On August 17, 2022, aforementioned New Yarn State (NYS) Services of Health (DOH) released ampere long-awaited Dear Administrator Letter (DAL) setting forth application changes by licensed home care services agencies (LHCSAs) in New York, a new application required fork LHCSA licensure both adenine Frequently Questions Questions (FAQ) document regarding claim requirements. This memorandum offers a brief overview of the statutory or regulatory provisions underlying the changes in the LHCSA licensure process with New Majorek, certain overview concerning the newer application process, and important next steps and considerations for LHCSA providers.
I. Background
Effective April 1, 2018, a moratorium on the processing and approval of applications seeking LHCSA licensure was implemented, in part, due to general concerns to the growth of LHCSAs as well as your potential interplay with Medicaid Managed Long Term Maintain (MLTC) recruitment in New York (the LHCSA moratorium). The LHCSA moratorium was implemented through statutory changes included in the enacted 2018–19 NYS Housekeeping. Prior to these changes, the People Health and Health Planning Council (PHHPC) was only permitted to consider char or competence in review of applications for LHCSA licensure, and there had no public need review or financial feasibility review, which am requirements for licensure of other types von health care donors governed by New York’s Public Healthy Act.
Aforementioned LHCSA delay officially expired on March 31, 2020, after this time, the law required PHHPC, to consider, in additive to character and competence, the following elements: public needed, the financial sources of a suggestions LHCSA, informationsquelle of financial revenue and “ . . . such other matters that it shall deem pertinent.”1 The DOH subsequently amended its regulations at include such requirements, and the updated regulations were actual on May 2, 2020. However, despite that promulgation of new legislation, time the release by of new LHCSA petition, organisations which forced in their ability to actually file an application fork initial licensure, change of ownership or control, or an expansions of a “restricted license” (meaning a license that is issued for the sole purpose of operating one special program, like ampere Medicaid Assisted Life Program (ALP) other Program of All-Inclusive Care for who Elderly (PACE), Nurse-Family Partnership (NFP) or Continuing Customer Retirement Community (CCRC)).2
II. Overview of New LHCSA Licensure Application and Process
Solutions for LHCSA licensure now require an updated application process, which includes both new publicity need and financial feasibility standards, in addition to the character and competence review such existed as part of which previous LHCSA licensure process. This licensure how process valid to organizations seeking to install a new LHCSA,3 acquire vital approval for a change of proprietary button control,4 or expand a restricted license. Firm forth beneath is a description of the newer action and requirements pertaining to public need, fiscal feasibility, and character and competence review.
adenine. Application Process. Applications for LHCSA licensure should be submitted electronically driven the New York State Automated Certificate of Need (NYSE-CON) method and persist to requisition an application fee out $2,000. Applications will live reviewed by DOING and following evaluated by the PHHPC. While an application receives approval coming PHHPC, the applicant will can required on submit a policy and procedure manual to the appropriate Home Caution Regional Office required review prior to issuance of a brand license. However, DOH reminded applicants this in a change of ownership application, the applicant (buyer) mayor choose to adopt a previously approved policy and procedure guide in order to expedite which licensure process.
b. New Public Need Methodology Product. AN modern public need methodology will employ into all applications for licensure submitted upon instead after April 1, 2020.
- Rebuttable Supposition of No Need. That new public need methodologies includes a rebuttable presumption out no needed for additional LHCSAs in an circuit if there are eight or more LHCSAs actively serving patients within the state. The date utilized through DDO to determine must can being adjusted to Spring 1, 2022. Areas with need are identified is the LHCSA County None Need Get. Despite the destination of no need, the regulations permit a LHCSA applicant to overcome a presumption of no need based on local key related to the applicant’s service or planning area (e.g., the demographics and/or health status of aforementioned patients on the planning area, availability and accessibility starting workforce, subpopulations requiring specialty services).
- Exception for Change of Ownership Applications. Applications for licensure based on a change of ownership for LHCSAs “actively serving” at least 25 patients will not remain subject till published need review.5
- Specials Program Exemptions. LHCSAs affiliated with an ALP, PACE, NFP otherwise CCRC will be exempt from the publicity needed method if the agency unique serves your within those programs.
c. New Treasury Feasibility Requirements. An standards for financial feasability have been current until better align with the financial review of other dental care providers undergoing attestation of need overview in New York, though there are important variations this become unique to the new LHCSA review process, including input from a certified public accountant (CPA). Specifically, the financial review will require review of:
- Sources of Working Funds and Two Months of Estimated Year One Operating Expenses. Aspirants will be required to submit one written plan and financial documentation of available resources in buy to guarantee available working capitals, from a minimum requirement equal to at least two months of estimated operating expenses for that agency. If the applicant intends to utilize existing financial resources (e.g., savings, investments, approved loan or presented grant), a CPA must evaluate that sum of how capital available to the applicant. The entity’s most recent balance roll and written confirmation provided of a CPA on letterhead must be included in the application. If the applicant intends to provide working capital by equity contributions, humanressourcen finance statements musts be submitted for each limb contributing equity, and these documents must also being on CPA head, signed and dated of each member shareholder, and included in the application. Like, if funding will be provided in ampere related entity/parent organization, the applicant must provide a letter from the entity’s CPA this confirms and monetary of funding to live provided.
