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Nearly 2,000 providers to receive $503M in Medicaid grants

[MM Curator Summary]: The FL HCBS ARPA money is finally moving to providers.

 
 

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.

 
 

 
 

Florida Medicaid officials are distributing nearly $503 million in enhanced payments to 1,945 providers that render community- and home-based services to the poor, elderly and disabled, the administration of Gov. Ron DeSantis announced Tuesday.

That’s about $180 million less than what the Agency for Health Care Administration initially said would be made available last year when the agency announced the availability of the funds and encouraged home- and community-based service providers to apply for the supplemental payments. The funding was made possible by the American Rescue Plan, pushed by President Joe Biden.

The state did not offer a list of the providers that will be receiving the money. Instead, the state is sending emails to the providers notifying them of whether their requests were accepted and to “provide instructions on next steps.”

AHCA told Florida Politics Tuesday the state is reopening the window of opportunity for providers that use 1099 staff to submit applications for the funds. Those providers will have until May 20 to submit a grant application to the state. The $180 million will be used to help fund those new grant applications.

It will also be used to fund $12 million in delayed egress grants. Those grant awards were not announced Tuesday.

 
 

If necessary, some of the $180 million can also be used to adjust grant applications that were erroneously rejected or wrongly calculated, AHCA said.

“From the beginning of his administration, Gov. DeSantis has led the charge amongst the nation’s Governors in putting Florida’s seniors and most vulnerable first,” AHCA Secretary Simone Marstiller said in a prepared release.

“The agency is pleased to award this enhanced funding to Florida’s home- and community-based services providers who are working hard to address record increases in operational costs and challenges in recruiting and retaining staff.”

Florida’s home- and community-based Medicaid providers have been waiting for weeks for word about the grant awards. The state on Feb. 15 told the federal government it wanted to have the money distributed by the end of March.

AHCA Communications Director Brock Juarez defended the agency’s work to get the money distributed.

 
 

“From the onset of the (home and community based) enhanced funding program, AHCA has been at the front of states in applying and administering this funding to mitigate the impacts of inflation and workforce capacity to support HCBS providers, who provide care for some of the most vulnerable Floridians,” Juarez said in a statement to Florida Politics. “We are proud of the hard work and dedication of our team to process over 2,000 applications and award over a half billion grant funding in only two months’ time.”

The agency announced late last year it would award $1.2 billion in supplemental payments in two rounds. More than $680 million was made available during the first round of funding, and the state accepted applications between Dec. 17, 2021, and Feb. 14, 2022. The money was divided into three silos: $405 million in grants for one-time provider stipends, $266.6 million for retaining employees and recruiting new ones, and $12 million for delayed egresses.

Ninety three percent of the approved grant applications requested funds from more than one silo.

Juarez said the money would be first distributed to providers who worked with Medicaid iBudget Waiver clients, followed by those who work with Medicaid managed long-term care clients.

The iBudget waiver program, administered by the Agency for Persons with Disabilities (APD), provides people with intellectual and developmental disabilities access to services that keeps them out of institutions and living in the community.

“The foundation of this funding plan builds on APD’s dedication to ensuring that vulnerable Floridians have the resources they need to thrive in their communities,” APD Secretary Barbara Palmer said in a prepared release. “These funds will make a huge difference to attract qualified applicants to serve our vulnerable customers.”

The state will rely on the contracted Medicaid managed long-term care plans to distribute the enhanced payment to the home- and community-based services providers they contract with. The Medicaid managed long-term care program allows people who qualify for nursing home placement to forgo institutional care and choose to receive home- and community-based services instead.

Clipped from: https://floridapolitics.com/archives/517612-nearly-2000-providers-to-receive-503m-in-medicaid-grants/

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Providers still waiting for state to deliver $1.2B in supplemental Medicaid funds

[MM Curator Summary]: Zero dollars and zero cents of the $1.2B Florida took from ARPA have been distributed to providers more than 6 months months after the funds made it to state coffers.

 
 

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.

 
 

 
 

In an effort to bolster the state’s home- and community-based services network, the Gov. Ron DeSantis administration late last summer agreed to tap into $1.2 billion in additional federal Medicaid funds.

More than six months later, the state hasn’t distributed any of the supplemental funds and providers don’t know when to expect the payments. They also don’t know how much to expect because the state did not finalize the distribution formula it was going to use to disburse the funds.

