Tag: Providers

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[MM Curator Summary]: Ask for $200M more, get $119M more.

 
 

 
 

PROVIDERS (NH)- Senate Finance votes to reduce Medicaid payment increase for providers by $15 million – New Hampshire Bulletin

 
 

Clipped from: https://newhampshirebulletin.com/briefs/senate-finance-votes-to-reduce-medicaid-payment-increase-for-providers-by-15-million/

 
 

Providers had requested an additional $200 million in the next budget. (Getty Images)

Mental health centers, midwives, home health care aids, and other human service providers may see a smaller increase in Medicaid payments than the $134 million the House approved. 

The Senate Finance Committee voted, 5-1, Tuesday to cut the House’s increase by $15 million, which would give providers about a $119 million increase. 

With the federal match for Medicaid, that is at least a $30 million decrease in Medicaid funding.

Providers had requested an additional $200 million in the next budget. The governor proposed $24 million. The House increased that to $134 million after providers said the state is paying them so little in Medicaid that they can’t hire staff or adequately care for the state’s most vulnerable residents.

Senate President Jeb Bradley, who authored the amendment reducing the House amount, called the $119 million a “huge appropriation of dollars.” 

“We’ve got several huge items: housing, child care, pay raise for state employees, education funding, and Medicaid provider rates,” Bradley said. “If we don’t, at least in my opinion, make a pretty concerted effort to enhance our Medicaid provider rates, our health care system and everybody that depends on it is going to suffer.”

Bradley’s amendment would also give the Department of Health and Human Services more flexibility than the House did in deciding how to target increases to various providers. 

Sen. Cindy Rosenwald, a Nashua Democrat on the Senate Finance Committee, was the lone no vote. She noted that the committee also cut other Medicaid funding by more than $100 million on Tuesday. 

“I’m really concerned about this,” she said. “We do have the revenues to do it in the next biennium, and I would hope we would have the will to continue with this important workforce piece.”

The Senate Finance Committee’s proposed budget will go before the full Senate next, and then to the House, which can agree or challenge Senate changes. 

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Details on poor quality in the RI nursing home market. In this article, explained entirely by payment gaps (that have been in place for 11 years).

 
 

PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

 
 

Clipped from: https://www.mcknights.com/news/medicaid-and-leadership-challenges-as-state-takes-over-nursing-home/

 
 

 
 

A Rhode Island nursing home with more than 30 citations for deficiencies and whose administrator’s license was suspended last month has been put into state receivership. 

While declining to comment about the situation at the facility itself, the sector’s leading advocates in the state told McKnight’s Long-Term Care News that the broader picture of nursing homes in distress has become acute due to surging labor costs and chronic underfunding. 

“Rhode Island Medicaid has been chronically underfunded for more than a decade,” said John Gage, president and CEO of the Rhode Island Health Care Association.

The state’s Medicaid rates are based on 2011 actual costs inflated by approximately 1% per year since 2012, Gage said. The estimated shortfall is $50 million to $60 million per year, and the pre-pandemic gap between reimbursement and the cost of care was approximately $30 per patient per day. Both Gage and his counterpart at LeadingAge Rhode Island, which represents nonprofit facilities, said the gap is likely much higher now.  

“We have a high rate of Medicare Advantage beneficiaries, and those plans don’t pay as well as 

traditional Medicare, so providers are squeezed on that end,” explained LeadingAge Rhode Island CEO James Nyberg. 

On top of that, the state’s skilled nursing facility workforce is down approximately 20% since the pandemic – registered nurses are down 16.5%, licensed practical nurses are down 18.3%, and certified nursing aides are down 25.4%, Gage said, adding that the usage of expensive staffing agency personnel has quadrupled.

What’s more, in 2021, the state approved a staffing minimum requiring 3.58 hours of direct care per patient per day that Gage said will cost approximately $60 million per year while funding was set at just $12 million per year. 

“Clearly, something has got to give,” he said. 

There are 80 nursing homes in Rhode Island, including the Charlesgate Nursing Center, which is in the process of closing due to staffing challenges and inadequate Medicaid reimbursements, Gage said.

Pattern of issues

The state Department of Health made a surprise inspection of the Pawtucket Falls Healthcare Center in October. What followed has been detailed in local media as a volatile situation in which a resident’s broken bone from a fall was not noticed for two days, staff medical errors, improperly administered COVID tests, and other problems. 

State investigators also said that former Administrator Sami Almadi “tried to deceive them” about discharge papers for a resident, who complained about an improper discharge. NBC10 reported that Almadi presented a discharge form on which at least one of two nurse’s signatures was forged. Almadi’s license was suspended last month, the station’s report said.

A court-appointed receiver has now been charged with overseeing the facility. A statement from the state’s interim health director said the department “tried to help the facility stabilize” but that a “pattern of health and safety issues” over the last seven months led to the receivership, NBC10 reported.

 
 

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[MM Curator Summary]: NC providers say Medicaid is too much of a hassle. I got 99 problems and Medicaid billing rules ain’t one of em’.

