LeadingAge New York Adviser Winter Vol. 1 | Page 29

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care organizations about the needs of this
populations and what needs to be covered for
payment (Such as Home Health Aide services).
Poor Medicaid reimbursement for Private Duty
Nursing is a particular issue that limits our
ability to discharge patients as well. We spend
a lot of effort, both for in-patient and at-home
pediatric patients, to provide education to
others about the unique needs this population
requires.
So, in light of those challenges what
keeps you up at night?
Like most providers, we live on a
reimbursement roller coaster and the
uncertainty of future dollars is really
troublesome. I cannot predict exactly how
we’re going to get paid, or estimate what we’re
going to get paid, three to five years from now.
I worry that the contracts that the managed
Medicaid plans are going to have with the
State won’t be adequate to cover the costs
of services that we provide and therefore
the plans are going to try and cut back on
services. Right now we have a mortgage
that we have to pay which is covered, by

regulation, by Medicaid. If that capital cost
gets passed over to plans it becomes a factor
of negotiating with each plan. It will be difficult
to ensure that I’ll be able to pay our mortgage
much less our operating costs.
Also, we are a very tiny, downstream provider
and within many different Performing Provider
Systems (PPSs) through Delivery System
Reform Payment Incentive Payment (DSRIP).
Right now, I have no idea how and if, money
is going to trickle down to us from the PPSs.
We’re putting an enormous amount of time
and energy into being good partners and
bringing creative ideas but I have no idea what
it’s going to mean for us. So it is really the
uncertainty of the dollars in the future that
most often keeps us up at night.
I think that when they wake up to the true
needs of moving medically complex kids to the
community, ultimately, we’re going to be a very
important player within these PPSs because
of our continuum of care, our in-patient
and community-based programs and case
management capabilities. But ultimately we
have no control. It’s just a matter of “how well
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