Attain Inc. has taken out two small business loans since September when the state announced it received approval from the federal government to use the funds, said Craig Cook, executive director of the not-for-profit agency that has been providing residential services to people with disabilities in central Florida since 1988.

The loan money, Cook said, is being used to cover deficit spending, the result of years of stagnant Medicaid reimbursement rates and a tight long-term care labor market that was made worse by the COVID-19 pandemic.

“We were given hope,” Cook said of the supplemental Medicaid payments. “But now, it’s like there’s no help at this point, because nothing is being realized.”

 
 

Cook, and many other providers like him, thought that the state would have distributed the supplemental payments by now. And according to documents submitted to the federal government, the state intended to have the payments distributed by winter 2022.

Agency for Health Care Administration Communications Director Brock Suarez did not comment on why the funds were delayed.

Cook’s application for funds was one of more than 2,400 received by the agency before the Feb. 14 deadline.

The agency announced late last year it would award the supplemental payments in two rounds. More than $680 million was made available during the first round of funding and the state would accept applications between Dec. 17, 2021 and Feb. 14, 2022.

The money was divided into three silos: $405 million in grants for provider stipends, $266.6 million for retaining employees and recruiting new ones, and $12 million for delayed egresses.

 
 

Providers could apply for funds from more than one silo.

And they did.

Of the more than 2,400 applications received, 89% of them were for one-time stipends and 82% of the applications were for retention funds. That’s according to Kristin Sokoloski, a Medicaid program coordination administrator.

Sokoloski told members of a Medicaid medical advisory committee that assisted living facilities, home- and community-based service providers, home health agencies and case management agencies qualified for supplemental Medicaid funds during the first round of funding.

The majority of the applications received, 70%, were submitted by home- and community-based providers. Of those providers, 70% worked with people enrolled in the Medicaid iBudget Waiver program, according to Sokoloski’s presentation to the committee.

Jim DeBeaugrine is the former director of the state Agency for Persons with Disabilities and currently is a lobbyist for a spate of clients that provide services to people with intellectual and developmental disabilities. That includes The ARC of Florida.

“They are definitely very interested in these funds and a lot of these guys are barely hanging on,” DeBeaugrine said. “The quicker this can get out there, the better.”

The DeSantis administration moved last summer to take advantage of a 10% bump in federal Medicaid dollars available under the American Rescue Plan Act.

Most Florida Medicaid patients who receive home- and community-based services are either enrolled in the Medicaid managed long-term care program or the Medicaid iBudget program.

The former is for frail and elderly individuals who qualify for nursing home placement but choose to receive assistance with daily living activities, such as eating and dressing, that enable them to continue to live in their homes or another non-institutional setting.

Similarly, the Medicaid iBudget Waiver program allows adults with intellectual and developmental disabilities to tap into the home- and community-based services they require to continue living outside of an institution and in their family home or a group home.

Tyler Sununu is the president and CEO of the Florida Association of Rehabilitation Facilities, an association that represents facilities that treat people with intellectual and developmental disabilities.

“Providers are asking me every day for an update,” Sununu said about the additional payments. “The bottom line is providers really need the money and I’m very hopeful that if not this week, next week we’ll see some of that.”

The agency is supposed to announce a second round of funding opportunities sometime this month.

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Clipped from: https://floridapolitics.com/archives/516083-providers-still-waiting-for-state-to-deliver-1-2b-in-supplemental-medicaid-funds/

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US hospitals with the highest share of patients on Medicaid

[MM Curator Summary]: NYC has 8 of the top 10, despite not being ranked in any list of cities with highest poverty.

 
 

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.

 
 

Becker’s calculated which U.S. hospitals have the highest share of their patients covered under Medicaid.

Eight of the 10 highest-ranked hospitals are public facilities located in New York City.

The 2019 data released April 5 is from the coverage, cost and value team at the National Academy for State Health Policy in collaboration with Houston-based Rice University’s Baker Institute for Public Policy.