 
 

Clipped from: https://www.northcarolinahealthnews.org/2023/05/09/medicaid-is-an-expensive-proposition-for-free-clinics/

 
 

Tony Price is CEO of Moore Free and Charitable Clinic in Southern Pines, N.C. Price, who also chairs the North Carolina Association of Free and Charitable Clinics, said facilities like his would need to make major changes to accept Medicaid. || Photograph by Jaymie Baxley/North Carolina Health News (Southern Pines, N.C., May 2, 2023)

For nearly 20 years, uninsured people in the Sandhills have turned to Moore Free and Charitable Clinic for medical services.

Operating in a converted warehouse at the end of an unassuming road near Pinehurst in Moore County, the clinic provides free or low-cost care to patients with diabetes, hypertension and other chronic illnesses. Construction is underway to add a dental treatment area to the facility.

Moore Free and Charitable serves hundreds of patients, some of whom may soon become eligible for Medicaid under the expansion signed into law in March by Gov. Roy Cooper. But Tony Price, CEO of Moore Free and Charitable, said his clinic does not plan on participating in Medicaid — at least not for the time being.

“Medicaid is a complex process,” he said. “There’s a whole lot of compliance issues that we don’t have to deal with today that you do when you take Medicaid.”

One issue is billing. Unlike traditional providers, the clinic does not have a billing system in place to streamline the claims process for Medicaid. Price said Moore Free and Charitable tracks the estimated value of every service it provides, but those records are for “internal use only.”

Even if it had a billing system, the clinic would need to hire staff to prepare claims and submit them to the state. This work is time-consuming and requires a fastidious eye, according to Price. A claim could get kicked back or rejected if the person filing it accidentally enters the wrong code. (Codes signify what a patient’s diagnosis is and what care they received.)

Price chairs the North Carolina Association of Free and Charitable Clinics, an organization made up of more than 70 clinics that cater to the uninsured. The association’s members saw a combined 82,480 patients in 2021, the most recent year for which data is available.

Price’s misgivings about accepting Medicaid are shared by other members of the association, many of which lack the money and manpower needed to overhaul their clinic operations to accommodate Medicaid patients. All of the state’s free clinics rely primarily on donations and grants to stay afloat, and the facilities themselves are staffed mostly by volunteer physicians, nurses and other medical staff.

“The infrastructure will have to change in the clinics, and that’s an expensive proposition,” Price said.

Clinical contrast

April Cook, CEO of the North Carolina Association of Free and Charitable Clinics, said only eight of the organization’s members accept Medicaid. 

They mainly do so, she said, to deal with the “churn” of patients who receive Medicaid for a few months before being dropped from the program. Medicaid enrollees make up only 5 percent of the total number of patients served by the association’s member clinics.

Cook said the handful of free clinics that do take Medicaid are reimbursed at a lower rate than at community health clinics, officially known as Federally Qualified Health Centers. They also have far fewer employees. 

“Typically, an FQHC has two to three times the number of staff members as free and charitable clinics, and the biggest reason is Medicaid and Medicare,” Cook said. “It takes so many more individuals to dot all the i’s and cross the t’s when you’re dealing with these federal programs.” 

 
 

A member of Moore Free and Charitable Clinic’s staff confers with a patient in Southern Pines. Data from the N.C. Association of Free and Charitable Clinics showed that free clinics had an average of only eight full-time staff members in 2021. || Photograph by Jaymie Baxley/North Carolina Health News

While the centers and clinics both focus on underserved populations, they are not always in the same communities. Price’s county, for example, is home to FirstHealth Moore Regional Hospital but does not have a federally qualified health center listed with the N.C. Department of Health and Human Services.

“Here’s the bottom line: there’s not enough FQHCs to address all of the folks that have Medicaid,” Cook said. “So if you’re in a rural area where there’s already not an FQHC or there’s a primary care shortage, there’s not a whole lot of options for patients. 

“Medicaid doesn’t necessarily mean access, which is unfortunate.”

Filling gaps

Over 600,000 people are expected to benefit from Medicaid expansion in North Carolina, but only if they are U.S. citizens or lawfully present non-citizens who have “qualified” immigration status. 

Undocumented immigrants will remain ineligible for coverage, forcing an untold number of individuals to seek care through other channels. Free clinics are among the few available options for undocumented patients who have little or no income.

Cook said that while the association does not “want to condone people coming in illegally,” she believes it is “to everybody’s benefit to treat …  where you can.”

“There are people that are on both sides of the fence here, but it’s about understanding the implications of not serving someone that is undocumented,” she said, adding that undocumented individuals with easily treatable issues may turn to emergency rooms for service if they cannot be seen elsewhere. “I think part of free and charitable clinics’ mission is to help drive down health care costs and take care of people preventively before they reach a condition that requires them to be hospitalized.”

 
 

 
 

 
 

Medicaid will not be officially expanded in North Carolina until a state budget is approved. Before that happens, many North Carolinians are expected to lose their existing coverage through the unwinding of a federal provision that prevented states from removing enrollees from the program during the COVID-19 pandemic. 

This process, known as redetermination, will likely create a new coverage gap for free clinics to help fill. 

“There’s been some talk that if [the General Assembly] can get the budget passed in June then they would try to expand Medicaid by October, which would be very fast, because of the unwinding,” Cook said. “They don’t want people that have been treated to feel like they’re out in the cold. I’m here to say they won’t be out in the cold because we have 70 free and charitable clinics in North Carolina that are there ready to help lead the way.”

