In The News

In Win For Home-Based Care Providers, Health Care Workforce Bill Passes

Home Health Care News | By Patrick Filbin
A bill that passed Wednesday on the state level is being touted as a potential blueprint to mitigating home-based care workforce shortages nationwide.
In Frankfort, Kentucky on Wednesday, Gov. Andy Beshear passed the Kentucky Healthcare Workforce Development Act, legislation that aims to combat workforce shortages by building a public-private partnership that is designed to increase workforce training and education initiatives.
Joanne Cunningham, the CEO of the Partnership for Quality Home Healthcare (PQHH), told Home Health Care News this week that the bill felt different than others, in a positive way.
“It’s a public, private partnership that engages the private sector like health care organizations, insurers and others, as well as the government to try to incentivize all entities to work together on this,” Cunningham said. “I think that’s one of the reasons there’s such an appeal, certainly in the Kentucky state government, but also in Washington, D.C.”
The Kentucky legislation creates an investment fund with two primary programs. The first is a matching fund where, for every dollar a private-sector partner dedicates to the fund, a match is made by an educational program to fund scholarships for health care professionals.
The second program is designed to reward excellence among health care educational and training programs through certain benchmarks and measurements.
Earlier this month, the U.S. Senate sent out a request for information (RFI) for solutions to the national health care workforce crisis. PQHH was one of many organizations that submitted a letter suggesting solutions for these issues.
One of the solutions PPQH prosed was the bill from Kentucky.
“I’ve heard a number of members of the U.S. House and Senate recently talk about bipartisan solutions being the way we should be approaching these thorny policy issues,” Cunningham said. “The Kentucky proposal certainly lands squarely in that category and I think it’s getting a lot of interest for that reason, among many others.”

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Providers Assessing Impact of Medicaid HCBS Rule Now in Effect

McKnight’s Home Care | By Diane Eastabrook
The deadline for providers to comply with Medicaid’s home and community-based services rule went into effect last Friday, more than nine years after the rule was announced. It could take several weeks for months for home care firms to assess what the impact of the new rule will be.
Under the rule, HCBS must be integrated in and provide full access to the community. Beneficiaries have the right to select the setting, which must also offer privacy, dignity and respect.
The Centers for Medicare & Medicaid Services disclosed  the final rule in 2014 and laid out guidelines for providers to follow, including the requirement that beneficiaries receive care at home or in a community setting. CMS said it designed the rule to help states develop and tailor Medicaid services to accommodate their individual needs and improve patient outcomes. It is also expected to help states better manage their Medicaid resources.
When the rule surfaced, providers were expected to be compliant by 2019, but in 2017 the Trump administration pushed the deadline back to 2022. The compliance date was delayed again due to the COVID-19 pandemic. Last spring, the CMS said it would grant more time for states that have approved corrective action plans to demonstrate full compliance with requirements that are directly affected by the pandemic and related workforce challenges.
The rule could potentially help home care services providers. LeadingAge told McKnight’s Senior Living late last week some assisted living facilities may have difficulty complying with the rule if they also house skilled nursing in the same space, so they might stop taking Medicaid as a payment. That could force some seniors into nursing homes or into another home setting.
The new rule is expected to affect more than 1 million people who receive HCBS under Medicaid.

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With MA Cuts Coming, Home Care Supplemental Benefits Hang In The Balance

Home Health Care News | By Andrew Donlan
Home care providers have complained about Medicare Advantage (MA) becoming a more mainstream payer source.
Still, many have begun to work with MA plans for the first time over the past few years. But now, there’s concern that the government’s crackdown on MA could restrict opportunities even further, particularly when it comes to supplemental benefits.
“There’s no question that the recently proposed risk-adjustment policy would reduce payments enough that plans would certainly reduce supplemental benefit offerings,” ATI Advisory founder and CEO Anne Tumlinson told HHCN in an email.
Specifically, the U.S. Centers for Medicare & Medicaid Services (CMS) is attempting to cut plans’ payment rate by 2.27%. CMS is also hoping to regain billions of dollars in overpayments from major insurers in the near-term future.
That, some believe, could mean that plans are “less generous” with the supplemental benefits they offer. Health Affairs covered the issue in an analysis published Wednesday.
“Concerns that … plans are overpaid have motivated calls to reduce MA benchmarks – the dollar amounts set by [CMS] against which MA plans bid to set premiums and fund extra benefits,” the Health Affairs analysis states. “However, cutting benchmarks may lead to higher MA enrollee premiums and decreased plan generosity.”

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Medicare Advantage Value-Based Insurance Design (VBID) Model to be Extended

The Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030 and will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.

The CMS Innovation Center looks forward to sharing more information on model updates when available. For more information on the current model design, see our overview CY24 RFA fact sheet. You can also contact the model team at [email protected].


LeadingAge Poll Shows Stagnant Workforce Issues, Foreign Workers as Potential Solution

Health Leaders Media | By Jasmyne Ray
A small percentage of the aging services providers the nonprofit association represents has found success hiring foreign workers through work-based visas.

  • Poll results show that there hasn't been a positive change regarding workforce struggles for over half of aging services providers.
  • With some staff leaving their positions for better pay elsewhere, nursing homes and home health agencies are having to limit the number of patients they care for.
  • Some organization's have seen success in recruiting foreign workers, but policymakers will need to take action to make the process easier.

In a recent poll, 64% of aging services providers stated their workforce situation hasn't improved since June 2022.
The poll, conducted by LeadingAge, a nonprofit association representing aging services providers across the country, shows that providers continue to struggle with hiring and retention, worsening financial burdens, and frustration with policymakers’ lack of action.
"The hours are insane for the pay people get. It is not uncommon to have staff routinely working 60+ [hours] per week because they do not want to let their residents go without," a LeadingAge member stated. "I have been doing this for 32+ years and this is the most dire time I have ever seen."
LeadingAge last surveyed its members in 2022 on similar issues to gain insight on their struggles.
Staffing struggles
Results of the poll showed that the three most difficult positions to hire for are registered nurses (86%), licensed practical nurses (85%), and certified nursing assistants (85%). Many have found that current staff are leaving their positions for better-paying roles (78%) and better hours (53%).
Another 73% are leaving due to burnout.
Member comments included with poll results note that some providers turn to agencies for staffing, which can be costly. As a result, nursing homes and home health agencies are limiting the number of patients they serve to ensure they can provide quality care with the staff they have.
Getting creative
70% of respondents said they've implemented different strategies to help with recruitment efforts, including offering sign-on bonuses (69%), flexible scheduling (61%), and emphasizing career advancement opportunities (56%).
92% of providers have offered increased hourly wages to employees in hopes of retaining them.
"We have closed units or delayed filling apartments … due to insufficient staff to provide quality care in SNF and memory care assisted living;" one provider commented. "Staffing continues to get worse, so [we] anticipate additional measures may need to be taken if it doesn't turn around."
Other options
Some organizations have found success in recruiting foreign workers to work in the United States through work-based visas (12%) or on refugee status (5%). The interest in foreign recruitment overall is high, according to almost 200 member comments from the poll. To make this process easier, they will need help from policymakers.
"We are in the process of starting a foreign workers program, but our approval for prevailing wages has been pending for 6+ months," one provider said. "There seems to be no urgency among the government agencies involved in this process."

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