 
 

Hospitals with the highest percentage of Medicaid in their payer mix:

 
 

(1) Queens Hospital Center — 96 percent

Location: New York City

Beds: 200

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(2) Laguna Honda Hospital — 94 percent

Location: San Francisco

Beds: 6

System: San Francisco Health Network

Ownership type: public

 
 

(3) Lincoln Medical & Mental Health Center — 94 percent

Location: New York City

Beds: 287

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(4) Kings County Hospital Center — 89 percent

Location: New York City

Beds: 406

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(5) Woodhull Hospital Center — 86 percent

Location: New York City

Beds: 238

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(6) Metropolitan Hospital Center — 85 percent

Location: New York City

Beds: 196

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(7) North Central Bronx Hospital — 84 percent

Location: New York City

Beds: 130

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(8) Elmhurst Hospital Center — 83 percent

Location: New York City

Beds: 358

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(9) Bellevue Hospital Center — 82 percent

Location: New York City

Beds: 527

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(10) Pacifica Hospital of the Valley — 81 percent

Location: Los Angeles

Beds: 133

System: independent

Ownership type: for-profit

 
 

(11) Kensington Hospital — 81 percent

Location: Philadelphia

Beds: 31

System: independent

Ownership type: for-profit

 
 

(12) College Hospital Costa Mesa — 80 percent

Location: Costa Mesa, Calif.

Beds: 122

System: independent

Ownership type: for-profit

 
 

(13) Coney Island Hospital Center — 78 percent

Location: New York City

Beds: 292

System: New York City Health and Hospitals Corp.

Ownership type: public

 
 

(14) East Los Angeles Doctors Hospital — 78 percent

Location: Los Angeles

Beds: 102

System: Avanti Hospitals

Ownership type: for-profit

 
 

(15) Red Bud Regional Hospital — 77 percent

Location: Red Bud, Ill.

Beds: 25

System: independent

Ownership type: for-profit

 
 

Clipped from: https://www.beckershospitalreview.com/finance/us-hospitals-with-the-highest-share-of-patients-on-medicaid.html

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State to invest over $130 million for Medicaid home and community based service providers who care for vulnerable New Mexicans

[MM Curator Summary]: NM will pay HCBS providers 15% more for staff retention, PPE, training and IT.

 
 

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.

 
 

SANTA FE – This week Medicaid home and community based service (HCBS) providers statewide will receive a 15% temporary reimbursement increase to help support the critical services they provide to vulnerable New Mexicans, including those who are aging, disabled, and with severe behavioral health needs, announced the New Mexico Human Services Department (HSD) today.

HSD, through Section 9817 of the American Rescue Plan Act (ARPA), is investing over $130 million in the first of three rounds of HCBS temporary economic recovery payments to providers that have supported our community throughout the Public Health Emergency (PHE).  The ARPA provides states the opportunity to obtain additional funding to enhance, expand, and strengthen HCBS in New Mexico communities. New Mexico is a leader in ensuring access to HCBS, and this investment will help serve the most vulnerable New Mexicans. The enhanced federal funding provides New Mexico with an historic opportunity to make both short and long-term investments in our programs that serve the most vulnerable New Mexicans. 

“The New Mexico Medical Assistance Division values the important work of home and community based services providers and understands how challenging it has been to continue to deliver care over the past two years. Our proposed spending plan will strengthen the caregiver workforce and facilitate greater access to HCBS,” said Nicole Comeaux, Medicaid Director for the New Mexico Human Services Department. “I really want to thank the Medicaid team for a herculean effort in making these increases a reality.” 

The reimbursement increase will be available for eligible services retroactively to May 1, 2021 through June 30, 2022. To offset increased costs related to the PHE, payments may be used for staff retention, personal protective equipment, hazard pay, training, infrastructure and/or technology improvements that will aid to enhance current HCBS service delivery. 

“This much needed influx of dollars will help our state’s provider network in many important ways,” said Jason Cornwell, New Mexico Department of Health Developmental Disabilities Supports Division Director. “From mitigating pandemic costs and inflation, to being able to better provide a living wage to the workforce dedicated to providing services for our state’s most vulnerable citizens and their families, this money will further expand access to the essential services many have waited years to receive.” 

For more information visit  https://www.hsd.state.nm.us/community-benefit-program/

We talk, interpret and smile in all languages.  We provide written information to our customers in both English and Spanish and interpretation services are available in 58 languages through our provider, CTS Language Link. For our hearing, and speech impaired customers, we utilize Relay New Mexico, a free 24-hour service that ensures equal communication access via the telephone to individuals who are deaf, hard of hearing, deaf-blind or speech disabled.

