NAHC Affiliate, National Council on Medicaid Home Care, Holds Call with the Experts on Balancing Incentive Program
May 30, 2014 09:46 AM
The National Council on Medicaid Home Care - a NAHC affiliate - recently held its monthly “Call with the Experts” teleconference. The call was an open discussion among Council members on the Balancing Incentive Programs (BIP). Michelle Martin, the Council’s director of policy, moderated the call. The main contributors on the call were:
Beth Foster, Director of Regulatory Affairs, Ohio Council for Home Care & Hospice;
Vicki M. Hoak, CEO, Pennsylvania Homecare Association; and
Jenny Sand, Chief Strategy Officer, Home Care by Black Stone.
The call discussed the background of BIP, how BIP is being implemented in the states, and BIP’s efficacy in rebalancing LTSS away from institutions and towards the home and community.
At the beginning of the call, Ms. Martin gave a brief overview of BIP. BIP, a program arising out of the Affordable Care Act, authorizes grants to states to increase access to home and community long-term services and supports (LTSS). The three objectives of BIP, according to the Centers for Medicare & Medicaid Services (CMS) are: 1) lowering costs through improved systems performance and efficiency; 2) creating tools to help consumers with care planning and assessment; and 3) improving quality measurement and oversight.
BIP is available to any state that spends under 50% of its Medicaid LTSS expenditures on LTSS in the home and community. Any state that spends under 25% is eligible for a 5% enhanced FMAP, while any state that pends between 25% and 50% is eligible for 2% enhanced FMAP. States that receive these funds can only use these funds for home and community LTSS.
States must also complete the following structural changes by October 1, 2015: 1) No Wrong Door/Single Entry Point (NWD/SEP) System; 2) Core Standardized Assessment Instrument(s); and 3) Conflict-Free Case Management. For specifics on these three structural changes, see pages 9-31, here. Each state must submit a work plan for how it will implement these structural changes within six months following the application. For states’ approved applications and structural change workplans, click here.
As of April 2014, nineteen states have been approved for BIP: Arkansas, Connecticut, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New York, Ohio, and Texas.
Ohio: Ms. Foster stated that the stakeholders had been pretty involved in bringing BIP to Ohio from the beginning. She stated that stakeholder workgroups have been in place for many years, and her association has been a member of the Front Door Stakeholder Group for five to six years.
Pennsylvania: Ms. Hoak, on the other hand, expressed frustration with the stakeholder process in Pennsylvania. While her association met with an LTC advisory group, she thought that the group, and the state, gave her association little room for public comment. Ms. Hoak claimed that the state wanted the BIP grant application submitted as soon as possible, and would be receptive to input from her association only after the application was received.
Funding and Its Disbursement
Ohio: Ms. Foster stated that Ohio was awarded $179 million in grant money for BIP. These funds were released to the state in June 2013, and Ohio starting drawing down the funds in July 2013. Ohio has until September 30, 2015 to spend all of the BIP funds.
The funds are currently being used for convening stakeholder workgroups, including the Front Door Stakeholder Group, and establishing level of care assessments (LOCs) for children. These LOCs have been tested, and the state is now working on developing LOCs for adults. The funds are also being used in procurement of an I.T. system that processes the LOCs, as well as a firewall for conflict-free case management assessment.
Ms. Sand mentioned that it is the state that is getting money for eligibility assessments and I.T. procurement, and was wondering what funds, if any, home care providers were getting.
Pennsylvania: Ms. Hoak stated that her association had been asking for BIP for four years, but Pennsylvania only applied for a BIP grant a few weeks prior to this Call with the Experts. Therefore, while Pennsylvania could have been getting funds for years, if approved, the state will only have a short period of time to spend the funds as BIP ends in 2015. She stated that when she looked at the application, she noted that all the funds slated for Pennsylvania would go to correct the existing system via funding the three structural changes required for BIP (No Wrong Door/Single Entry Point (NWD/SEP) System; Core Standardized Assessment Instrument(s); and Conflict-Free Case Management).
Is BIP Generating More HCBS?
Ohio: Ms. Foster and Ms. Sand both stated that they do not have any data on whether or not more people are being served in the home and community as a result of BIP in Ohio. Ms. Martin commented that percentage of Medicaid LTSS spending in the home and community rose from 32.5% in 2009 to 42.7% in 2013, but thinks that this increase is a result of other rebalancing changes in Ohio independent of BIP.
Pennsylvania: Ms. Hoak stated that given the above BIP expenditures in Pennsylvania, she believes the states’ goal with BIP is to first correct the existing system, and then expand the number of beneficiaries receiving home and community-based services (HCBS).
The Council plans to ask states with active BIP grants whether or not they would find a conference call on BIP beneficial, and hold a follow up Call with the Experts if so indicated. Home care agencies are advised to continue to monitor BIP in their states, and contact the Council with any questions or concerns.