Medicaid Home Care Priorities Presented at NAHC’s March on Washington
April 12, 2016 10:56 AM
Home care now exceeds institutional care for the first time in Medicaid Long Term Services and Supports, and Medicaid home care continues to grow to meet the increasing needs across the country. The National Association for Home Care & Hospice’s (NAHC) 2016 March on Washington Conference included a session focused on the priority issues in Medicaid home care. These priority issues include pending legislation and legislative remedies relative to Medicaid Managed Care Long Term Services and Supports, the Fair Labor Standards Act minimum wage and overtime compensation requirements, and the Affordable Care Act employer mandate. The session provided advice and strategies for discussing these issues with members of Congress. Subsequent NAHC Report coverage will summarize the discussion on private duty home care issues.
The Medicaid Action Council, a NAHC affiliate, launched in order to implement strategies that affect Medicaid policy. Andrea L. Devoti and Ellen Bolch are the co-chairs of the Medicaid Action Council, and Colin Roskey is the Executive Director. “Recognizing in advance that we cannot be in 50 state capitols every day, in that vein we want to support you the best way that we can, with advocacy that’s smart, focused and important to the membership that you support,” Roskey said.
With the growth in Medicaid home care, Devoti said, the efforts by the Medicaid Action Council are increasingly important. “Medicaid and the Medicaid expansion is becoming the biggest part of home care and hospice. We need to have our delegations understand that we really have to protect and expand those benefits across the country for hospice and home care… They have to understand the regulatory problems involved and I think that’s a major issue for us,” Devoti said.
With regards to advocacy efforts, Roskey recommended expressing a willingness to partner with a rapidly changing system. “What I think your constituencies and Congressional offices want to hear is that you are willing to and are able to partner with and change with the system,” Roskey said.
Roskey further explained that the current administration is focused on improvements to Medicaid, and that many of those changes benefit home and community-based care. “The central focus of this administration in its waning months is to do as much value over volume as possible in every program that they run, including Medicaid. You can see it in the President’s budget request for fiscal year 2017. There’s more spending dedicated to improving Medicaid than there is spending dedicated to improving Medicare.” For example, the budget contains proposals to expand waiver programs improving home and community based-services, move away from institutional care, and support compliance with Olmstead.
Another issue discussed during the session was that, with the growth in Medicaid, there will be an increased focus on program integrity measures, such as legislation to require electronic visit verification under Medicaid.
Following are the top Medicaid home care priorities discussed during the session:
Position Medicaid home care providers as strategic partners and advocates for home care programs within Medicaid managed care organizations.
CongressshouldrequirethatanyLTSSMedicaidmanaged care program develop an Olmstead compliance plan, maintain or expand thehomecarebenefits previouslyprovidedbythestate,complywiththefee-for-servicequalityofcarestandards,andensure enrolleeschoiceamonghome careproviders. Additionally, CMS should create a program of federal oversight to monitor the compliance of managed long term services and supports programs with respect to payment, network and care adequacy as currently done for Medicare Advantage plans.
Protect and expand access to mandatory Medicaid home care and hospice benefits
Congress should establish a mandatory Medicaid home care and hospice benefit.Congressshouldalso setminimum standardsregardingthe scope of such benefits.
Congress should continue its work in combating waste, fraud, and abuse in our nation’s health care system by requiring CMS to promulgate model minimum standards for compliance and program integrity, with adequate financial support for all parties.
Engage with stakeholders to develop and advocate for national uniform data sets and measurable quality outcomes in Medicaid home care, in both fee for service and managed care
Congress should require that CMS work with stakeholders to devise appropriate quality standards for long term services and supports as well as minimum mandatory uniform data sets that would be required of state Medicaid programs to measure the care and cost effectiveness of long term services and supports.
Ensure appropriate reimbursement rates as well as fair and appropriate compensation and benefits for Medicaid home care staff.
Congressshouldenactlegislationthat requiresthatstates continually assessthe adequacy of Medicaidhomecareandhospiceratesofpaymentandthe methodology utilized for establishingrates to prevent any loss in access to care.
The longstandingcompanionshipservicesovertime compensation exemption,as applied to home care underFair Labor Standards Act,should be restored to the standards in effect from 1975 to 2015 as Medicaid programs are not prepared to absorb additional costs triggered by the regulatory change. Alternatively, Congress should ensure that Medicaid adequately reimburse employers for any added costs of overtime compensation and enact reforms to the FLSA that establish a reasonable compensation structure that recognizes the unique aspects of care in the home.
Congress should establish appropriate protections for Medicaid home care from the consequences of the employer mandate of the Affordable Care Act. These can include: an exemption of Medicaid home care providers; an increase in funding for home care services to cover the costs of compliance; and automatic Medicaid enrollment for certain Medicaid home care workers.
Stay tuned to NAHC Report for further coverage of the March on Washington.