Still, Cook acknowledged that funding is a persistent challenge for free clinics. The association, she said, has asked lawmakers to earmark $15 million in the state’s budget for recurring appropriations that will allow the clinics to hire additional staff and provide more services to patients. The budget passed by the House of Representatives last month contains only $5.5 million in annual funding for the free clinics, and the amount in the final budget passed by the legislature is likely to be less than what the association has asked for.

“We will not benefit financially from Medicaid expansion,” Cook said. “We are hoping that the General Assembly won’t forget about us and it realizes the critical part that we play as a safety-net provider.”

Looking ahead

Cook stressed that the free clinics represented by the association are “fully in support” of Medicaid expansion.

“We’re very happy for our patients that will be eligible,” she said. “However, that being said, [expansion is] going to extend coverage to 500,000 to 600,000 uninsured in North Carolina, with a remaining 700,000 that will not qualify for Medicaid and will remain uninsured. We are primarily focused on those individuals.”

 
 

Christina Sanford is an enrollment specialist at Moore Free and Charitable Clinic in Southern Pines. Many of the state’s free clinics are bracing for an uptick in new patients as a result of Medicaid redetermination. || Photograph by Jaymie Baxley/North Carolina Health News

While none of the association’s members have immediate plans to begin accepting Medicaid, the prospect is not entirely off the table. Cook said there is a possibility that some free clinics may adjust their operations to serve enrollees who continue to lack access to traditional  providers. 

“If two years down the road we’re hearing over and over that patients that we had are suffering because they can’t find primary care for their Medicaid, then we may have to pivot,” she said.

Price, the association chair and clinic CEO in Moore County, said it is too early to tell what the future might hold for Medicaid in free clinics.

“How many patients are we apt to lose? How many might we get back from [redetermination]? How many undocumented patients do we have out there that weren’t counted in the first place?” he asked. “We’re gonna try to pull together data to better help us make a decision about how to proceed.”

Correction: A previous version of this article stated that only U.S. citizens will benefit from Medicaid expansion in North Carolina. Non-citizens who have “qualified” immigration status will also be eligible for coverage.

 
 

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[MM Curator Summary]: This is a bigger deal than you may be thinking.

 
 

 
 

Clipped from: https://medcitynews.com/2023/04/zocdoc-adds-fqhcs-to-marketplace-to-support-medicare-medicaid-beneficiaries/

Zocdoc, a healthcare marketplace, is adding Federally Qualified Health Centers (FQHCs) to its platform. Patients are now able to find and book appointments with FQHCs working with Zocdoc on the company’s website or app, and can filter based on factors like specialty and location.

 
 

To improve healthcare accessibility for patients on Medicare and Medicaid, healthcare marketplace Zocdoc announced last week that it is adding Federally Qualified Health Centers (FQHCs) to its marketplace.

FQHCs are health clinics that focus on underserved communities and provide services on a sliding pay scale based on the patient’s ability to pay. 

New York City-based Zocdoc allows patients to find and book in-network providers for in person or virtual services via its website or app. Patients are now able to book appointments with FQHCs working with Zocdoc, and can filter based on factors like specialty and location.

The company chose to add FQHCs to its marketplace so it can provide extra support for patients on Medicare and Medicaid, said Dr. Oliver Kharraz, CEO and founder of Zocdoc.

“Zocdoc’s mission is to give power to the patient, which importantly includes all patients — not just the well-to-do or commercially insured. Introducing FQHCs is right in line with that mission, as it will make it easier for federally funded beneficiaries, and other underserved patients, to seamlessly find and book care,” he said in an email. “With access to affordable, quality care at risk for so many Americans given the expiration of the [public health emergency] and its impact on Medicaid enrollments, this was a natural time for us to focus on this effort.”

Zocdoc is already working with several FQHCs in New York, Texas and Michigan through a pilot program that began in December 2022. One of these FQHCs is Spring Branch Community Health Center (SBCHC), which serves patients in the Spring Branch and West Houston communities in Texas.

Promoted

 
 

 
 

Nicholas Turos, vice president of business development with Babson Diagnostics, talks about how his company has reimagined the blood testing experience.

Babson Diagnostics and MedCity News

“We know that access to care is one of the biggest barriers facing patients, and we decided to join Zocdoc to make our providers even more accessible to residents throughout our community,” said Michael Bsaibes, chief operating officer of SBCHC, in a news release. “Zocdoc has helped us alleviate call center volumes and is expanding our access points to more patients as we look to bring on even more providers to serve our community.” 

Zocdoc is working to add more FQHCs to its marketplace by offering its services at a 50% discount. The company charges providers a fee for each new patient booking made through the platform. For FQHCs, this fee would range from about $20 to $55 depending on the specialty. 

Although FQHCs are new to Zocdoc’s marketplace, the company has long been serving federally funded beneficiaries, Kharraz said. In 2022, about 15% of bookings made on the platform were from federally funded patients.

By working with FQHCs, Zocdoc ultimately aims to increase access to care, Kharraz said.

“Our goal is to bring more FQHCs on to Zocdoc’s marketplace to further accelerate access to high quality, affordable care for the patients and communities that need it most,” he stated.

Photo: Nataliia Nesterenko, Getty Images

Clipped from: https://newhampshirebulletin.com/2023/03/22/were-teetering-on-the-edge-are-medicaid-rates-making-it-harder-to-age-at-home/

 
 

 
 

 
 

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[MM Curator Summary]: Two main HCBS providers are saying they are out if they don’t get millions more in this year’s budget theater.