The Human Services Department provides services and benefits to 1,057,175 New Mexicans through several programs including: the Medicaid Program, Temporary Assistance for Needy Families (TANF) Program, Supplemental Nutrition Assistance Program (SNAP), Child Support Program, and several Behavioral Health Services.

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Clipped from: https://www.hsd.state.nm.us/2022/03/31/state-to-invest-over-130-million-for-medicaid-home-and-community-based-service-providers-who-care-for-vulnerable-new-mexicans/

 
 

 
 

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Compassionate Homecare to Pay $6.53M to Resolve Allegations; OIG Releases Medicaid Fraud Report

[MM Curator Summary]: Compassionate Homecare execs stole $6.5M from MA Medicaid with an un-authorized services scam.

 
 

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.

 
 

Compassionate Homecare Inc., has agreed to pay $6.53 million to MassHealth in order to resolve allegations of unauthorized billing for services.

The settlement irons out a 2018 lawsuit filed by the Attorney General’s office against Compassionate. The state’s lawsuit alleges that the company stole millions of dollars from MassHealth.

Aside from the $6.53 million settlement, $375,000 will be earmarked for payment of unpaid wages for former Compassionate employees.

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“This settlement is a victory for MassHealth and for workers who deserve to be paid back for missed wages,” Maura Healey, the attorney general of Massachusetts, said in a press release. “We will continue to protect the integrity of our MassHealth program and ensure compliance with our wage and hour laws.”

Compassionate owner, Francis Kimaru, pleaded guilty to separate criminal charges brought in by the Attorney General’s Medicaid Fraud Division in September 2019. Kimaru confessed to over-billing and falsely billing for services that were not authorized by a physician, or provided to patients.

The company also filed for bankruptcy in May 2020.

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OIG releases Medicaid fraud report

In addition to Massachusetts’ fraud news, the U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released its latest Medicaid fraud report.

The report examines data from 2021 annual statistical reports that 53 Medicaid Fraud Control Units (MFCU) submitted to the OIG.

Overall, fraud convictions were about 70% of all 2021 convictions.

OIG saw an increase in total convictions resulting from MFCU cases, which went from 1,017 in 2020 to 1,105 in 2021. MFCU cases checked in at 780 convictions for fraud and 325 convictions for patient abuse or neglect.

Personal care workers and agencies had the highest number of fraud convictions each year from 2017 through 2021 compared to other types of providers.

In fact, there were 329 fraud convictions involving personal care workers and agencies, or 42% of the total 780 fraud convictions in 2021.

Personal care workers, or other home care aides, also made up a significant amount of the convictions for patient abuse or neglect. Specifically, workers in this sector accounted for 69, or 21%, of the total 325 convictions for patient abuse or neglect.

In total, MFCU criminal recoveries increased from $173 million in 2020 to $857 million in 2021. OIG credits cases prosecuted by MFCUs in Virginia and Texas for the increase in criminal recovery amounts.

In 2021, the OIG saw the total number of civil settlements and judgments decrease from 786 in 2020 to 716, though the pandemic may have resulted in skewed numbers.

 
 

Clipped from: https://homehealthcarenews.com/2022/03/compassionate-homecare-to-pay-6-53m-to-resolve-allegations-oig-releases-medicaid-fraud-report/

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TennCare is preparing to expand dental benefits, but only 1 in 3 dentists accepts reduced payments

[MM Curator Summary]: The Governor is putting up more money, but 70% of TN dentists won’t take Medicaid as payment because of low rates and higher no-show appointments.

 
 

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.

 
 

 
 

More dentists will have to start participating in the state’s Medicaid program if every adult is going to get new oral health coverage. That’s the conclusion of TennCare advocates who found that fewer than one in three dentists in Tennessee accept the lower rates paid by Medicaid.

Gov. Bill Lee has put the money in his budget to expand dental benefits to everybody on TennCare. It also includes money to help incentivize dentists to open offices in underserved communities. But that doesn’t necessarily fix the problem of so few dentists taking Medicaid patients.

“There’s not enough to even see the children who have been able to go with their Medicaid insurance and get dental benefits,” says Kinika Young, senior policy director of the Tennessee Justice Center. “So we need more providers to step up.”

A TJC policy brief published in January finds that 30% of Tennessee dentists take Medicaid. And only about half of the children on Medicaid in Tennessee went to see a dentist in 2019.

