Paying Family Members for At-Home Care of Their Children Found to be a Viable Answer to Healthcare Worker Shortage

Medical Xpress | By Ann & Robert H. Lurie Children’s Hospital of Chicago

A recent study found that a Medicaid program in Colorado can help address the shortage of home healthcare workers for children with complex medical needs by offering family members certified nursing assistant (CNA) training and paying them for at-home medical care their child requires. Results show that children who received family-CNA care were not more likely to be hospitalized than children cared for by a non-family CNA. Children with family-CNA caregivers also experienced greater care continuity since turnover was not an issue as it tends to be with traditional home healthcare workers. Findings were published in the Journal of Pediatrics.

There is a general shortage of healthcare workers nationally across the board, which worsened with the COVID pandemic. The shortage of home healthcare workers has been an even longer standing concern and often drives families to leave a job or reduce work hours to care for their child with complex medical needs. In addition to the financial burden on families, the lack of professional home healthcare services can lead to unnecessarily prolonged hospitalizations and institutionalization.

Some states allow non-parent family members, such as grandparents, to be paid to provide care. But most states do not allow parent guardians to be paid to provide medical care to their children, except for some select programs that make exceptions for parents who are registered nurses (RNs) or licensed practical nurses (LPNs). Illinois Medicaid has committed to finding alternative ways for parents to be paid caregivers and is exploring ways for that to be implemented.

"Our study provides evidence that paid family caregiving as a concept is feasible and can be successfully applied to meet the home care needs of children with medical complexity," said lead author Carolyn Foster, MD, MS, from Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "States should consider adopting policies that promote avenues to allow for parents to obtain CNA or other relevant credentials and to be paid for their child's at-home medical care. Such policies would enable state programs to meet their legal obligation to provide medical services for enrolled children while also reducing family financial strain and providing care continuity for these children."

Dr. Foster and colleagues stress that according to previous research, care continuity results in higher quality care. Broader literature also demonstrates cost savings to the health system with reduced employee turnover. The lack of costs for re-training and onboarding employees may be a source of savings in family CNA programs.

The study compared the characteristics and healthcare utilization of children with medical complexity who received paid CNA care by a family member and by a traditional non-family CNA from 2017 to 2019, as part of the Medicaid program in Colorado. Researchers analyzed de-identified billing claims data for 861 children, including information such as hospitalization frequency and hospital lengths of stay.

"Colorado's family-centered model addresses the significant shortage of healthcare workforce while providing additional income to parents who are compelled to leave work to care for their children. This program may not be a fit for all situations but is a meaningful option for many children going without enough services," said Dr. Foster.

The US Needs More Nurses, and the Crisis Is Bringing US Lawmakers Together

Bloomberg | By Lauren Coleman-Lochner
 
“Legislators on both the state and federal level are turning their attention to how to meaningfully address this issue that’s been plaguing health care for years and worsened during the pandemic. A bipartisan group of 14 US senators sent a letter to the Centers for Medicaid and Medicare last week seeking to extend an expiring program that helps poorer hospitals boost pay to retain workers.”
 
There’s a rare area of bipartisan agreement these days: the need for more government action to help fill the hundreds of thousands of vacancies for health-care workers.
 
Legislators on both the state and federal level are turning their attention to how to meaningfully address this issue that’s been plaguing health care for years and worsened during the pandemic. A bipartisan group of 14 US senators sent a letter to the Centers for Medicaid and Medicare last week seeking to extend an expiring program that helps poorer hospitals boost pay to retain workers.
 
The federal government has already taken some steps, including a $1.8 billion program to create 1,000 new residency slots in the next five years at hospitals in under-served communities. The Biden administration allotted $103 million from the American Rescue Plan to improve retention and well-being for health-care workers. Meanwhile, legislation introduced in Congress would boost residency slots, route more medical residents to under-served areas, and pause student loan obligations during residency. 
 
Another measure would grant tens of thousands of visas for doctors and nurses. 
 
“Certainly there are a lot of tools at the federal government’s disposal as well as at the state and local levels to deal with these issues,” said Zachary Baron, associate director of the O’Neill Institute for National and Global Health Law at Georgetown University in Washington, noting the broad bipartisan consensus to address the issue. 

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CMS PDGM Webinar and Data

CMS has announced a webinar on March 29 that will provide an overview of provisions from the CY 2023 HH PPS final rule, including behavior changes, and payment rate development. They've also released data on simulated 60 day episodes and actual 30 day periods used in their rate setting and adjustments.

Webinar registration, the released data, and additional information can be found here: www.cms.gov/medicare/medicare-fee-for-service-payment/...

Provider Groups, Lawmakers Weigh in on MA Plan Proposed Rule

McKnight’s Home Care | By Eastabrook

Provider groups and lawmakers have flooded the Federal Register with comments about the Centers for Medicare & Medicaid Services’ proposed Medicare Advantage and Medicare Part D rule released in December. Among other provisions, the rule would crack down on MA marketing practices and create requirements to increase access to behavioral health and culturally competent care. 
 
LeadingAge urged CMS to ensure that MA enrollees have proper protections and access to services as the penetration rate of those private plans nears 50%.
 
“We want to ensure MA enrollees’ access includes up to 100 days of skilled nursing care (when medically necessary) and coverage for all medically necessary, 30-day home health episodes, as is permitted under traditional Medicare,” Nicole Fallon, LeadingAge vice president of health policy and integrated services, penned in a letter to CMS Administrator Chiquita Brooks-LaSure. 
 
The Partnership for Quality Home Healthcare urged CMS to ensure continuity of care across all Medicare plans to prevent MA beneficiaries from being denied services covered under Medicare.
 
“We urge CMS to clarify that a home health plan of care, ordered by a physician or allowed practitioner, which would be covered under traditional Medicare as a home health episode, should be considered a “course of treatment” for which prior authorizations must be valid for the duration of the entire plan of care,” Partnership CEO Joanne Cunningham wrote in her letter to CMS.”
 
Senate Finance Committee Chairman Sen. Ron Wyden (D-OR), who released a report last year on deceptive advertising and marketing used by MA plans, urged CMS to crack down on MA plan fraud.
 
“It has become clear that not all enrollees are seeing that value or being put first,” Wyden said in his comments to CMS. “I strongly support the proposed rule as it seeks to restore important protections against deceptive and fraudulent marketing tactics, expands access to non-physician behavioral health providers, and promotes health equity for historically underserved communities.”
 
MA plans, which are less expensive than traditional Medicare fee-for-service plans, have been coming under increased scrutiny. Last year, the Office of Inspector General accused MA plans of denying or delaying services to beneficiaries covered under Medicare. A recent study by Kaiser Family Foundation found MA plans denied 6% (35 million) prior authorization requests for medical services in 2022.

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