 
 

 
 

Edrie Fortin, with nurse Ellen DeStefano, was able to age at home in Manchester thanks to in-home care she received from Waypoint of New Hampshire through the Medicaid-funded Choices for Independence program. Fortin died in 2022 at age 95. (Courtesy | Waypoint of New Hampshire)

Instead of living in nursing facilities, nearly 3,800 Granite Staters are in their own homes and communities thanks to the help they receive with basic needs like bathing, transferring from a wheelchair to bed, managing medications, making meals, and getting to medical appointments.

Approximately 600 of them risk losing that care in July if the state doesn’t increase what it’s paying providers through the Medicaid-funded Choices for Independence (CFI) program, which covers the cost of housekeeping and personal care services for people who want to age at home and qualify for Medicaid.

The heads of Ascentria Care Alliance and Waypoint of New Hampshire, who have 600 CFI clients between them, said they will leave the program in July if lawmakers do not increase their Medicaid payments. They said they’ve stayed in the program this long only by fundraising to cover their losses.

It’s still early in state budget negotiations, but their rate requests far exceed the 3.1 percent increase Gov. Chris Sununu has proposed in his two-year budget. Their departure would leave their clients few options; the state has a massive shortage of direct care workers, and long-term care nursing facilities are full.

“It’s turned into, we used to subsidize (the care) somewhat, to now, it’s going to break the organization if it continues at this rate,” said Angela Bovill, president and CEO of Ascentria. “It’s not that we don’t care. We haven’t stopped caring or we wouldn’t have been subsidizing it the last bunch of years. But the subsidy numbers are getting so high, that it’s no longer even a viable question.” 

It’s been a moral and practical decision, Bovill and Borja Alvarez de Toledo, president and CEO of Waypoint, said.

Even with fundraising and temporary American Rescue Plan money, Ascentria and Waypoint  said they can’t pay their direct care workers more than $13.50 an hour, so little that in 2020, 32 percent of those in New Hampshire relied on some kind of public assistance, according to PHI, a national policy organization focused on elder care and disability services. 

“I can’t go to sleep at night and continue to treat the staff that we hire this way because it’s not right,” said Alvarez de Toledo. “And we’ve been doing it because we care about the seniors. And who’s going to take care of them? At some point, I’m like, ‘Wait a minute, is this our responsibility? Do I have to, year after year, raise half a million dollars to just break even in this contract?'”

 
 

Doris Morton, an in-home-care provider at Ascentria Care Alliance, cares for Irene Rousseau of Concord. (Courtesy | Ascentria Care Alliance)

Amy Moore, director of in-home care at Ascentria, said it has become so hard to recruit staff at that salary that her agency is turning down 100 client referrals a month and increasingly relying on families or close friends to provide CFI services. 

About four years ago, about 40 percent of the agency’s care givers were family members and friends caring for a loved one. Now it’s 90 percent, Moore said.

“Those people have all had to leave careers, move, and uproot their lives,” she said. “Those family members are the only reason, frankly, we still have a program going, and we’re teetering on the edge. That’s a very broken system.”

The fragile finances are hurting clients, too, Alvarez de Toledo said.

Unable to recruit or retain workers, Waypoint is providing clients fewer services than what they’ve qualified for. “They’re authorized for 25 hours, and you say, ‘Well, I can only give 12. That’s what they’re getting from us,” Alvarez de Toledo said. “And that’s not OK either.”

Services approved versus services provided

A 2021 federal lawsuit against the state Department of Health and Human Services alleges it paid for only 55 percent of the services it approved for CFI clients in 2018 and 2019. New Hampshire Legal Assistance, Disability Rights Center – New Hampshire, AARP Foundation, and the Nixon Peabody law office, who brought the case on behalf of four plaintiffs, have asked a judge to certify it as a class action lawsuit.

Jake Leon, spokesman for the Department of Health and Human Services, said there are a number of reasons why CFI participants do not receive all their authorized services. They often don’t request the transportation services they could, or they don’t receive them because they are in the hospital or a short-term rehabilitation center for a surgery, illness, or some other reason, he said in an email. Concerns about COVID-19 have led some to forgo services, he said. Others have very specific preferences about which worker delivers services in their home.

The New Hampshire Fiscal Policy Institute identified additional reasons in a 2022 analysis.

The workforce shortage was a big one but not the only one. Determining financial eligibility for Medicaid can be very complex, it said. There can be long waits for documentation and approval, and finding the right information or methods for applying for Medicaid can be difficult. And getting approval for services for in-home care can take longer than those for provided in nursing homes.

In Oct. 2021, the median processing time for Medicaid application approval was 36 days for nursing facilities and 45 days for CFI services, the analysis found. In some cases,  the wait was 90 days, it said. “These long delays mean people may not receive critically needed services,” the report said.

$153.2 million in lost funding

CFI services are available to people who are over 18, have a chronic illness or disability, qualify for nursing-home level care, and are eligible for Medicaid. The state sets the reimbursement rate and splits the cost with the federal government. 

It’s a much less expensive way to care for people who would otherwise go to a nursing home.

