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Northern Lights moves toward CHHA

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CANTON — Options for home health care are expanding in St. Lawrence County, but additional choices could prove difficult for the county-run agency.

On Thursday, a committee of the state’s Public Health and Health Planning Council approved the application of Northern Lights to operate a certified home health agency in the county. The application moves to the council’s full board Oct. 11.

Additional applications to establish CHHAs in the county are pending from L. Woerner Inc., which does business as Health Care of Rochester, and Visiting Nurse Service of New York CHOICE.

County residents already are served by Health Services of Northern New York, an affiliate of the Hamister Group, and by the St. Lawrence County Certified Home Health Agency, whose continued existence could once again be fodder for legislative debate.

“We might end up with a lot of competition,” said county Public Health Director Susan J. Hathaway.

The county has known for months that it would be opened up to new CHHAs because the state lifted a moratorium to meet the challenges proposed by a redesign of Medicaid. As the state moves into more managed care, it wants enough CHHAs to meet needs.

County agencies often have more generous benefit packages, making it harder for them to compete with private agencies.

Earlier this year, legislators rejected Northern Lights’s offer to buy the county agency for $80,000. Northern Lights is a partnership of Canton-Potsdam Hospital, Potsdam, Claxton-Hepburn Medical Center, Ogdensburg, Hospice and Palliative Care of St. Lawrence Valley and United Helpers Management Co.

“We think it’s a needed part of our continuum,” said United Helpers Chief Executive Officer Stephen E. Knight. “We look forward to opening our doors.”

If approved by the state board, the partners will have a lot of logistical decisions to make and do not have a target opening date yet, Mr. Knight said.

Health Care of Rochester previously had been interested in operating in St. Lawrence County and has been expanding for several years. It filed applications to operate CHHAs in 13 counties, including Jefferson, Franklin, Essex and Oswego.

“It certainly was an opportunity to do a lot at once,” said Mark Maxim, HCR president and chief executive officer.

Since 2009, HCR has taken over county-run agencies in Genesee, Orleans, Schoharie, Delaware, Cortland, Madison and Clinton counties.

Visiting Nurse Service of New York CHOICE, which provides services mostly in the New York City area, is also trying to expand into Central New York. The status of its application for St. Lawrence County is unknown.

HCR was asked by the state for more information, which is due Oct. 17, Mr. Maxim said.

He said he doubted the state would approve all of the agencies vying for a piece of St. Lawrence County, but said competition does not bother him.

“We’re fine with it, although it doesn’t make sense to have five,” he said. “We’ll expand as soon as we can to meet the need.”

Ms. Hathaway worried that the county might be driven out of home health care but have to retain responsibility for long-term care, which covers patients with chronic conditions whose bills are paid by Medicaid. Medicaid reimbursements are typically lower than those paid by Medicare, insurance companies and self-pay clients who use home health care.

“Right now, we have about 60 long-term care patients,” she said. “We could be the only long-term care providers in the county and we can’t quit. We have to continue.”

Long-term care coverage would be a decision for Northern Lights’ partners to consider, Mr. Knight said.

HCR did not apply for long-term care certification, first because it was not allowed under the home health agency window, but also because of pending changes in how the state structures the program, Mr. Maxim said.

“It’s all going to change very quickly,” he said.

However, much of the work VNSNY CHOICE does is Medicaid-managed long-term care.

“VNSNY CHOICE is a safety net for a growing population that is at risk for falling through the cracks in our health care system,” Christopher Palmieri, president of VNSNY CHOICE Health Plans, wrote in an email message. “Our mission has always been to help people take responsibility for their own health, while providing the care and assistance they need to live with dignity in the homes and communities that sustain them. We’re interested in expanding our service to communities like St. Lawrence where we know there’s a growing need — one that our home- and community-based mission is specifically designed to fill.”

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