A common complaint among dentists is that low-income patients are more likely to miss appointments. But Young says that’s why dentists need to learn how to better serve them, like offering extended hours and flexible scheduling.

Dentists have said the state’s Medicaid program, known as TennCare, must raise its rates. And Young agrees. According to a national analysis by Milliman consulting firm, the rates are usually less than half of what private insurance pays.

 
 

Clipped from: https://wpln.org/post/tenncare-is-preparing-to-expand-dental-benefits-but-only-1-in-3-dentists-accepts-reduced-payments/

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Lawmaker Takes Aim at 1960s Law That Blocks Medicaid Funds for Psych Care

MM Curator summary

[MM Curator Summary]: NY Senator Hoylman is pushing the state health agency to submit a waiver to avoid the IMD-exclusion rule in order to allow the state to house more patients in long term facilities for mental health.

 
 

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.

 
 

 
 

 
 

This article was originally published on Mar 10 at 9:13pm EST by
THE CITY.

Sen. Brad Hoylman wants New York to pursue a waiver to allow federal funding for long-term residential treatment, which could include innovative alternatives to incarceration.

As New York struggles to get treatment to people with serious mental illness, one barrier hasn’t budged: Medicaid is forbidden from covering long-term stays for most patients receiving mental health or substance abuse treatment in a facility with over 16 beds.

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That federal law, in place for more than half a century, blocks a major source of funding that could pay for residences that provide long-term treatment — anything from traditional psychiatric care to innovative efforts to divert people to therapy instead of prison.

But that could change in New York, under a bill recently introduced in Albany by State Sen. Brad Hoylman (D-Manhattan). It would require the state health commissioner to seek a waiver from the federal Centers for Medicare and Medicaid Services to make payments for long-term stays at large mental health institutions.

Through this we will be creating an incentive to create new beds,” Hoylman told THE CITY. “We have to move swiftly to address this crisis. We see human suffering in our midst and it’s really time to take decisive action like this legislation. New Yorkers are in desperate need of treatment.”

Hoylman’s West Midtown district has been in the spotlight for a mental health crisis playing out in its streets and transit stations. One man with untreated mental illness is accused of fatally shoving Michelle Go into the path of a subway train at Times Square.

A spokesperson for the state Department of Health, Erin Silk, said the agency won’t comment on pending legislation.

The number of inpatient psych beds has sharply declined over the last two decades. A 2020 report from the New York State Nurses Association found that the state had reduced the number of overall psychiatric beds from 6,055 to 5,419 from 2000 to 2018 –– a 12% loss, with the bulk of the reduction coming from the private sector.

New York City has 3,991 inpatient psychiatric beds, according to the state Office of Mental Health, but about 600 aren’t in service. The state repurposed many of those beds for COVID patients at the start of the pandemic and is working to get them back, according to OMH spokesp

 
 

Michelle Go’s image was illuminated over Times Square during a vigil after she was fatally pushed onto the subway tracks in a random attack, Jan. 18, 2022.
Photo by Ben Fractenberg/THE CITY

erson James Plastiras.

Under Medicaid, the federal government picks up half of the costs and state government the other half, with New York budgeting $170 billion on all Medicaid services for this year and the next combined.

Already, Maryland, Oklahoma, Utah, Vermont, Washington, Idaho, Indiana and Washington, D.C. have successfully applied for such waivers to the ban on funding for “Institutions for Mental Disease” (IMDs), while several more states have applications pending.

New York State is already exploring the possibility. “The Department of Health is actively considering a waiver request to the Centers for Medicare & Medicaid Services,” Silk told THE CITY.

Hoylman decided to force the issue because the state hasn’t submitted an application or committed to sending one. He didn’t offer a cost estimate for a waiver, but claimed that it would save money in the long run by bringing down street crime.

Even within the current restrictions, Gov. Kathy Hochul is attempting to invest more in mental health care.

In February, she announced a $49 million initiative to improve psychiatric services across New York state. That includes $27.5 million to increase Medicaid’s payout for the psychiatric beds it does cover by 20%, which the state projects will bring at least 600 psychiatric beds back online in New York City. It also earmarks $9 million to recruit nurses and other staff as well as create 500 more supportive housing beds for people experiencing homelessness.