A year of CFI services costs less than $20,000 compared to $80,000 to $100,000 for a nursing home, Alvarez de Toledo said. And nursing homes can’t accommodate hundreds of new patients. As it is, the state’s hospitals say they are unable to discharge patients to long-term care, sometimes for weeks, because nursing homes have so few available beds. 

But the state has not funded the CFI program as generously as it has nursing home care, according to the New Hampshire Fiscal Policy Institute analysis.

 
 

In a 2022 analysis, the New Hampshire Fiscal Policy Institute found that organizations providing in-home care through the Choices for Independence program would have received an additional $153.2 million between 2011 to 2021 if the state has more closely kept up with inflation. (Screenshot | New Hampshire Fiscal Policy Institute)

 It found that the state’s Medicaid payments to nursing facilities kept better pace with inflation than its CFI payments for in-home care did. Between 2011 and 2021, the CFI providers would have received an additional $153.2 million had the state adjusted their Medicaid rates for inflation the same way it did for nursing home services, the institute found.

‘If I said to you, ‘We’re going to develop a program that makes the client happy, keeps the client in their home, saves the state money, benefits the hospitals, and benefits the nursing homes,’ you would say, ‘Where can we implement this program?'” said Keith Kuenning, director of advocacy at Waypoint. “We have that program. Right now. It’s ongoing in New Hampshire, except the program is on the verge of collapse because they won’t fully fund it the way that they need to.” 

‘I’m not sacrificing the people who work for us’

Leon said his agency supports the kind of comprehensive review of CFI rates that’s called for in Senate Bill 86. The bill would also put $40 million each of the next two years into Medicaid rate increases, but it is not yet determined how that will be divided up.

There’s lots of competition for that money. The state’s 10 community mental health centers, which rely on Medicaid for 70 percent of their budgets, requested a 21.5 percent to 23 percent increase in their rates.

Leon noted that the department requested and received funding from the Legislature to increase what it pays for CFI services over the last five years. He said in fiscal year 2022, payments for personal care services increased 15 percent, while payments for homemakers services rose by 6 percent. Leon said rates have increased since 2018 by 3 percent or 4 percent each year. 

Kuenning characterized those numbers as accurate – but misleading. 

For at least a decade, the state has paid CFI providers less than the cost of delivering CFI services, he said. A 6 percent increase on an underfunded system is not sufficient, he said.

“If those were adequate, why is Ascentria losing $1.5 million a year? Why are we losing $500,000 a year?” said Kuenning of Waypoint’s work with its 200 clients. “It’s true that they’ve given us the raises, but honestly, it doesn’t do enough to make a difference to keep our program running.”

Leon said the department has invested $30 million in federal money into increasing the workforce with retention and hiring bonuses and stipends. The agency also worked with the state Department of Employment Security to recruit and train additional service workers, he said.

Providers like Ascentria and Waypoint argue that solving the workforce shortage must begin with an increase in their $13.50 hourly wage, which would require rate increases,  not only temporary stipends and bonuses.

When asked about potentially losing Waypoint and Ascentria in the CFI program, Leon said, “A loss of provider may impact the provision of service to New Hampshire’s most vulnerable citizens, but a thorough analysis would be necessary to determine the extent of that impact.”

It looks certain that Medicaid rates will increase in the next budget. Sununu’s proposed 3.1 percent annual increase won’t be enough, according to Medicaid-funded organizations. 

Ascentria and Waypoint said their requested 11 percent increase for homemaker services would bump that hourly payment from $21.60 to $24. The 33 percent increase they are seeking for personal care services would bring that hourly payment from $22.48 to $30. 

It would be enough just to break even, Bovill and Alvarez de Toledo said. It wouldn’t be enough to pay a competitive wage or give clients all the services the state has said they qualify for, they said. 

“As mission driven organizations, we can’t say, ‘Well, we’re delivering our mission to seniors because we’re really not’,” said Bovill. “I’m not sacrificing the people who work for us on behalf of an attempt to care for some other people, because then everybody fails. And I can’t see how that’s an acceptable answer to anything.”

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and the John A. Hartford Foundation.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Turns out they didn’t just do what the consultants said. Still increased the provider payments by $88M (but of course providers say that’s still not enough).

 
 

Clipped from: https://billingsgazette.com/lifestyles/health-med-fit/amendment-to-fund-medicaid-provider-rates-to-benchmark-fails/article_b08add74-c289-11ed-8ea0-bba0b8bc9b2a.html

An amendment to further increase Medicaid provider reimbursement rates failed in a 13 to 10 vote Tuesday before the House Appropriations Committee.

Carried by Rep. John Fitzpatrick, R-Anaconda, the amendment would have brought provider rates in line with the benchmarks suggested by Guidehouse, the team commissioned by the state to assess reimbursement falls short in four essential human services departments.

The amendment also added a 3% inflationary increase for each year between 2021 and 2024. An additional 3% increase would have covered 2025.

“The concern I have with this issue is that we’re making a big bet. And the bet is this: we’ve either provided them with enough money so that they can continue on and go through the next biennium and survive. Or two, we’ve short changed them and we’re going to lose service providers,” Fitzpatrick said.

Over the last two years, providers serving a large population of Medicaid recipients reported a 14% increase to their expenditures, much greater than the typical 2% inflation seen in a typical biennium, Fitzpatrick said.

