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HCBS Staffing Shortages Lead to Severe Cuts to Programs, Services, New Report Finds
McKnight’s Home Care / By Adam Healy
With the vast majority of home- and community-based services providers suffering from a lack of direct support workers, patients in need of home care have fewer programming options.
Among 581 HCBS providers across 45 states, as many as 95% have experienced moderate to severe staffing shortages throughout 2022 and 2023, according to the American Network of Community Options and Resources’ (ANCOR) most recent State of America’s Direct Support Workforce Crisis survey. And as a result, 77% have had to turn away patients due to a lack of available workforce, and more than half said they have had to discontinue programs because of their staffing situations.
As part of the fallout from the shortage, connecting patients with care has become harder. About 75% of case management providers have experienced challenges connecting patients with services, since many are understaffed and unable to accept new patients. And though many states have laws barring providers from turning away new referrals, wait lists can make it just as difficult to access care.
“Even if someone is cleared from their state’s waiting list and approved to seek services, they are likely to continue facing barriers because of a lack of available providers,” the researchers wrote.
Lack of staff also makes it more challenging to meet quality standards. More than 70% of survey respondents said this was the case, and the HCBS Settings Rule implemented by the Centers for Medicare & Medicaid Services has made compliance even trickier, according to the report.
The biggest problem, according to ANCOR, is the lack of sufficient funding for HCBS programs. Many funding flexibilities put in place during the COVID-19 public health emergency have reached their expiration date.
“The roots of our ongoing direct support workforce crisis trace back to one source: underinvestment in Medicaid,” They noted. “Insufficient reimbursement rates in the Medicaid program have long hindered the ability of providers to compete for labor against other hourly wage industries.”
Last month, the Biden administration celebrated the American Rescue Plan Act’s investment of $37 billion in states’ HCBS programs. |
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IRS Issues Standard Mileage Rates for 2024
SESCO Management Consultants
- The Internal Revenue Service (IRS) has released the optional standard mileage rates for 2024.
- The standard mileage rates for 2024 are: 67 cents per mile for business uses; 21 cents per mile for medical uses; and 14 cents per mile for charitable uses.
- FAVR allowance for 2024. For purposes of the fixed and variable rate (FAVR) allowance, the maximum standard automobile cost for vehicles places in service after 2023 is $62,000. Employers can use a FAVR allowance to reimburse employees who use their own vehicles for the employer’s business.
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Panel Considers Potential Changes to Home Health Model
American Hospital Association
The Centers for Medicare & Medicaid Services Dec. 29 released a report on the Expanded Home Health Value-Based Purchasing Model that summarizes input from the first two meetings of a technical advisory panel considering potential refinements to the model’s methodology, measures and approach to health equity. Launched in 2022, the expanded model includes Medicare-certified home health agencies in all 50 states and in U.S. territories. The model’s measure set currently uses data already reported by HHAs through the Home Health Quality Reporting Program or Medicare claims and Home Health Care Consumer Assessment of Healthcare Providers and Systems surveys. |
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The 2024 Adult Vaccine Schedule Changes Are Here
Medscape / By Sandra Adamson Fryhofer, MD
This segment of Medicine Matters by Sandra Fryhofer, MD, highlights updates in the 2024 Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule.
The biggest change for 2024 is that you don't need to wait till January 1, 2024, for these schedules go into effect. Both schedules were published and became available in November 2023 and became effective immediately. They include ACIP recommendations approved by the Centers for Disease Control and Prevention (CDC) director through October 23, 2023.
Subsequent recommendations (before publication of the 2025 schedule) will be added to the addendum, a new Step 5, Section 5 in the schedule. The addendum should make Affordable Care Act (ACA)–compliant insurance plans cover ACIP-recommended immunizations sooner.
This year's schedule includes more vaccines with new recommendations and new color code keys for the schedule's vaccine tables. The newest vaccine additions to the schedule include respiratory syncytial virus (RSV) vaccines, the mpox vaccine (Jynneos), a new MenACWY-MenB combo vaccine (Penbraya), and the new 2023-2024 formulation of the updated COVID vaccine (both mRNA and protein-based adjuvanted versions).
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We Need To Go Where The Patients Are’: How Home Health Agencies Are Adjusting To Medicare Advantage
Home Health Care News / By Patrick Filbin
Medicare Advantage (MA) enrollment has been on a steady climb over the last two decades. As such, home health agencies have started to adjust operations to better fit the payer landscape in the future, and not just now.
Agencies in states like Michigan, Hawaii and Alabama have already had to do that — and those transitions haven’t been seamless.
Cleamon Moorer Jr., the president and CEO of the Detroit-based American Advantage Home Care, has been molding his company’s strategy around one of the greatest NBA point guards of all time.
“We’re understanding that we need to take a lead position and meet patients where they’re going,” Moorer told Home Health Care News. “It’s like the ‘80s Lakers with Magic Johnson. He threw the ball where Worthy was going to be, not where he was at. We need to go where the patients are going to be.”
American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area and has a census of 200 patients.
Changing of the tides
In 2023, 30.8 million people were listed as enrollees in a Medicare Advantage plan — which made up 51% of the eligible Medicare population — and $454 billion (or 54%) of total federal Medicare spending, according to KFF.
The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across states and counties, however.
Providers are concerned about MA plans’ reimbursement rates for home health services. Meanwhile, patients have some reason to be concerned over the home health access they’ll have underneath an MA plan.
“One concern that certainly comes up is that one in 10 Medicare Advantage patients say they have trouble accessing needed care,” Jennifer Schiller, executive director at the Research Institute for Home Care (RIHC), told HHCN. “It’s a coverage [issue] — but I think everybody is constantly aware of the fact that Medicare Advantage is not going anywhere.”
The tides have already started to shift in favor of MA.
Enrollment in MA has seen gradual increases (8% in both 2021 and 2022) and there is no sign of it slowing down.
“I think you’re going to see some more changes — especially over the next few years with various regulations that may impact who is using home health and who is using Medicare Advantage,” Schiller said.
In order to capitalize on that shift – or survive it – home health providers have had to adjust.
Challenges in MA…
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