Colorado Medicaid seeks millions from legislature to pay home health care workers competitive wages

Budget request would also better fund nursing homes, eliminate most medicaid copays

Meg Wingerter | The Denver Post

In eight years, Amy Wiedeman has never been able to hire enough people to provide all of the health care her son needs to stay in their Centennial home. Luke Schiller, 12, has cerebral palsy and other health conditions that qualify him for around-the-clock care at home. He needs someone watching at all times to make sure he doesn’t have a seizure or choke on his saliva, and to deliver medications through his feeding tube and reposition him so he doesn’t get pressure sores, Wiedeman said. 

She and her ex-husband Rod Schiller handle some “night shifts” with Luke and stay home with him on weekends, but it wouldn’t be possible to hold a job or even go to a different part of the house to start a load of laundry if they didn’t have help, she said.

“We could not function without it,” she said. “It requires a lot of hands-on nursing skill, and that’s just to get through every day.”

Medicaid covers Luke’s home care, but it’s difficult to find qualified nurses who are willing to work for the rates it pays, Wiedeman said. She estimated they’ve had about 20 nurses over the last eight years, with many leaving for more-lucrative jobs, though their current day and night nurses have been with them six and three years, respectively. “The wages are not competitive enough,” she said.

Colorado’s home care providers might get a raise next year, if legislators grant a request from the state agency that runs Medicaid for money to raise those wager, increase rates paid to nursing homes and more. Whether it will be enough to attract more workers to the field is an open question, though.

Click here to read more from the Denver Post. 

How The Public Health Emergency Helped Cut Regulatory Red Tape For Home Health Agencies

Home Health Care News | By Joyce Famakinwa
 
With the public health emergency (PHE) set to finally end on May 11, home health stakeholders are finding that the impact won’t be as disruptive as once feared.
 
This is because most of the biggest issues have already been addressed by Congress and the Centers for Medicare & Medicaid Services (CMS).
 
“Congress addressed the face-to-face encounter side of it, so we’re not going to be losing as much as we might have, if that hadn’t happened,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News. “For example, CMS early on in the pandemic made permanent the ability of home health agencies to use virtual visits, if authorized by the treating physician or treating practitioner.”
 
This means that the required face-to-face encounter for home health services can take place through telehealth.
 
Another factor that will potentially lessen the negative impact of the PHE ending is the Acute Hospital Care at Home waiver — which was originally tied to the PHE — getting an extension through the omnibus spending bill, Moving Health Home Founder Krista Drobac told HHCN.
 
“We were successful in decoupling the waiver related to acute care in the home from the PHE at the end of last year when we secured the two-year extension,” she said. “Now we’re focused on educating Congress about the other barriers that didn’t get waived during the PHE but are necessary for providing patients more options in the home.”
 
Drobac noted that Moving Health Home is pushing for a bill that will potentially be introduced in the House.
 
“It will give patients the options for care in the home,” she said. “There’s a lot of pieces that are still missing related to home infusion, home dialysis, home-based primary care, home-based imaging, home-based labs and even Medicare personal care services. We’ve taken a look across the full spectrum of all the things that need to change in order for a patient to truly be able to stay home in a variety of different cases, so we’ll be introducing legislation there.”
 
Still, there are some concerns providers should keep their eye on with the PHE coming to an end in the spring.

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Read the Statement of Administration Policy related to the end of the COVID-19 Public Health Emergency and National Emergency

With End of PHE in Sight, Providers Need to Stay Abreast of Waivers, Experts Advise

McKnight’s Home Care | By Liza Berger & Diane Eastabrook

Telehealth. Home care aide training. Hospice volunteer hours. The COVID-19 public health emergency (PHE) initiated waivers for many areas of home health and hospice. As of May 11, according to President Biden this week, the PHE will end, thus summoning the end of many of these flexibilities.
 
While providers have a little more than three months to plan for the change, LeadingAge President & CEO Katie Smith Sloan said her organization still has questions about how the administration plans to transition to a true post-COVID environment.
 
“We are actively reaching out to CMS, HUD, and other agencies to better understand what their plans are for the end of the PHE and preparing for how we can best support members,” Sloan said in a statement.
 
The key now, according to Katie Wehri, director of home Health and hospice regulatory affairs for the National Association for Home Care & Hospice, is for providers to determine the status of the waivers they have been using and act accordingly.
 
“What they do need to do is to take a look at all of the waivers that they have utilized,” she told McKnight’s Home Care Daily Pulse on Tuesday. “If they are still utilizing any of those waivers they need to determine whether this waiver was made permanent … through legislation or regulatory change. If it was not made permanent, what is the plan for tapering off the use of this waiver?”

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Release of Revised State Operations Manual – Appendix M - Guidance for Surveyors: Hospice

NHPCO Regulatory Alert: Summary at a Glance

On January 27, 2023, CMS posted QSO-23-08, Revisions to the State Operations Manual, Appendix M – Hospice. Appendix M contains the LTags and Interpretive Guidelines for each Medicare Hospice Condition of Participation. They provide valuable insights on what surveyors will be reviewing, as well as details on the hospice survey process.

These revisions incorporate changes that were a part of the HOSPICE Act, passed by the Congress and signed into law by President Trump on December 27, 2020. Appendix M now includes guidance for surveyor training, the inclusion of accrediting organizations in surveyor training, protocols for surveyor conflict of interest, and adds a sample selection protocol for choosing patient visits in the list of survey tasks. CMS announced that the survey protocols have now been "revised to place an increased focus on quality of care concerns."

Providers should pay special attention to the changes in the survey protocols and the survey focus on quality of care.

Phase 1 includes three core Conditions of Participation and six associated CoPs:

• §418.52 Patient Rights
• §418.54 Initial and comprehensive assessment of the patient
• §418.56 Interdisciplinary Group, care planning, and coordination of services

Phase 2 includes one core Condition of Participation, with 13 associated CoPs:

• §418.58 Condition of participation: Quality assessment and performance improvement

For staff responsible for survey preparation, a thorough review of the revised Appendix M will help prepare hospice teams for the changes in the survey process and a successful survey.

The changes outlined in the revised Appendix M are effective immediately.

Read QSO-23-08-HOSPICE memo