthStarRatings.html.

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 35 October 7, 2019 

VA Releases Quality Standards The Department of Veterans Affairs (VA) has posted standards for quality regarding hospital care, medical services and extended care services (home care and hospice) that will apply to Department and non-Department health care providers alike.

The standards are here: https://www.govinfo.gov/content/pkg/FR-2019-10-03/pdf/2019-21538.pdf.

They consist of Quality Domains and Quality Measures. The domains are broad categories used to describe the desired characteristics of care received by veterans, whether by the VA or community-based providers. Quality measures are numeric indicators that evaluate clinical performance within each of the quality domains.

Some quality standards include: timely care; effective care; safe care; and veteran-centered care. Each standard includes quality measures that are listed at the above link.

Preventive Pediatric Care Advisory Group Releases Final Report Last week, the state Department of Health (DOH) released the final report of the Preventive Pediatric Care Clinical Advisory Group. The group consists of experts in children’s health care formed under New York State’s “First 1,000 Days on Medicaid Initiative.”

According to DOH, the report is one of 10 proposals included in the initiative and outlines a comprehensive pediatric health care model that integrates behavioral health into children’s primary care.

It also recommends a two-generational approach to care, focusing on the biomedical and socialemotional elements that affect early development and are essential to achieving health equity.

The First 1,000 Days on Medicaid Initiative is a collaborative effort which recognizes that the first three years of a child’s life can have a lasting impact on future health, educational achievement, and economic stability.

The full report can be found on the Medicaid Redesign Team’s website (https://health.ny.gov/health_care/medicaid/redesign/1000_days/docs/2019-10-01_final_report.pdf).

To learn more about the First 1,000 Days Initiative, follow this link: https://www.health.ny.gov/health_care/medicaid/redesign/first_1000.htm.

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