Good Intentions

The federal prohibition on Medicaid mental health payments to states applies to patients between the ages of 21 and 64, and dates back to the original creation of the health program in 1965.

Congress intended to discourage the creation of large psychiatric facilities in response to exposés documenting horrors of large residential institutions, and to shift the costs of mental health care onto the states, according to the Treatment Advocacy Center, an organization that promotes investment in inpatient mental health services.

“The point of the policy was to disincentivize long-term hospital care for people with the most severe illnesses. It was supposed to be accompanied by a massive investment in community based care that incidentally never really happened,” said Brian Stettin, policy director at the group.

Yet the need for long term hospitalization never went away for many individuals with mental illnesses, he added. “The idea was that hospital care is a bad thing, per se, which is clearly an overgeneralization of a well-intentioned policy that was taken too far.”

 
 

U.S. Sen. Charles Schumer, left, and State Sen. Brad Hoylman (D-Manhattan).
Photo by Javier Alejandro Duran/THE CITY

The Treatment Advocacy Center and others are pushing Congress for a full federal repeal of the exclusion, but has also supported states that are seeking waivers.

Supporters of a waiver say that the 16-bed limit hurts people who really need care by discouraging the creation of innovative, high quality treatment centers.

The nonprofit Greenburger Center for Social and Criminal Justice, which advocates for alternatives to incarceration, has for years been trying to build Hope House, a residential treatment center for women who’ve been convicted of felonies and have mental illnesses. They have a site near Crotona Park in The Bronx, but no ability to receive Medicaid reimbursement for inpatient psychiatric beds.

“We can’t go above 16 beds and get Medicaid because of the IMD exclusion. When you go above 16 beds, our folks can’t get Medicaid. So these kinds of facilities never get built,” said Cheryl Roberts, executive director of the Greenburger Center.

“You can’t really, without a lot of gap funding, make a facility that has high quality care work with 16 beds. You need more beds, not a lot more, but a few more to make the economies of scale work.”

 
 

THE CITY is an independent, nonprofit news outlet dedicated to hard-hitting reporting that serves the people of New York.

 
 

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Clipped from: https://brooklyneagle.com/articles/2022/03/16/lawmaker-takes-aim-at-1960s-law-that-blocks-medicaid-funds-for-psych-care/

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Higher Medicaid spending away from SNFs here to stay, official says

MM Curator summary

[MM Curator Summary]: The HCBS rebalancing effort reached a historic high of 59% of long-term care services delivered in the community in 2019.

 
 

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.

 
 

 
 

Credit: ozgurcankaya/Getty Images

The Centers for Medicare & Medicaid Services expects that Medicaid’s recent trend of spending more on home- and community-based services than institutional care will continue for the foreseeable future, a top program official said Tuesday. 

HCBS spending reached 59% in 2019 — a stark difference from when the program was spending just about 13% on HCBS 30 years ago, according to the most recent publicly available data on the percent of total Medicaid long-term services and supports expenditures.

“When the Medicaid program was created in 1965, states were required to cover medically-necessary nursing facility care for most eligible individuals but coverage for HCBS was generally not included,” Jennifer Bowdoin, Ph.D, director of the Division of Community Services Transformation at CMS, said Tuesday. Her comments came while speaking remotely during the National Association for the Support of Long Term Care’s 2022 Winter Legislative & Regulatory Conference. 

“This has shifted quite about over the past several decades as states have gotten more flexibility to cover more long-term care services in home- and community-based settings, and as states have increasingly taken advantage of that flexibility,” she added. 

Bowdoin also noted that several federally funded grant programs, like Money Follows the Person and the now-ended Balancing Incentive Program, have pushed states to seek additional funding to provide HCBS alternatives to nursing homes. 

CMS’ long-standing benchmark for Medicaid HCBS spending within has been about 50%. It has remained above that mark since 2013, while institutional spending has steadily gone down. 

Bowdoin added that rebalancing LTSS systems has been a long-standing priority for the Medicaid program and the public health emergency has also “accelerated states’ interest and effort to promote the use of HCBS over institutional services.” 

“[It’s] really showing that HCBS has become a really critical component of the Medicaid program, especially the long-term services and supports system, and they’re an important part of the progress of the national progress that has been made towards community integration of older adults and individuals with disabilities,” she said.

