Long Term Care White Papers

Long Term Care (LTC) Reform began in earnest in New York in 1984 under a Federal Grant to develop a Nursing Home Resident Assessment Instrument (RAI) (called the Patient Review Instrument-PRI), a classification system (Resource Utilization Groups-RUGS II), a Case Mix payment system based on RUGS, and a quality monitoring system used for Survey targeting - driven by patterns of PRI responses (the New York Quality Assurance System-NYQAS).OBRA-87 began the expansion of assessment driven payment and quality monitoring to more comprehensive assessment and classification tools (the Minimum Data Set-MDS and RUGS III); to other states (the Multi-State Case Mix and Quality Demonstration); to other payors (Medicare RUGS PPS); and to other settings (Inpatient Rehabilitation Facilities-IRFs using the IRF-PAI, Home Health Care using OASIS, etc.). Alternative delivery models (Program for All-inclusive Care for the Elderly-PACE, Continuing Care Retirement Communities-CCRCs, etc.) and payment waiver/demonstrations (Managed Long Term Care-MLTC, Home and Community-Based Services -HCBS, Money Follows the Person-MFP, etc.) were tested throughout the country.By 1996, New York State created the Long Term Care Reform Task Force to review these developments over the past decade across the country, and formulate a strategic direction to implement these reforms. Since Next Wave was involved hands-on in many of these initiatives, we provided input to the Task Force, particularly outlining a framework to pull together and visualize these issues in an understandable form. Summary comments were provided at a Legislative Hearing. Follow-up comments outlining the framework we discussed at this hearing were requested by Department of Health staff.