Nurses for Medically Fragile Kids are Underpaid and Hard to Find. Parents Want the State to Step In.

The Colorado Sun | By Jennifer Brown

Nurses willing to care for medically fragile children and adults — including patients who use feeding tubes, can’t walk or speak, and rarely leave their homes — are hard to find in Colorado. 

Amid a statewide nursing shortage so dire that even state mental institutions offer $14,000 signing bonuses, the lowest-paying nursing positions are going unfilled. That means many parents who have relied on “private duty nurses” for in-home care for their children and adult children are getting no help. 

Colorado’s Medicaid program reimburses the agencies that employ these in-home nurses at some of the lowest rates in the nation, according to the Home Care and Hospice Association of Colorado. The rate for registered nurses in Colorado is $7.05 per hour below the national median, while the rate for licensed practical nurses is $9.04 below the median, according to the association’s analysis. 

This puts Colorado in the bottom third of states and it’s why parents of children with extreme health issues are asking lawmakers for a $15 million boost in state funding. The money would raise Medicaid rates that pay nurses’ salaries...

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Employee Retention Credit – Voluntary Disclosure Program

IRS

If you claimed and received the Employee Retention Credit (ERC), but you are ineligible and need to repay the ERC, this page will help you figure out if you can apply for the Employee Retention Credit Voluntary Disclosure Program (ERC-VDP) and how to do that. 

The ERC-VDP is open through March 22, 2024. The program requires you to: 

  • Voluntarily pay back the ERC, minus 20%,
  • Cooperate with any requests from the IRS for more information, and
  • Sign a closing agreement. 

If you need help checking your eligibility for the credit itself, use the Employee Retention Credit Eligibility Checklist and see the Frequently asked questions (FAQ) about the ERC

For additional information see the Frequently asked questions focused on ERC-VDP.

Work with a trusted tax professional if you need help or advice on this process or on the ERC.

For more information, see:

 

Proposed HCBS Rule Could Diminish Service Access, Hamper Provider Retention Efforts, 11 Senators Tell CMS

McKnight’s Senior Living | By Lois Bowers
 
A proposed federal rule that would require providers of home- and community-based services to spend at least 80% of the Medicaid payments they receive for personal care, homemaker and home health aide services on compensation for direct care workers could diminish older adult access to services and hamper providers’ workforce retention efforts, 11 Republican senators told the administrator of the Centers for Medicare & Medicaid Services on Thursday.
 
“We have significant concerns that the proposal could and will likely harm access for seniors and people with disabilities, particularly in rural regions of the country, as well as harm workforce retention and provider networks,” the senators wrote CMS Administrator Chiquita Brooks-LaSure in a letter.
 
The missive was signed by Sens. Marsha Blackburn of Tennessee, Ted Budd of North Carolina, Shelley Moore Capito of West Virginia, Steve Daines of Montana, James Lankford of Oklahoma, Markwayne Mullin of Oklahoma, Tim Scott of South Carolina, Dan Sullivan of Alaska, John Thune of South Dakota, Thom Tillis of North Carolina and Roger Wicker of Mississippi.
 
CMS proposed the “Medicaid Program; Ensuring Access to Medicaid Services” rule in April. The proposal, which also would mandate quality measures and make other changes to the HCBS program, was sent to the White House Office of Management and Budget in January, and CMS has indicated that it plans to issue a final rule by April.
 
The 11 lawmakers recommended that CMS assess Medicaid data through collaborations with states and other stakeholders, as well as federal resources such as the Medicaid and CHIP Payment and Access Commission, and then work with MACPAC “to create a stakeholder and interagency evaluation of the impacts on payment, data and other outcomes of defining the direct care workforce.”…

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The Bottom Line: Top Billing, Financial Mistakes Responsible for Home Health Agency Struggles

Home Health Care News | By Joyce Famakinwa
 
Home health providers often make mistakes that leave money on the table at best, and at 
worst, lead to financial ruin. 
 
However, providers that learn to avoid these stumbling blocks will be better positioned to achieve longevity and financial stability. 
 
In general, the home health consulting firm SimiTree has noticed an increase in the amount of providers that have been struggling with things like unbilled claims, inaccurate primary payer selection and more, according to Lynn Labarta, vice president of post-acute revenue cycle management at SimiTree. 
 
In fact, Labarta recently wrote about this very topic for SimiTree. 
 
“SimiTree has thousands of customers in the home health and hospice space all over the country, and we have been seeing an uptick in these issues and agencies struggling or feeling that they may not survive,” she told Home Health Care News. 
 
Labarta believes that not staying on top of unbilled claims is the No. 1 issue that providers are currently struggling with. It’s an issue that pops up at companies of all sizes.
 
“We see this unbilled claims issue with all sorts of agencies — all the way from startups to mid-size agencies, even some of the largest agencies in the country struggle with this for different reasons,” she said.
 
Broadly, most providers’ EMR has a section in the software where all of the unbilled claims are housed. These are claims that can’t be billed because there is some type of hold on them. Typically it’s a clinical hold, or regulatory issue that prevents the claim from being billed. 
For many providers, this is where most of the revenue lives. 
 
“We’ve seen agencies that have thousands of claims sitting in the unbilled claims list,” Labarta said. “When you translate the thousands of claims sitting in that bucket, depending on the size of the agency, you’re talking about hundreds of thousands of dollars. Of course, if you’re dealing with a smaller agency it could be smaller dollars, but it still impacts cash flow. This makes agencies feel like they’re seeing patients and working very hard, but not seeing the money coming through the door.”…

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‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients

Home Health Care News | By Patrick Filbin
 
As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
 
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
 
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
 
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
 
Staffing costs and physician engagement
 
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
 
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
 
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
 
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
 
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.

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