 
 

Clipped from: https://www.mcknights.com/news/higher-medicaid-spending-away-from-snfs-here-to-stay-official-says/

 
 

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KY- Bill would let Medicaid to pay certified community health workers

MM Curator summary

[MM Curator Summary]: KY legislators are working to get CHW services billable for Medicaid.

 
 

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.

 
 

A bill to require Medicaid reimbursement for certain services provided by certified community health workers, and streamline their certification process, awaits a vote in the full House. 

CHWs aren’t trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy and deliver education on prevention and disease self-management.

  

Rep. Kim Moser speaking at a Feb. 17 news 
conference about HB 525. (Photo from news release) 

“What makes community health workers unique is not that they are necessarily clinical professionals, rather they are the point guard in helping individuals understand what resources are available,” Rep. Kim Moser, R-Taylor Mill, said at a press conference about the bill in a video from the Kentucky Primary Care Association. 

The federal Bureau of Labor Statistics says Kentucky had 1,350 CHWs in May 2020, with an annual average wage of $37,320.

House Bill 525, sponsored by Moser, would require the Department for Medicaid Services to seek federal approval for a state plan amendment, waiver or alternative payment model, including public-private partnerships, for services delivered by certified CHWs.

Teresa Cooper, director of government affairs for the KPCA, said in an e-mail that CHWs are hired as a staff person by a facility, but their services cannot be billed to Medicaid or private insurance.This legislation would allow the clinic to bill for their services and receive reimbursement or count them in their cost of operations,” she said.

The bill would also require CHWs to be employed and supervised by a Medicaid-participating provider and says as of Jan. 1, 2023,no person shall represent himself or herself as a community health worker unless he or she is certified as such” in accordance with the provisions laid out in the act. 

The bill passed out of the House Health and Family Services Committee, which Moser chairs, on Feb. 24. She pointed to a Kentucky Homeplace study that found between July 2001 and June 2021, community health workers achieved a return on investment of $11.32 saved for every $1 invested in their services. 

“The cost-benefit analysis has shown it to be a very productive use of our taxpayer dollars,” she said, adding that because Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act in 2014, the program serves 1.6 million Kentuckians, about one of every three. 

“We know that it’s time, because of this Medicaid expansion, to really get more targeted with our Medicaid dollars and work on programs that work,” Moser said.

Emily Beauregard, director of Kentucky Voices for Health, said Moser’s bill, if passed, could be a “real game-changer” toward providing a sustainable funding source for community health workers in Kentucky. 

“House Bill 525 creates a very, very important pathway to expand our current network of community health workers,” Beauregard said.


Pamela L. Spradling, a CHW with Big Sandy Health Care, a federally qualified health center in Prestonsburg that covers five counties, said their CHWs are currently  paid as staff or through grant funding. 

 
 

Asked what it would mean for them to be able to bill Medicaid, she said, ” That would be huge for us because it would mean sustainability for our program. . . we wouldn’t have to constantly be worrying about where the money is going to come from to pay our community health workers.She added that the challenge with grant funding is that when the grant money runs out, so does the CHW program. 

 
 

Spradling also spoke to the value of CHWs in changing health outcomes, noting that 62% of their 150 patients with diabetes who have a CHW have seen a 2.5 point reduction in their A1C, and some of them with even higher reductions. An A1C is a blood test for diabetes that measures your average blood sugar levels over the past three months. A normal A1C level is below 5.7%. 

 
 

Tiffany Taul Scruggs, a certified CHW and the patient service outreach coordinator for Sterling Health Care, a federally qualified health center based in Mount Sterling, said the CHWs in her facility are either on staff or paid for by grants. 

 
 

“If we could bill Medicaid, we could probably hire more community health workers just because we have such a big population in our coverage area,” she said. “It would be wonderful if we could bill.” 

 
 

Scruggs noted several services their CHWs provide, including helping their patients obtain medical equipment, medications and food, helping patients navigate the health care system and providing health education. She added that one their greatest needs is transportation to and from medical appointments. 

“I am proud to say our transportation service has provided just shy of 1,300 rides to our most vulnerable population in 2021,” she said in a statement prepared for the House committee. “The team consists of one full-time driver, one part-time driver who was recently hired, two outreach and enrollment specialists, and three community health workers ready to assist our patients when needed.” 

