Med­i­caid pro­grams brace for new home health wage rule

Modern Healthcare - - NEWS - By Vir­gil Dick­in­son

State Med­i­caid pro­grams, the largest pay­ers of home health ser­vices and per­sonal care sup­port, are ill-pre­pared to pay work­ers in that sec­tor min­i­mum wage, over­time or trav­el­ing ex­penses, which next month will be re­quired un­der a new U.S. La­bor Depart­ment rule.

Home health­care agen­cies haven’t ever had to pay min­i­mum wage or over­time to com­pan­ion­ship work­ers who pro­vide “fel­low­ship, care and pro­tec­tion” to home­bound pa­tients. The new rule nar­rows that def­i­ni­tion to those who spend no more than 20% of their time pro­vid­ing ac­tual care, such as feed­ing and bathing. The rule will also no longer ex­empt com­pan­ion­ship work­ers em­ployed by third par­ties, such as home health agen­cies, from wage pro­tec­tions.

The industry had strongly op­posed the rule, say­ing it would make home health­care un­af­ford­able for pa­tients. States, which through Med­i­caid, spent more than $56 bil­lion in fed­eral and state dol­lars for those ser­vices last year, had largely re­mained out of the de­bate.

“Broadly, I’d say states are not pre­pared,” said Matt Salo, ex­ec­u­tive di­rec­tor of the Na­tional As­so­ci­a­tion of Med­i­caid Di­rec­tors. Salo said the new La­bor Depart­ment rule ig­nores the com­plex­ity of how Med­i­caid pays for, ad­min­is­ters and de­liv­ers long-term ser­vices and sup­ports (LTSS). The depart­ment, he said, “is like a bull in a china shop. (It) changed the face of LTSS de­liv­ery with a sweep of an arm.”

Fed­eral of­fi­cials have noted a lack of pre­pared­ness as well. “This is a com­pletely new con­cept for Med­i­caid sys­tems around the coun­try,” said James Toews, a se­nior ad­viser with HHS’ Ad­min­is­tra­tion for Com­mu­nity Liv­ing.

In ad­di­tion, man­aged-care plans that over­see home health Med­i­caid ben­e­fits may not be aware they will be re­spon­si­ble for the ad­di­tional costs, he said.

Med­i­caid plans that are aware of their new obli­ga­tions are push­ing for a bump in their rates.

“Our pri­mary con­cern is that, should costs go up ma­te­ri­ally as a re­sult of com­pli­ance, re­im­burse­ment rates will be ad­justed ac­cord­ingly to main­tain their ac­tu­ar­ial sound­ness,” said Meg Mur­ray, CEO of the As­so­ci­a­tion for Com­mu­nity Af­fil­i­ated Plans.

Med­i­caid plans tend to sub­con­tract with home health agen­cies to over­see home aid ser­vices.

Amida Care has started to re­ceive wage-in­crease re­quests from some of its home health ven­dors, ac­cord­ing to Su­san Cum­mins Ca­puto, an ex­ec­u­tive vice pres­i­dent at the New York Med­i­caid plan. She’s un­sure whether Amida will be able to pay its ven­dors more with­out a rate in­crease. States must go to their law­mak­ers for rate-hike ap­proval.

Leslie Mo­ran, a se­nior vice pres­i­dent with the New York Health Plan As­so­ci­a­tion, said that the ap­proval process has many plans wor­ried, since it is im­pos­si­ble for new rates to be ap­proved and funds to flow be­fore the im­ple­men­ta­tion dead­line.

The New York State Depart­ment of Health is sur­vey­ing Med­i­caid plans to find out how many hours home health providers cur­rently work, so they can de­ter­mine how much the rule change will cost the state, Mo­ran said. Louisiana and Texas are tak­ing sim­i­lar sur­veys. All that in­for­ma­tion might not help, though.

In 2011, New York placed a cap on what the state can spend on Med­i­caid. The bud­get can’t grow more than 4% a year.

With­out ad­di­tional fund­ing, many home health agen­cies are likely to re­act to the rul­ing by cut­ting work­ers’ hours to avoid in­cur­ring over­time ex­penses, ac­cord­ing to an op-ed writ­ten by Marki Flan­nery, an ex­ec­u­tive vice pres­i­dent at Vis­it­ing Nurse Ser­vice of New York. Ben­e­fi­cia­ries are also voic­ing their con­cerns. Athena Savides, a 25-year-old woman with cere­bral palsy liv­ing in Brook­lyn, wrote to the La­bor Depart­ment say­ing that with­out ad­di­tional gov­ern­ment fund­ing to com­ply with the new wage rule, in­di­vid­u­als like her would be in­sti­tu­tion­al­ized in­stead of re­ceiv­ing care at home.

In 2014, on av­er­age, a year of home health aide ser­vices cost $45,800 on av­er­age, while care at a skilled-nurs­ing fa­cil­ity av­er­aged $87,600, ac­cord­ing to the Kaiser Fam­ily Foundation.

But not all states are un­pre­pared. In Cal­i­for­nia, where 350,000 res­i­dents work pro­vid­ing per­sonal care ser­vices to Med­i­caid ben­e­fi­cia­ries, an ad­di­tional $270 mil­lion was put in the state’s gen­eral fund to cover the costs of the new rule.

The La­bor Depart­ment has said it will not start en­forc­ing the rule un­til Nov. 13. Of­fi­cials also said they would ex­er­cise dis­cre­tion in de­cid­ing whether to pe­nal­ize non­com­pli­ant par­ties. They will also take into con­sid­er­a­tion good faith ef­forts to com­ply with the law, agency of­fi­cials said.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.