Inflation, provider shortages and wage pressures have pushed services to the brink of closure in the years since the pandemic.

Perhaps the most significant being the 11 nursing homes that closed in 2022. The sudden decrease in skilled nursing beds has created a bottleneck in Montana’s hospital systems, creating a significant financial burden.

Rep. Bob Keenan, R-Bigfork, defended the work done in the Human Services Subcommittee where legislators voted to increase provider rates from the governor’s proposed budget, but did not opt to fully fund rates to the benchmarks.

“We had an opportunity this session to help (with the traditionally low reimbursement rates) and I was pretty excited about it because it’s been fairly lonely trying to advocate for these providers across the state,” Keenan said. “…I resist this amendment just for the simple fact that I’m really proud of what our subcommittee has done at this point in time,” Keenan said.

With the subcommittee’s budget vote, $87.5 million is directed to provider rates. With the Medicaid match, that amounts to $305 million directed into the Medicaid system.

Benchmark rates ‘foundational’

While the infusion of cash marks a historic budgetary increase for these Medicaid providers, dozens of leaders representing organizations for SUD treatment, children and adult behavioral health, nursing homes, in-home care providers, aging services, developmental disabilities, and more encouraged lawmakers to bring reimbursement in line with the benchmark rates.

“Funding these rates is not a fix for everything but it really is foundational. It’s what needs to happen first before we can begin to make a lot of those other fixes within the system,” said Erin McGowan, who spoke in support of fully funding the benchmark rates at an appropriations committee meeting last Thursday. McGowan is a lobbyist for various provider groups across the state including Homecare Montana and Confluence Public Health.

What’s missing from the subcommittee’s budget, said McGowan, is a regular cost of living adjustment that would prevent future underfunding of these services.

Many of the services included in the rate study are highly sensitive to inflation. Group home providers, for example, provide food and transportation to residents. When grocery and gas prices go up, so do the group home’s expenses.

Joshua Kendrick, CEO of Opportunity Montana, said that the rate increase would equate to a wage increase for staff.

Many who spoke during public comment explained that the staffing shortages are, in part, due to the inability to offer a competitive wage to current and future employees who could make better money working in food service.

Over the course of the pandemic, Youth Dynamics, which provides mental and behavioral health services for kids, lost 56 full-time employees and 83 part-time employees, said Dennis Sulser who represented the organization at the hearing.

Since July 1, 2022, 43% of the employees who provided a reason for their departure from Youth Dynamics said it was due to low wage or better job opportunities elsewhere, according to Sulser.

Countless providers expressed to lawmakers that the benchmark rate would just barely bring reimbursement rates up to their current costs.

Nonetheless, health department director Charlie Brereton, again pushed for the governor’s initial budget proposal in the Thursday meeting. The proposal mostly consists of one-time-only funding that would close 58% of the gap between current rates and the benchmark in 2024. In 2025, the rates would decrease, covering only 36% of the gap in 2025.

Brereton said the proposal centered on being responsive.

In an effort to address questions about not fully funding the benchmark rate, Brereton read a statement.

“The benchmark is average costs and reflects a wide array of provider practices. The average costs are important in identifying the accuracy of a rate but ultimately reflect an average of the costs. It’s a compass that shows where we should be headed, but not necessarily a minimum of what is needed to stabilize any provider type,” Brereton said.

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: How much of a rate increase is needed to deal with nursing facility challenges in PA? The answer is not 17%.

 
 

 
 

Clipped from: https://www.mcknights.com/news/despite-major-medicaid-boost-lack-of-staff-still-limits-nursing-home-admissions/

 
 

Tine Hansen-Turton, president and CEO of the Woods in Pennsylvania, discusses workforce solutions at a summit Tuesday. Credit: PHCA

Months after a 17% Medicaid increase kicked in, hundreds of Pennsylvania nursing home beds remain empty because facilities can’t hire enough staff to provide care, a new survey finds.

The Pennsylvania Health Care Association released its 2023 State of Nursing Facilities Report Tuesday showing that 57% of responding members have beds they cannot fill due to a lack of staff.

Thirty-one percent of respondents said they have 21 or more direct care positions open but cannot find certified nurse aides, licensed practical nurses or registered nurses to fill them.

The association held a Long-Term Care Policy Summit Tuesday in the state capital to bring together lawmakers, providers and others to brainstorm and share workforce solutions.

The PHCA survey showed:

• The average facility denied 17 admissions because of a lack of staff between November 2022 and February 2023.
  
• 81% of respondents are using staffing agencies to fill open positions.
  
• 93% of respondents anticipate either needing to use or increasing their use of agency
  
• Facility labor costs increased an average of 20% from 2019 to 2022.
  
• 93% of respondents anticipate either needing to use or increasing their use of agency workers to meet the new state staffing minimum that will begin in July.
  

In related news, LeadingAge Pennsylvania on Wednesday sent a letter to US Sen. Bob Casey Jr. (D-PA) outlining members’ concerns about the looming federal staffing requirement.

“We must recognize that providers are in crisis and residents’ access to care is at risk, due in large part to historic underfunding and a workforce crisis that predated the pandemic,” wrote President and CEO Garry Pezzano. “As we get back on our feet after the pandemic, we need to [give] common sense approaches a chance to make an impact before jumping to arbitrary staffing mandates on a national level. Common themes worthy of support include efficient and accessible training and competency programs, workforce immigration pipelines, faster turnaround times for staff licensing and test center coordination, and developing and incentivizing modern career pathways.”

