2014 alfa conference thinking about new york

Thinking About New York?

A Good Time to Consider the Changing Regulatory Environment Presented by Nancy Hodes & Ginger Landy Hodes & Landy

Hodes & Landy Principals: Nancy Hodes and Ginger Landy • Full Service, Bi-Partisan, State Government Affairs Firm • Association Management and Representation, NY ALFA • Specializing in Assisted Living & Home Care Licensure and Regulatory Representation

New York and the Assisted Living Industry: A brief timeline 2000 • Assisted Living is not defined in NYS Law; • Only options: Adult Care Facilities with limited retention standards or Nursing Homes; • No consensus among providers of senior housing and services; • Resistance from the Nursing Home Industry; • Adversarial Environment; • Professionally Managed AL providers reluctant to enter NY Market;

2000-2003 • Professionally Managed , multi-state AL providers begin major advocacy campaign to establish a comprehensive assisted living statute to allow true “aging in place”; • Coalition Building with consumer advocates such as AARP; • Secured Champions in the NYS Legislature and in the Governor’s Office;

2004 • Passage of the Assisted Living Reform Act of 2004; • Allows for three levels of assisted living: Basic, Enhanced, and Special Needs; • True Aging in Place model; • Aligns with ALFA’s Core Principles; • Established a Task Force on Adult Care Facilities and Assisted Living Residences, giving AL providers a role in development of regulations and creating transparency in the process;

New York and the Assisted Living Industry: A brief timeline 2004-2008

• Task Force participated in the development of governing regulations; • NY ALFA, established in 2005, was an active member; • Opportunity to provide input, feedback and promote operational experience; • All ALR applications for existing operators were due in June 2005;

2008

2010 - Present

• Regulations drafted and released for public comment in late 2007; • Following two draft comment periods, the final Regulations were promulgated in March; • Lawsuit challenging several regulatory provisions filed July 24th; • All pending ALR applications put on hold.

• Lawsuit settled in 2010; • Application reviews begin to move forward; • During this time, State budgetary cuts reduced licensure review staff significantly.

Challenges, Developments, & Progress

CHALLENGES

Challenges In 2010, backlog of over 300 Pending ALR Applications

Confusion Regarding Statutory and Regulatory Requirements – both DOH and Providers

Department of Health Resource Shortages Not enough Staff to Create a New AL Unit

Inconsistent Regulatory Interpretations Across the State’s Four Regional DOH Offices

Unmanaged, Lengthy and Unpredictable Licensure Review Process

Major Administration Priorities Take Precedence Over Long Term Care and the AL Industry: Medicaid Reform

NY ALFA Responds

Drew attention to: Application Backlog; Inefficient & Duplicative Applications

Advocated with the Legislature and the Governor’s Office to increase DOH staff for Licensure Review and Surveillance

Introduced Legislation: Provisional Licensure; CARF Accreditation

DEVELOPMENTS

Developments Architectural Work Group NY ALFA Active Member

EALR Work Group NY ALFA Active Member

Paperwork Reduction Work Group NY ALFA Active Member

• Tasked with examining ACF, ALRs, EALRs, & SNALRs architectural standards and making recommendations to better align them with the aging in place model; • Created the Third Party Architectural Certification Form to address the lack of a DOH Architect- recommendation from NY ALFA;

• On- Going Work Group charged with examining issues related to full aging in place; • Providers work collaboratively with DOH to iron out areas of disagreement;

• Examined the numerous DOH required forms, including the Medical Evaluation Form and the Personal Data Form; • Streamlined and condensed forms to make them more user friendly and less dense;

PROGRESS

Progress New Leadership in the Division of Assisted Living Recognized the Credibility of Assisted Living Providers

Building a Collaborative relationship with Assisted Living Providers

Recognized the Backlog of Pending Applications and lengthy and unpredictable licensure review process is an impediment to expanding assisted living in NYS Created the ACF/ALR Licensure Streamlining and Consolidating the ACF, Streamlining Work Group ALR, EALR, & SNALR Applications

Adult Care Facility Common Application Collaborative Process with DOH Staff and Assisted Living Providers

Operational Recommendations from Providers Incorporated into New Application

On-Going Efforts • Assisted Living Providers continue to work with DOH to improve the Operational Environment through active work groups and NY ALFA advocacy

• Planned Joint Training for DOH Staff and Providers on Regulatory Requirements

• DOH Internal Review to Establish Consistent Regional Standards Across the State

Now is a Good Time to Consider New York Positive Changes & Progress

• More Focus on AL by DOHNew Leadership • Continuous Steps to Create a Predictable and Timely Licensure Review Process • Additional Review Staff

Evidence & Results

• Substantial Increase in Interest by Outside Developers and Providers • Timeline for New Development is Promising

Importance of a Strong Team

• Engage an experienced consultant; • Ensure the Review Stays on Track

Continuing Role for NY ALFA- More To Be Done

Challenges Still Exist Need to Keep Develop an Positive Surveys and Affordable Momentum Regulatory Assisted Living Moving Interpretations Model Forward