Medicaid Programing Descriptions

Audience Key:
| HH = Home Health | HOS = Hospice | NUR = Nurses |
| PHY = Physicians | PD = Private Duty | TH = Therapists|
 

108. Medicaid Home Care and Hospice Program Integrity: Surveying the Landscape

Federal and state oversight of Medicaid programs that finance home care and hospice services is on the increase. From studies and investigations to prosecutions, the message is clear: Program integrity concerns in Medicaid home care and hospice has grown. This program will offer a landscape review of the activities of the HHS Office of Inspector General, The U.S. Department of Justice, Medicaid Anti-Fraud Units and others charged with oversight of government health care programs. The lessons learned from these experiences provide the background for the recommendations that will be offered in this program for how to achieve compliance and reduce risk in Medicaid.

Objectives:

• Identify the Medicaid home care and hospice program integrity risk areas uncovered by federal and state oversight entities
• Recognize the target areas of the oversight entities
• Discuss the program integrity measures supported by the home care and hospice community

Faculty: William A.  Dombi,  Esq.,  Vice President for Law, National Association for Home Care & Hospice, Executive Director, National Council on Medicaid Home Care, Washington, DC

Course Level: Intermediate; 1.5 nursing CEs; 1.5 CPEs (NASBA/RE)

Track: Legal & Regulatory
Audience: | HH | HOS | NUR | PHY | PD | TH

204. Medicaid Pediatric PDN: Meeting Patient Needs within Budget

Many home care companies specialize in providing pediatric private duty nursing services to technology-dependent children. Successfully operating a Medicaid pediatric PDN program takes a combination of solid cost controls, utilization oversight, and staffing management. This program will focus on the operational and management actions that provide the best opportunity for delivery of high quality care to pediatric Medicaid patients while staying within budget.

Objectives:

• Identify the highest risks to financial solvency in providing Medicaid PDN
• Describe an analytical framework for evaluating operational weaknesses in Medicaid pediatric PDN
• List the steps to consider to stabilize the financing and operations of a Medicaid pediatric PDN program

Faculty: TBA

Course Level: Intermediate

Track: Financial
Audience: | HH | HOS | NUR | PHY | PD | TH

404. Medicaid Home Care: Adjusting to the Changes Successfully

Medicaid home care is the largest publicly-funded home care program in the country with over $40 billion in annual spending through the state Medicaid programs. It is also the most varied, with benefits available for children, adults, and the elderly including skilled care, high-tech supports, and personal care services. Medicaid is undergoing seismic changes nationwide with a combination of dramatic increases in Medicaid beneficiaries through the Affordable Care Act to wholesale delivery and financing reforms. Two of the biggest Medicaid changes affecting home care are the shift to Managed Long Term Services and Supports (MLTSS) and the implementation of demonstration programs that merge funding and care management of dual Medicare-Medicaid eligibles. With all of these changes taking place, a Medicare home health agency may need to become a Medicaid provider as well. This program will include an overview of the states’ movement to Medicaid managed care and the issues presented therein. The program will also focus on strategies to turn these changes into home care opportunities as Medicaid seeks ways to control long term care spending. Additionally, the program addresses successful approaches to Medicaid pricing in managed care and systems for integrated care.

Objectives:

• Identify the types of financing and care delivery reforms affecting Medicaid home care
• Recognize the opportunities that Medicaid managed long term care presents to home care and how to maximize these opportunites
• Manage in the development of pricing and service integration strategies in Medicaid managed care

Faculty: TBA

Course Level: Intermediate

Track: TBD
Audience: | HH | HOS | NUR | PHY | PD | TH

504. Medicaid Rate Advocacy: What it Takes to Get Fair Payment

Medicaid is the largest payer of home care services in the U.S., yet payment rates for Medicaid home care are often far below the cost of the care delivered and require providers to find additional sources of financial subsidy in order to continue delivering Medicaid services. While this unfortunate phenomenon occurs in virtually all provider sectors, there are some steps that can be taken to heighten the chances that rates can be improved. This program will present the experiences of several states that have grappled with Medicaid home care rates with some success, focusing on creating an evidentiary base for rate advocacy that can prevail in the always difficult political climate of state Medicaid programs.

Objectives:

• Identify sources of financial data that can be used to support revisions in payment rates
• Recognize the state and federal legal standards for Medicaid payment rates
• Define the techniques that can be used in Medicaid rate advocacy with state Medicaid programs and state legislatures

Faculty: TBA

Course Level: Intermediate

Track: Financial
Audience: | HH | HOS | NUR | PHY | PD | TH

704. Medicaid Issues Open Forum

Medicaid is fast becoming the center of home care services for all age groups, the elderly, and persons with disabilities. At the same time, Medicaid home care is fast evolving with innovative home and community-based care programs starting in the States, expansion of Medicaid Managed Long Term Services and Supports (MMTSS), and the major expansion in Medicaid enrollment slated for 2014. NAHC’s National Council on Medicaid Home Care will host its third annual open forum that offers an electric dynamic focused on the hottest Medicaid issues of the day. This is one of the sessions that you must not miss if you have any interest in Medicaid home care whether as a provider or supporting vendor.

Objectives:

• Identify the priority issues and trends affecting Medicaid home care
• Describe the activities of the National Council on Medicaid Home Care
• Recognize the growing opportunities in Medicaid home care

Faculty: Moderator: William Dombi, Esq., Executive Director, National Council on Medicaid Home Care, Washington, DC

Course Level: Intermediate; No CEs or CPEs awarded for this session nursing CEs

Track: Financial
Audience: | HH | HOS | NUR | PHY | PD | TH