 
 

Tammy Collett, Cumberland River regional director for Mountain Comprehensive Health Corp. in Whitesburg, said in an e-mail that funding for their CHWs is provided through a grant from Marshall UniversityThe University of Chicago and the Merck Foundation. She said the goal of this grant program is to demonstrate the effectiveness of using CHWs to improve health outcomes and quality of life. 

“It is our hope that payers will recognize the benefit of CHWs and consider coverage for their services,” Collett said.

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Clipped from: https://www.sentinel-echo.com/news/bill-would-let-medicaid-to-pay-certified-community-health-workers/article_715516e6-9987-11ec-8e15-279094a12cc1.html

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Nonprofit hospitals’ unreimbursed Medicaid costs don’t warrant tax subsidies, study suggests

MM Curator summary

[MM Curator Summary]: A new analysis shows that non-profit hospitals don’t necessarily serve more Medicaid patients or take more of a financial loss on uncompensated care.

 
 

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.

 
 

 
 

Nonprofit hospitals shoulder a similar amount of unreimbursed Medicaid costs as their for-profit counterparts, suggesting that these hospitals may not provide enough community benefit to justify the various tax subsidies granted by their status, according to a new study.

By reviewing 2019 Medicare cost reports from nearly 3,500 private hospitals across 45 states, researchers identified $20.59 billion in total unreimbursed Medicaid costs, according to the study published in JAMA Network Open.

In just over half of these states, for-profit hospitals’ unreimbursed Medicaid costs comprised a larger portion of their total expenses than the nonprofit hospitals operating in the same state, according to the analysis.

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“Our results suggest that the largest component of community benefit supposedly provided by nonprofit hospitals (i.e., unreimbursed Medicaid costs, net of supplemental payments) is poorly aligned with the (effectively automatic) tax subsidy that these institutions receive,” researchers wrote in the journal. “Prior research suggested similar results for the provision of charity care by nonprofit vs for-profit hospitals.”

Unreimbursed Medicaid costs comprised 2.52% of private hospitals’ total expenses across the 45-state sample, with that proportion ranging from 7.74% in Nevada to as low as 0.02% in Maryland, according to the study.

To determine whether nonprofit hospitals were taking on a greater portion of this load, the researchers calculated and compared the weighted mean unreimbursed Medicaid cost to expense ratio—defined as total unreimbursed Medicaid cost across all of the state’s hospitals divided by their total expenses—of the for-profit and nonprofit hospitals in each state.

RELATED: Nonprofit hospitals spend less on charity care than for-profits, study finds

They found that for-profit hospitals outpaced the nonprofits across this measure in 23 of the 45 states in which for-profit and nonprofit hospitals operate.

The disparity peaked in Texas, where researchers found for-profit hospitals’ unreimbursed Medicaid cost to expense ratio was ten-and-a-half times that of the state’s nonprofit hospitals. In New York and the District of Columbia, meanwhile, the researchers found that nonprofit hospitals took on effectively all of the state’s unreimbursed Medicaid care.

Also of note, the researchers found similar median for-profit to nonprofit relative ratios within the 28 states that expanded Medicaid and the 17 states that did not.

Unreimbursed Medicaid costs are the largest of eight community benefit components nonprofit hospitals report to the Internal Revenue Service (IRS). Providing these community benefits are a requirement for nonprofit hospitals to receive tax-related subsidies, although the researchers noted that “federal law does not impose a minimum requirement.”

RELATED: The average nonprofit hospital CEO takes home 8 times more than their hourly workers, Lown Institute finds

The researchers also acknowledged that their analysis does not account for supplemental payments intended to offset unreimbursed Medicaid costs, which more than two-thirds of included hospitals reported receiving during 2019.

Amending reporting requirements to include the size of these subsidies hospitals receive would promote greater transparency, the researchers wrote, and provide a better understanding of the community benefit these organizations are truly providing “whether in the form of unreimbursed Medicaid costs, charity care, or some other measure.”

The new study comes about 10 months after a previous Health Affairs study, conducted by many of the same researchers, found that nonprofits spent less on charity care for the uninsured than both for-profit and government hospitals. That analysis reviewed 2018 data from over 5,000 hospitals.

 
 

Clipped from: https://www.fiercehealthcare.com/hospitals/nonprofit-hospitals-unreimbursed-medicaid-costs-dont-warrant-tax-subsidies-study-suggests