New resources haven’t turned tide yet

Pennsylvania increased its Medicaid reimbursement rates by 17.5% last year after nearly a decade with little to no increases. That boosted rates by approximately $35 per resident per day. Association President and CEO Zach Shamberg said survey respondents “overwhelmingly” plan to use those extra funds to recruit and retain staff.

Despite that, nursing homes in the state continue to struggle.

“The problem is, we’ve made a promise to [aging] Pennsylvanians that we will care for them and that care, the availability of that care, and the accessibility to that care is very much at jeopardy today,” Shamberg said in opening remarks at the summit. “There are providers … who are having real difficulty keeping that promise.”

Pennsylvania has relied heavily on temporary nurse aides during the pandemic, giving frontline staff key training opportunities even as the state saw significant certification delays.

Joseph DeMattos, president and CEO of Health Facilities Association of Maryland, also attending the summit and said the tens of thousands of temporary nurse aides in his state during the pandemic played an “incredibly critical role” in caring for residents.

Shamberg said Pennsylvania facilities that used temporary aides each converted an average of eight into full time CNAs over the last few months, which has resulted in approximately 4,500 new, full-time workers.

But Centers for Medicare & Medicaid Services TNA waivers in all remaining states expire along with the public health emergency on May 11.

“The pandemic may be over but if we don’t get on the right track — if we don’t start addressing this today, then the challenges will be long lasting,” Shamberg said, noting that the association plans to make approval of nursing home medication aides a legislative priority this year.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The legislature decided to just do exactly what the consultants said this time.

 
 

Clipped from: https://dailymontanan.com/2023/03/01/house-human-services-advances-bill-to-fully-fund-medicaid-rates-in-guidehouse-study/

 
 

The House Human Services Committee on Tuesday passed a bill to fully fund Medicaid reimbursement rates recommended in an in-depth study by a national consultant — plus the cost of inflation.

House Bill 649 passed 17-4 with bipartisan support following a lengthy hearing Friday where an onslaught of providers from across the health care and medical community spoke in support.

Levi Anderson, with the Western Montana Mental Health Center, said he had just sent a letter one week earlier notifying partners across the state the center was closing 31 community-based mental health crisis stabilization beds, which represent 65% of state capacity.

“That is a direct result of a lack of funding for those services,” Anderson said.

At the meeting Tuesday, Rep. SJ Howell, D-Missoula, said all the other bills the committee would deal with rest on HB 649. In other words, if legislators are to truly address the continuum of care, they need to address “deeply underfunded providers.”

“I think this might be the most important bill this committee is going to grapple with this session,” Howell said.

Howell joined all other Democrats on the committee and a majority of Republicans in voting in favor of the bill, sponsored by Rep. Mary Caferro, D-Helena.

“It is critical that we fully fund healthcare services before another nursing home closes and more Montanans are left to sleep the night in their wheelchairs,” Caferro said in an email Wednesday. “We have the data that proves Medicaid providers are underpaid. We have the money. Let’s solve the problem.”

The bill notes inadequate rates have resulted in the closure of 11 nursing homes and loss of 857 skilled nursing facility beds in the state. It is expected to be on the House floor Thursday.

In the last session, the legislature authorized the Department of Public Health and Human Services to spend $2.75 million to pay for an analysis of provider rates in the state.

The review by national consulting firm Guidehouse showed Montana was underfunding businesses that provide support and services for people who rely on Medicaid.

Republican Gov. Greg Gianforte proposed an increase to reimbursement rates, and a legislative subcommittee approved even higher rates.

Pointing to estimates from the Health Department that showed the work the subcommittee did pushed many rates close to 100% of the recommended benchmarks, Chair Rep. Bob Keenan, R-Bigfork, said, “I think we’ve solved the problem.”

At the hearing on HB 649, Caferro, a member of the subcommittee, agreed the group worked hard and got close to benchmarks — “but not quite.” She and other sponsors proposed to close the rest of the gap.

“If we don’t fully fund the Medicaid rate, then we will continue to see a decline in people’s health and well-being to the point of death,” Caferro said.

She pointed to one woman with Alzheimer’s who had been moved to three different nursing homes because of closures and couldn’t be with loved ones: “Well, then that lady passed away.”

Caferro characterized the effects of underfunding in Montana as “tragic and unnecessary.”

She pointed to waiting lists for in-home care for seniors, for children and adults who have physical disabilities, and for children and adults who have developmental disabilities. She said community crisis centers are sitting empty and children are being sent out of state for care.

“Medicaid provides health care in every corner of the state and all parts in between,” she said. “The problem is we are running out of providers due to a long history of underfunding.”

The bill would cost $12 million a year in state funding, she said. It would translate into more money for services because the federal government matches the money the state contributes.

Caferro earlier estimated the match as at least $3 of federal money to $1 of Montana money, and in some cases as much as $9 in federal money: “It’s a good bang for the buck.”

At the hearing, she said the estimated $2.5 billion surplus includes at least $150 million saved by the state because of an enhanced federal Medicaid match, and she believes that portion should go to fund services.

In response to a question at the hearing, Mary Windecker, with the Behavioral Health Alliance of Montana, said the last couple of years, more and more people have been leaving the health care industry in the wake of rising housing costs and inflation.

