Senate Bill that Would Grow HCBS Earns Home Care Kudos

McKnight’s Home Care | By Liza Berger
 
Home care providers praised a bill introduced Tuesday that would give states a 10 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) for Medicaid to enhance home- and community-based services (HCBS).
 
“The looming expiration of the additional HCBS funding provided by the American Rescue Plan Act (ARPA) will put further pressure on states that are already struggling with growing long-term services and supports budgets and caseloads,” Damon Terzaghi, director of Medicaid HCBS for NAHC, said in a statement to McKnight’s Home Care Daily Pulse. “We greatly appreciate Senator Casey for recognizing this challenge and introducing this legislation.”
 
Jason Lee, the new CEO of the Home Care Association of America, which concluded its two-day conference in Chicago, Tuesday, told McKnight’s Home Care Daily Pulse in a statement that he “appreciates Sen. Casey’s continued focus on home care.”
 
The HCBS Relief Act would allow states to use the increase in the FMAP to increase direct care worker pay, provide benefits such as paid family leave or sick leave, and pay for transportation expenses to and from the homes of those being served. The additional funds also could be used to support family caregivers, pay for recruitment and training of additional direct care workers, and pay for technology to facilitate services. Sen. Bob Casey (D-PA) introduced the bill on Tuesday with 17 other Democratic senators.
 
“A vast majority of seniors and people with disabilities would prefer to receive care at home or in their communities,” Casey said in a statement. “Unfortunately, because of our nation’s caregiving crisis, home and community-based care has become increasingly difficult to access. By stabilizing and investing in the caregiving workforce, we can better provide seniors and people with disabilities with a real and significant choice to receive care in the setting of their choosing.”
 
The bill come as the Kaiser Family Foundation on Tuesday released a report that found that states are struggling with shortages of HCBS workers, particularly direct support professionals, personal care attendants, nursing staff and home health aides. Most states (43) reported permanent closures of HCBS providers within the last year. Increasing provider payment rates is the most common strategy to increase the number of HCBS workers, the report found.
 
LeadingAge CEO Katie Smith Sloan noted that the bill would help providers struggling with a dire workforce shortage.​
 
“Older Americans increasingly want choices that allow them to stay in their homes and communities as they age — but it’s increasingly difficult for people to access the care and services they need,” she said in a statement to McKnight’s Home Care Daily Pulse. “Home health providers are already forced to reject referrals due to workforce shortages, an extremely competitive labor market, financial pressures and drastic cuts to Medicare payment rates in 2023 [with more anticipated in 2024.] The kind of support Senator Casey’s bill offers for providers of home health and other services is massively needed to keep the country’s ability to support older adults intact.”
 
In April, the Biden administration, to increase access to HCBS, proposed a rule that would require that 80% of Medicaid payments go toward direct care worker wages. In January, Casey reintroduced the Better Care Better Jobs Act, which would permanently increase the FMAP by 10%. The American Rescue Plan included a 10% increase in the FMAP, but that provision sunsetted with the end of the public health emergency.

Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Home Health Care News | By Robert Holly
 
Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much.
 
In light of those sentiments and expected constraints, some believed MA plans could begin trimming their supplemental-benefits packages, which could lead to fewer home-based care offerings delivered under the Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) options.
 
MA plans began touting their benefits to Medicare beneficiaries at the beginning of October – and early signs suggest a pullback is, indeed, taking place.
 
“Fewer plans are using SSBCI to offer benefits, with decreases in Social Needs Benefits (128 fewer plans than in 2023) and Meals (99 fewer plans),” Washington, D.C.-based research and advisory firm ATI Advisory wrote in a LinkedIn post.
 
Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.
 
It’s not exclusively due to the brighter spotlight on plans, however.
 
“We suspect the main reason behind the decrease is that IHSS is a more administratively complex benefit to offer, especially compared to something like a grocery card,” Bill Winfrey, director of Medicare innovation at ATI Advisory, told Home Health Care News in an email. “To offer the benefit, plans must identify providers in a crowded marketplace, build a provider network to ensure market coverage and manage increasing labor costs that are driving up the cost of the benefit itself.”
 
Before heading into the 2024 plan year, IHSS had been one of the most popular benefits. There was a 364% increase in plans offering the benefit since 2020…

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Caring for the Animal Companions Left Behind: Pet Endowment Trust (PET) 

When a pet owner dies and nobody in the family wants the pet, they are either put down or dropped off at a shelter. It’s a sad scenario that plays out daily across the country. Pet estate planning stops pets from being euthanized or left homeless.

The mission of the Pet Endowment Trust (PET) is to help pet owners make plans should the unexpected happen. To accomplish our mission, we:

• Work with veterinarian associations and college veterinarian programs;
• Provide resources to organizations that offer legal estate planning;
• Assist animal welfare groups with pet planning; and, most recently
• Partner with hospice providers.

Making a difference can be as simple as asking a hospice client pet owner, “If something should happen to you, is there a plan in place for your pet?,” and directing them and their family to www.PetEndowment.org where they can find a simple DIY planning form. PET can also directly assist a pet owner with their planning needs.

PET would like to bring attention to hospice partners in the states served by HHAC, by sharing social media and print materials that name agencies as supporting partners. Opportunities for joint public awareness projects about pet planning are also available.

See https://www.petendowment.org/pet-hospice-and-nursing-care or reach out to us directly at [email protected]

With regards,

Kenne Smith - Executive Director                               409-651-9808
Linda Moon – Chief Operations Officer                    214-697-8019

Pet Endowment Trust (PET) is a 501c3 national non-profit animal welfare organization 

The First Year of Hospice VBID Is the Hardest for Payers

Hospice News | By Jim Parker

Implementation of the Medicare Advantage hospice carve-in has been challenging for both payers and providers, though a recent analysis indicates that it may get easier over time.

The U.S Centers for Medicare & Medicaid Services (CMS) commissioned the RAND Corp. to conduct the analysis of the program, formally called the hospice component of the value-based insurance design model (VBID). CMS launched the carve-in in 2021. The RAND analysis released this week covers the calendar year 2022.

The results suggest that the first year of participation is the hardest for both payers and providers.

“Hospices and new insurers reported substantial implementation challenges, but insurers with more than one year of experience with VBID reported fewer challenges, suggesting that implementation is becoming easier over time,” CMS indicated in a fact sheet.

In 2022, 13 insurance companies offered hospice VBID benefits through a total of 109 health plans. For more than half of these plans, 2022 was their first year of participation. The payer participants tended to be large national organizations with higher average plan enrollment, according to CMS. 

Payer companies reported greater challenges in 2022 than those who participated in 2021, according to the RAND report.

Among the top roadblockss for payers was the need to build out a network of hospice providers and development of payment contracts with those agencies. Another difficulty was the retooling of some administrative processes, including claims processing.

Hospice participants likewise encountered challenges when it came to claims processes as well as plans’ adjudication of denied claims, which they found to be time consuming and resource intensive. They also indicated that their payments from MA plans were often delayed, which put constraints on their cash flow.

However, hospices also reported that things became easier in their second year of participation compared to their first, CMS indicated…

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