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Last week, CMS sent the proposed Medicaid Access Rule, which would require that at least 80% of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for the direct care workforce, to the Office of Management and Budget. This marks the next step in the lengthy rulemaking process and signals that a final rule could be released this Spring.
CMS released state spending plan summaries for section 9817 of the American Rescue Plan Act of 2021 (ARP) on January 4. The spending plan summaries illustrate how states expect to spend $36.8 billion on activities to enhance, expand, or strengthen home and community-based services (HCBS) under Medicaid. Last week, the White House announced the American Rescue Plan Act has invested $37 billion in home- and community-based services (HCBS), significantly more than the $12 billion in federal funds due to matching investments by all 50 states and DC. CMS also released new guidance to states to leverage worker registries which can help beneficiaries find qualified HCBS providers.
West Virginia Bureau for Medical Services (BMS) Commissioner, Cindy Beane, presented to the Legislative Oversight Commission on Health and Human Resources Accountability (LOCHHRA) regarding the Medicaid home and community-based services (HCBS) rate study, which included four programs: Aged and Disabled Waiver (ADW), Personal Care (PC), Traumatic Brain Injury (TBI), & Intellectual/Developmental Disabilities Waiver (IDDW). Click here for a PDF of that report. Good news for home care agencies in New Mexico! An additional $409 million will be allocated to reimbursement rates for Medicaid providers. The increased rates, effective from July 1, 2023, aim to elevate reimbursements to as high as 120% of Medicare rates. This is part of an ongoing effort to ensure broader access to essential healthcare services for all participants in the Medicaid program, including home- and community-based services (HCBS) providers. The rate increase is expected to support hiring efforts while maintaining normal profit margins. With the termination of pandemic-driven Medicaid funding by the federal government, states are now confronted with the responsibility of covering the expenses for Medicaid long-term services and supports (LTSS), which includes home- and community-based services (HCBS). The Federal Medical Assistance Percentage (FMAP), supplemented federal Medicaid funding to states, is scheduled to phase out next month under the Consolidated Appropriations Act of 2023. A report by KFF anticipates that to compensate for this reduction in funds, state Medicaid spending is estimated to surge by more than 17% in the coming year.
HCAOA encourages all providers considering the Guiding an Improved Dementia Experience (GUIDE) Model to thoroughly assess its financial feasibility. It is crucial for home care providers to carefully evaluate the associated expenses tied to participating in the GUIDE Model. This includes the costs of providing in-home respite care and conducting in-person face-to-face live assessments, both mandated components of the GUIDE Model. Furthermore, assessing the financial implications helps home care providers determine whether the GUIDE Model allows for profitability under the payment rates set by the Center for Medicare & Medicaid Services (CMS). This evaluation is critical in determining if implementing the GUIDE Model allows your business to meet its financial goals and is sustainable for your home care agency. Recently, the Washington LTSS Trust Commission recommended (see slide 27) that family-funded home care providers be excluded from accessing WA Cares Act funding if they do not have a contract to provide Medicaid services. HCAOA and its Washington Chapter submitted a letter to the Commission expressing its vehement disagreement with the proposal, which you may read by clicking here. On October 10, it was announced all 10 drug companies selected for Medicare Drug Pricing Negotiations Program'sfirst cycle have opted to participate. These companies manufacture some of the most expensive and commonly used prescription drugs. These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, representing about 20% of the total Part D gross covered prescription drug costs between June 1, 2022, and May 31, 2023. Medicare enrollees taking these 10 drugs paid a total of $3.4 billion in out-of-pocket costs in 2022. Senate Special Committee on Aging Seeks Answers on Oversight of Medicaid Managed Care Organizations10/11/2023
AARP's Long-Term Services and Supports (LTSS) 2023 State Scorecard Report was just released and reveals significant gaps in the care provided to older adults and individuals with disabilities in the United States. Although there has been some overall progress compared to the 2020 update, every state still has areas that require improvement. The U.S. Department of Health and Human Services (HHS) has successfully reenrolled nearly half a million children and families in Medicaid and Children’s Health Insurance (CHIP) coverage, fixing an error that was causing improper disenrollment. The Centers for Medicare & Medicaid Services (CMS) identified a state systems issue that was improperly disenrolling individuals, even when they remained eligible based on available information. CMS stated that measures were in place that would prevent further improper disenrollments. End of Pandemic Payments to Family Caregivers Could Exacerbate Workforce Shortages in Medicaid HCBS9/27/2023 A recent analysis by the Kaiser Family Foundation (KFF) warns that the termination of payments to family caregivers, which were allowed during the COVID-19 pandemic, may intensify workforce shortages in Medicaid home- and community-based services (HCBS). Over 4 million individuals rely on Medicaid HCBS, making it a vital program for elderly and disabled Americans. Medicaid spent approximately $162 billion on HCBS in 2020, out of a total of $245 billion in HCBS spending, as Medicare generally does not cover these services.
CMS has addressed operational issues causing people to lose their Medicaid coverage during the federal unwinding period. CMS identified problems with how certain states auto-renew enrollees at the family level rather than the individual level, potentially leading to the improper disenrollment of eligible individuals when family members don't qualify for coverage. In response, CMS has mandated that affected states pause procedural terminations for those improperly disenrolled, reinstate their coverage, switch to individual-level auto-renewals, and implement strategies to mitigate further issues, such as extending Medicaid eligibility for affected families up to a year after their scheduled renewal period. CMS aims to rectify flaws in a renewal process that has resulted in millions of individuals losing Medicaid coverage because of the end of COVID-19 eligibility requirements. |
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