Vacancies are hitting 20% to 30% across all the sectors that were studied, she said.

“We do believe that there are people out there who would very much love to work in the industry again, but they have to be able to put a roof over their head and food on the table,” Windecker said.

Caferro said those people should not be asked to sacrifice their own economic well-being. She also said she appreciated the support for health care initiatives from a wide spectrum of groups.

“I’ve never been in a legislative session where the human service issues have been so prominent, and the sponsors and people bringing the issues are so diverse, and that makes me really happy,” Caferro said.

Proponents for her bill included representatives from the Montana Medical Association, the Montana Hospital Association, St. John’s United retirement community, the Human Resource Development Councils, the Montana Association of Counties, the Montana Coalition to Solve Homelessness, the Behavioral Health Alliance of Montana, the Centers for Independent Living, the Montana Health Care Association, Montana Women Vote, and many others.

Before approving the bill, the committee adopted an amendment that Rep. Laura Smith, D-Helena, said aligned Caferro’s bill with House Bill 2, the big budget bill.

Rep. Alice Buckley, D-Bozeman, said the bill offered legislators the opportunity to support their constituents and communities across the state.

“We were elected here to do the people’s work,” Buckley said.

In addition to Howell, Smith and Buckley, the following Democratic representatives voted “yes” on HB 649: Donavon Hawk of Butte; Ed Stafman of Bozeman; Minority Leader Kim Abbott of Helena; and Zooey Zephyr of Missoula.

The following Republican representatives also supported the bill: Lola Sheldon-Galloway, of Great Falls; Jodee Etchart of Billings; George Nikolakakos of Great Falls; Tom Welch of Dillon; Gregory Frazer of Deer Lodge; Mike Yakawich of Billings; Wayne Rusk of Corvallis; Greg Oblander of Billings; Ed Buttrey of Great Falls; and Jennifer Carlson of Churchill.

Voting “no” were Republican representatives Amy Regier of Kalispell, Caleb Hinkle of Belgrade, Ron Marshall of Hamilton, and Nelly Nicol of Billings.

Daily Montanan reporter Nicole Girten contributed to this story.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A local university is willing to foot the state’s share of the bill.

 
 

Clipped from: https://stateofreform.com/featured/2023/01/utah-bill-proposes-expanding-dental-care-coverage-to-adults-under-medicaid/

 
 

Senate Bill 19, a measure that would extend dental benefits under Medicaid to adults 21 years of age and older, advanced to the House after passage in the Senate by a vote of 19 to 0 with 10 abstentions Monday. 

 
 

 
 

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Sponsored by Sen. Evan Vickers (R – Cedar City), the measure passed with bi-partisan support and has the backing of the Utah Dental Association (UDA). 

Under current state law, only members who are pregnant, disabled, blind, age 65 or older, enrolled in Targeted Adult Medicaid (TAM) receiving treatment for substance use disorder, or children receiving Early Periodic Screening, Diagnostic and Treatment (EPSDT) have access to dental benefits through Medicaid. 

In partnership with the Utah Department of Health and Human Services (DHHS), the University of Utah School of Dentistry (UUSOD) administers dental care to these individuals through the school’s clinics and affiliated providers in over 150 locations throughout the state. 

“Back in 2008, the state eliminated all dental benefits for adults and the University of Utah School of Dentistry subsequently went to the legislature and said we’d like to partner and provide this care, and there are federal programs available that allow for that,” said James H. Bekker, Associate Dean for Professional and Community Partnerships at UUSOD. 

“The School of Dentistry participates in creating that pathway. And so we opened up gradually to first the TAM patients that have substance abuse disorder and then we added to that blind and disabled patients. And then we added to that elderly. So it’s just been something that’s happened gradually and we’ve been able to do well.”

SB 19 would allow the state to pursue federal Medicaid waivers that extend dental care to all adults 21 years of age and over who are eligible for Medicaid. The bill, like previous ones that expanded dental coverage eligibility, contains a zero fiscal note because UUSOD pays the state’s portion to receive federal matching funds to provide care. 

Should SB 19 pass, the number of Medicaid members eligible for dental coverage could grow from 70,000 to over 200,000, according to UUSOD estimates. 

“This program allows [dentists] to see the patients and be compensated at a much better rate,” Bekker said. “It’s clear that with [currently eligible] Medicaid patients, that’s about 70,000 patients throughout the state, the School of Dentistry can’t possibly see all those patients at our clinics.

And so we have created an associated provider opportunity so any dentist in the state of Utah can become associated with the School of Dentistry and thereby treat these populations in their own office. They bill directly to Medicaid, they’re reimbursed directly [by] Medicaid. It’s just that association that they need with a state entity in order to be able to qualify.”

As the legislative liaison to the UDA and its past president, Bekker says dentists in the state are supporting the proposal. 

General dentists had previously been reluctant to join the program and serve Medicaid patients because of low reimbursements rates, Becker noted. He has been working to change the perception that Medicaid does not pay adequately and recruit more dentists to participate and meet the potentially increased demand. 

“We’re doing what we can to educate dentists out there to understand that it’s different than it was,” Bekker said. “The compensation rates are better and this is a wonderful opportunity to enhance your practice and provide care to underserved populations.”