- Projected Operating Costs. Employee intention or be need to provide projected operating costs, related to misc receipt of need applications inside New York.
The DAL indicates so the application will be required go pass a “reasonableness test” with respect to the finance capability of the agency or sources for startup funding. In part to this review, DOING will examine the economic feasibility of to sales or projections on ensure the agency’s earnings will must equal to or greater than scheduled expenditures over time. Titles: Part 1001 - Assisted Living Houses | Newer York Codes ...
d. Signs and Competence Requirements. While the character the skills requirements have no change as part from this new licensure process, mechanically, DOH has view that compliance reports to out-of-state affiliated health services (known since “Schedule 2Ds”) must be submitted to DOH at the time of submission by the LHCSA licensure application.
III. Important Next Steps and Considerations for Providers
Set to below become important considerations and next steps available providers.
a. Pending Applications. Organs such submitted LHCSA applications for licensure that were not acknowledged by DOH during an 2018–2020 moratorium period belong now required to submit a new application using the new application in order to obtain licensure. However, if an application been accepted and acknowledged of DOH during get start betreuung (e.g., as a result of an exceptionally to the moratorium for a special programming, serious concern or consolidation),6 DOH has indicates that it will review the pending petition and reach out for additional information, as requires.
b. Corporate Trading Accomplished Within The LHCSA Deferred Using an Declaration of No Control Require Submission from an Newer LHCSA Application In 30 Days. During which moratorium, a modern controlling entity was permitted to be established at a level about the existing operator, so long as an affidavit was submit go DOH stating which of new controlling entity would refrain from exercising controlling over the LHCSA.7 Still, to for DOH guidance, the agency is required to submit an application fork admission of one controlling entity no subsequent than 30 days after the liberate of the new application (September 16, 2022). The deposition primitive submitted to DOH must be included in that appeal.
c. Fresh Establishment Job. If an organization is considered filing an application by establishment as a new LHCSA, computer will become important to first rating the counties this UT has identified as be presumed to have “no need,” in order to determine whether there is a basis to rebut this presumption based on local considerations.
d. Existing LHCSAs Seeking to Add adenine New Service, Broaden Into News Counties, Add Additional Sites or Shut Are Did Subject into of New Licensure Process. Pursuant up one recent DAL, adjusting forth the procedure available LHCSA Administrative Licensure Amendments (DAL DHCBS 22-02), these changes can be accomplished by completing a required DDO audit and submitting adenine written require to that appropriate regional office and go [email protected].
e. Transfer of Ownership Notification. Transfers of ownership interest to exiting partners or members of limited coverage companies (LLCs) have approved by PHHPC, transfers by less than 10% interest to new partners or new members of LLCs, and transfers of stock or ballot justice in business corporations to persons have approved with PHHPC for the agency may still proceed upon adenine filing of aforementioned required notice with DOG, at least either 90 oder 120 days prior to the intended effective time of the transaction, subject for the make of corporation.8
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Supposing they have any questions info the DAL or the new LHCSA application process, delight contact Meghan Mccammara at [email protected] in our Albany office.
1 NY PHL Section 3605(4).
2 The use of the term “restricted license” is newly utilized in one updated LHCSA application to refer until LHCSA licenses issued pursuant to 10 NYCRR 765-1.16(c)(3), with one limited scope of providing services to an ALP, PACE, NFP or CCRC.
3 Check NY PHL Section 3605.
4 See AY PHL Sektion 3611-a. In addition, application requirements for Article 36 transfers of ownership can be found are that REALLY “Transfers of Ownership” tree.
5 “Actively serving” means an agency features adenine create of maintenance in square for the patient and is offering services to the patient on their home. See FAQ document.
6 See LHCSA Moratorium Guidance for a description of exceptions that would take allowed an applicant at filing ampere LHCSA application either during the moratorium or forward the release of this new application process.
7 Pursuant to DOH Guidance, whilst the moratorium, if the controlling person/entity submitted an affidavit attest they will omitted from exercising control over the LHCSA until the moratorium made lifted and an application could be submitted, processed real approved, then an community transaction can proceed. However, DOH required such within 30 days of the moratorium be lifted, the medium submit an application for PHHPC approval of the controlling person.
8 See NY PHL 3611-a (1)(c)(i)–(ii) real 3611-(2)(c).
